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Lo CW, Sum KWR, Leung FLE, Yang Y, Chan KL, Lam KK, Lau KW, Sum CH, Lin WL, Ho SH, Lin ZX. Efficacy of soothing cream gel in the range of motion and chronic pain at the shoulder and elbow: protocol of a double-blinded, randomised, placebo-controlled trial. BMJ Open 2024; 14:e085856. [PMID: 38969378 PMCID: PMC11227787 DOI: 10.1136/bmjopen-2024-085856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/03/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Upper limb problems have a significant impact on the global population leading to pain and restricted joint mobility, ultimately impacting their quality of life. Traditional treatments, such as non-steroidal anti-inflammatory drugs and corticosteroids, often come with undesirable side effects, prompting patients to seek alternative therapies. In this trial, we hypothesise that soothing cream gel (SCG) will improve range of motion and chronic pain in the shoulder and elbow. The objective of this trial is to evaluate the efficacy of SCG in improving the range of motion and chronic pain in the shoulder and elbow. METHODS AND ANALYSIS A double-blinded, randomised, placebo-controlled trial is conducted to compare the effects of SCG and placebo gel. SCG contains Vitis vinifera essence, Melaleuca viridiflora essential oil, etc, and is manufactured according to Good Manufacturing Practice standards. The placebo gel will be processed with similar appearance, texture and scent but will lack active ingredients. 70 participants with upper limb problems will be recruited from four study sites, including clinical centres and a sport department at the Chinese University of Hong Kong (CUHK). Participants will be randomly assigned to either treatment group or placebo group for 2 weeks. Primary outcome will be the range of motion in the upper limb, assessed by a goniometer, to measure active flexion and abduction for the shoulder, and active flexion and extension for the elbow. The primary efficacy analyses will be based on the full analysis set following the intention-to-treat principle. ETHICS AND DISSEMINATION The trial has obtained approval from the joint CUHK-New Territories East Cluster (CRE-2023.142), and the patient enrolment commenced in July 2023. Written informed consent will be obtained from all participants prior to participation. Study results will be disseminated through publication in peer-reviewed journals and presentations at conference. TRIAL REGISTRATION NUMBER NCT05799391.
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Affiliation(s)
- Cho Wing Lo
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kim Wai Raymond Sum
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam Leung Chan
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Koon Kit Lam
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam Wai Lau
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Him Sum
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Ling Lin
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Shing Hin Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhi-Xiu Lin
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Coates G, Clewes P, Lohan C, Stevenson H, Wood R, Tritton T, Knaggs RD, Dickson AJ, Walsh DA. Chronic Low Back Pain with and without Concomitant Osteoarthritis: A Retrospective, Longitudinal Cohort Study of Patients in England. Int J Clin Pract 2023; 2023:5105810. [PMID: 38020538 PMCID: PMC10653975 DOI: 10.1155/2023/5105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Despite the high prevalence of chronic low back pain (CLBP) and osteoarthritis (OA), few estimates of the economic cost of these conditions in England have been published. The aim of the present analysis was to characterise the economic burden of moderate-to-severe pain associated with CLBP + OA and CLBP alone compared with general population-matched controls without CLBP or OA. The primary objective was to describe the total healthcare resource use (HCRU) and direct healthcare costs associated with the target patient populations. Secondary objectives were to describe treatment patterns and surgical procedures. Methods This was a retrospective, observational cohort study of patients receiving healthcare indicative of moderate-to-severe chronic pain associated with CLBP, with or without OA. We used linked longitudinal data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics (HES). Patients (cases) were matched 1 : 1 with controls on age, sex, comorbidity burden, GP practice, and HES data availability. Results The CLBP-alone cohort comprised 13 554 cases with CLBP and 13 554 matched controls; the CLBP + OA cohort comprised 7803 cases with both OA and CLBP and 7803 matched controls. Across all follow-up periods, patients with CLBP alone and those with CLBP + OA had significantly more GP consultations, outpatient attendances, emergency department visits, and inpatient stays than controls (all p < 0.0001). By 36 months after indexing, the mean (SD) per-patient total direct healthcare cost in the CLBP-alone cohort was £5081 (£5905) for cases and £1809 (£4451) for controls (p < 0.0001); in the CLBP + OA cohort, the mean (SD) per-patient total direct healthcare cost was £8819 (£7143) for cases and £2428 (£4280) for controls (p < 0.0001). Conclusion Moderate-to-severe chronic pain associated with CLBP-with or without OA-has a substantial impact on patients and healthcare providers, leading to higher HCRU and costs versus controls among people with CLBP alone or together with OA.
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Affiliation(s)
| | | | | | | | | | | | - Roger D. Knaggs
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alastair J. Dickson
- Primary Care Rheumatology & Musculoskeletal Medicine Society, York, UK
- The North of England Low Back Pain Pathway, NIHR Applied Research Collaboration (ARC) North East and North Cumbria, St. Nicholas' Hospital, Newcastle Upon Tyne, UK
- AD Outcomes Ltd., York, UK
| | - David A. Walsh
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Willeke K, Janson P, Zink K, Tischer C, Heuschmann PU, Zapf A, Wildner M, Stupp C, Keil T. Comparing the occurrence of chronic physical disorders in self-employed individuals with that of employees: A systematic review. Work 2023; 75:1179-1198. [PMID: 36710710 PMCID: PMC10473076 DOI: 10.3233/wor-220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/14/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A stringent systematic review of population-based observational studies focusing on the physical health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking. OBJECTIVE We aimed to systematically evaluate all the studies of good quality that compared the occurrence of chronic physical disorders in self-employed individuals with that of employees. METHODS We searched three major medical databases (MEDLINE, Web of Science, Embase) following the Cochrane guidelines. The quality of the studies was rated based on the slightly modified validated assessment tool that was developed by Hoy et al.RESULTS:We included 16 population-based studies of good quality, with data from 15,369,964 participants in total. The two longitudinal evaluations of Swedish national registers with the longest follow-up periods showed increased cardiovascular mortality and incidence estimates of cardiovascular disease in self-employed individuals compared with those of white-collar (i.e., nonmanual) employees but decreased risk estimates compared with those of blue-collar (i.e., manual) workers. The results of the shorter cohort studies were heterogeneous. In cross-sectional studies, prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees. CONCLUSION The long-term cardiovascular disease risk and mortality of self-employed individuals seemed to be higher than those of white-collar employees but lower than those of blue-collar employees. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of physical health disorders for specific self-employment categories such as sole proprietors, small entrepreneurs, family businesses and others.
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Affiliation(s)
- Kristina Willeke
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Patrick Janson
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Katharina Zink
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Christina Tischer
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Department of Health Security, Finnish Institute of Health and Welfare, Kuopio, Finland
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andreas Zapf
- Bavarian State Ministry of the Environment and Consumer Protection, Munich, Germany
- Pettenkofer School of Public Health, University of Munich, Munich, Germany
| | - Manfred Wildner
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Pettenkofer School of Public Health, University of Munich, Munich, Germany
| | - Carolin Stupp
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas Keil
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Howard JT, Howard KJ. The effect of perceived stress on absenteeism and presenteeism in public school teachers. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2020. [DOI: 10.1080/15555240.2020.1724794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jeffrey T. Howard
- Department of Public Health, College for Health, Community, and Policy, University of Texas, San Antonio, Texas, USA
| | - Krista J. Howard
- Department of Psychology, College of Liberal Arts, Texas State University, San Marcos, Texas, USA
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Carvalho MPD, Fiori NS, Meucci RD, Faria NMX, Fassa AG. Dor na coluna torácica e fatores associados em fumicultores. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2020. [DOI: 10.1590/2317-6369000002019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: dor na coluna torácica diz respeito a traumas cumulativos envolvendo má postura, movimentos repetitivos e longos períodos na mesma posição. Objetivo: avaliar a prevalência de dor na coluna torácica e fatores associados em fumicultores no sul do Brasil. Métodos: estudo transversal cuja associação entre o desfecho e os fatores sociodemográficos e comportamentais, atividades laborais, cargas de trabalho e comorbidades foram examinadas pelo teste de Wald para heterogeneidade e tendência linear. A análise multivariável foi realizada utilizando modelo hierárquico e regressão de Poisson com variância robusta. Resultados: o estudo envolveu 2.469 indivíduos de ambos os sexos. A prevalência de dor na coluna torácica foi de 21,2%. Limpar equipamento para aplicação de agrotóxico, número de episódios de Doença da Folha Verde, sintomas respiratórios e transtornos psiquiátricos menores foram positivamente associados ao desfecho em ambos os sexos. Tabagismo e intoxicação por agrotóxicos foram associados ao desfecho entre as mulheres, enquanto escolaridade e passar varas com folhas de tabaco foram associados aos homens. Conclusões: reestruturação ergonômica, redução das cargas de trabalho, trocas de posição durante o turno de trabalho e mecanização do processo de trabalho são estratégias importantes para reduzir a exposição à nicotina, agrotóxicos e carga de trabalho ergonômica.
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Zuckerman RM, Silton RL, Tu FF, Eng JS, Hellman KM. Somatic symptoms in women with dysmenorrhea and noncyclic pelvic pain. Arch Womens Ment Health 2018; 21:533-541. [PMID: 29525829 PMCID: PMC6126970 DOI: 10.1007/s00737-018-0823-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/27/2018] [Indexed: 12/30/2022]
Abstract
Somatic symptoms are a robust, transdiagnostic risk factor for pain conditions. However, the extent to which somatic symptoms contribute to the manifestation of the women's pain syndromes, such as dysmenorrhea and noncyclic pelvic pain (NCPP), is unclear due to high rates of co-occurrence. Therefore, the present study investigated the primary hypothesis that somatic symptoms would be elevated in NCPP and distinctly influence the relationship between dysmenorrhea and co-occurring NCPP. A secondary analysis was performed on cross-sectional questionnaire data from 1012 nonpregnant reproductive-aged women. Eligible analyzed participants (n = 834) were categorized into four groups: healthy, dysmenorrhea, NCPP, and NCPP with co-occurring dysmenorrhea (NCPP+dysmenorrhea). A parallel mediation analysis was run to evaluate the primary hypothesis that somatic symptoms are the primary factor associated with increased NCPP accounting for dysmenorrhea. The NCPP+dysmenorrhea group had higher somatic, anxiety, and depression symptom T-scores (respectively 61, 61, 60) compared to the healthy controls (46, 51, 51; p's < .001) and the dysmenorrhea group (50, 53, 54; p's < .001). The pain and psychological symptoms were significantly correlated across the entire sample (r's = .29, - .64, p's < .01). Results from parallel mediation analysis showed that somatic symptoms were distinctly associated with NCPP+dysmenorrhea. Women with NCPP+dysmenorrhea have increased psychological and somatic symptoms compared to women with dysmenorrhea alone. Given that NCPP often co-occurs with dysmenorrhea, failure to account for comorbidity in previous studies has likely led to an overestimation of psychological symptoms in dysmenorrhea. Future studies should evaluate whether somatic sensitivity is a modifiable risk factor for NCPP.
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Affiliation(s)
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL, 60660, USA.
| | - Frank F Tu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, USA
| | - Joshua S Eng
- Department of Child and Family Health Studies, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kevin M Hellman
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, USA
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Abaraogu UO, Okorie PN, Duru DO, Ezenwankwo EF. Individual and work-related risk factors for musculoskeletal pain among computer workers in Nigeria. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 73:162-168. [PMID: 28287924 DOI: 10.1080/19338244.2017.1305325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/07/2017] [Indexed: 06/06/2023]
Abstract
We investigated the prevalence of musculoskeletal pain (MSP) and the association of 1-month prevalence with individual and work-related factors among commercial typists in Enugu. Participants responded to a questionnaire about occurrences of MSP and a 75.6% (242/320) response rate was achieved. Prevalence was summarized in frequencies and percentages while associations between MSPs and risk factors were explored using chi-square. MSP was most common in the low back (58.3%), and low back pain limited 51.7% from activities between 1 and 30 days. Advancing age was significantly associated with MSP in the low back (x2 = 19.885; p = .001), neck (x2 = 28.309; p < .001), shoulder (x2 = 13.122; p = .011), but not wrist/hand (p = .075). Working 1-5 years in this job was associated with increasing prevalence of MSP in all body regions studied. Lesser job control was associated with increased prevalence of wrist/hand pain. Prevalence of MSDs among computer operators in Enugu, Nigeria, is high and highlights the importance of workplace intervention.
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Affiliation(s)
- Ukachukwu Okoroafor Abaraogu
- a Department of Medical Rehabilitation, College of Medicine , University of Nigeria Enugu , Nsukka , Nigeria
- b School of Health and Life Sciences , Glasgow Caledonian University , Glasgow, Scotland , United Kingdom
| | - Paschal Nzubechukwu Okorie
- a Department of Medical Rehabilitation, College of Medicine , University of Nigeria Enugu , Nsukka , Nigeria
| | - Deborah Onyinyechukwu Duru
- a Department of Medical Rehabilitation, College of Medicine , University of Nigeria Enugu , Nsukka , Nigeria
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Fujii T, Oka H, Katsuhira J, Tonosu J, Kasahara S, Tanaka S, Matsudaira K. Disability due to knee pain and somatising tendency in Japanese adults. BMC Musculoskelet Disord 2018; 19:23. [PMID: 29351756 PMCID: PMC5775591 DOI: 10.1186/s12891-018-1940-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/14/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Knee pain is common and related to knee osteoarthritis. However, there is a discrepancy between knee pain and radiographic osteoarthritis. In the general population, knee pain is associated with psychological and cognitive factors, which would be one explanation for the discrepancy. Limited evidence demonstrates that somatization is associated with knee pain. This study examined the association between disability due to knee pain and a high somatising tendency. METHODS Japanese adults (aged 20-64 years) who had experienced knee pain in the past four weeks were included in this study (n = 14,695, 50% women). Data were extracted from a large internet survey. Somatising tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). Disability due to knee pain was categorized into three levels: 1) knee pain without difficulty with activities of daily living (ADL), 2) knee pain with ADL difficulty but without requiring sick leave, and 3) knee pain requiring sick leave. The association between ≥ high somatising tendency (SSS-8 score ≥ 12) as well as very high somatising tendency (SSS-8 score ≥ 16) and disability due to knee pain was examined using logistic regression models adjusted for age, sex, body mass index, depressive symptoms, education level, regular exercise, chronicity of knee pain (≥3 months), osteoarthritis, rheumatoid arthritis, and fibromyalgia. RESULTS Greater disability due to knee pain was associated with a higher odds ratio for ≥ high somatising tendency (adjusted odds ratio (aOR) = 2.36 [2.10-2.66] in group 2 vs. group 1, aOR = 3.23 [2.66-3.92] in group 3 vs. group 1). Stronger associations were found for a very high somatising tendency (aOR = 2.80 [2.42-3.23] in group 2 vs. group 1, aOR = 4.51 [3.64-5.58] in group 3 vs. group 1). CONCLUSIONS Somatization may play a role in disability due to knee pain in the general adult population with knee pain, similar to the role of somatization in low back pain.
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Affiliation(s)
- Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Junji Katsuhira
- Department of Prosthetics & Orthotics and Assistive Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198, Japan
| | - Juichi Tonosu
- Department of Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Satoshi Kasahara
- Department of Pain and Palliative Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Sadeghian F, Coggon D, Ntani G, Hosseinzadeh S. Predictors of low back pain in a longitudinal study of Iranian nurses and office workers. Work 2016; 51:239-44. [PMID: 24763343 DOI: 10.3233/wor-141850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A previous survey had indicated high rates of low back pain (LBP) in Iranian nurses and office workers. OBJECTIVE To explore possible risk factors, we carried out a longitudinal study of the same subjects. METHODS Baseline information about risk factors and recent history of LBP was collected by self-administered questionnaire from 246 nurses and 182 office workers. Approximately 12 months later, 385 (90%) answered a second questionnaire about LBP in the past month. Predictors of LBP at follow-up were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs) with 95% confidence intervals (CIs). RESULTS In a regression model that included all risk factors, the strongest predictor of LBP at follow-up was report of recent LBP at baseline. In addition, LBP was associated with older age, adverse beliefs about the work-relatedness of LBP (PRR 1.3, 95%CI 1.0-1.5), and incentives from piecework or bonuses (PRR 1.4, 95%CI 1.1-1.6). When baseline report of LBP was omitted from the model, associations were also observed with tendency to somatise, poor mental health and time pressures at work. CONCLUSIONS Our findings support the importance of psychosocial risk factors for LBP, including adverse health beliefs and working conditions that encourage higher output.
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Affiliation(s)
- Farideh Sadeghian
- Department of Occupational Health, Faculty of Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - David Coggon
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Samaneh Hosseinzadeh
- Biostatistics Department, Social Welfare and Rehabilitation Sciences University, Tehran, Iran
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Vargas-Prada S, Serra C, Coggon D, Martínez JM, Ntani G, Delclos G, Palmer KT, Benavides FG. Are determinants for new and persistent upper limb pain different? An analysis based on anatomical sites. Work 2016; 53:313-23. [PMID: 26409386 DOI: 10.3233/wor-152143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Only few longitudinal studies have explored separately predictors of pain incidence and persistence. OBJECTIVE To investigate whether biological, lifestyle, occupational and psychological risk factors for the development of new episodes of upper limb pain (ULP) differ from those for its persistence. METHODS Spanish nurses and office workers (1105) were asked at baseline about biological, lifestyle, occupational and psychological risk factors and pain in the past month at six anatomical sites in the upper limb (left and right shoulder, elbow and wrist/hand). At follow up, 12 months later, pain in the past month was again ascertained. Analysis was based on anatomical sites clustered by person. Associations were assessed by multilevel logistic regression models. RESULTS Nine hundred and seventy-one participants (87.9%) completed follow-up. Job dissatisfaction and older age carried higher risk of new ULP. Somatising tendency (OR 2.2, 95% CI 1.6-3.1) was the strongest predictor of new ULP, with a risk estimate which differed significantly from that for the same exposure and persistence of ULP. Having adverse beliefs about the work-relatedness of ULP carried a significantly reduced risk for persistence of ULP. CONCLUSION Our study provides only limited evidence that risk factors predicting new ULP differ from those predicting its persistence.
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Affiliation(s)
- Sergio Vargas-Prada
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Consol Serra
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Department of Occupational Health, Parc de Salut MAR, Barcelona, Spain
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - José Miguel Martínez
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - George Delclos
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, TX, USA
| | - Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Fernando G Benavides
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Vargas-Prada S, Coggon D, Ntani G, Walker-Bone K, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Sarquis LMM, Marziale MH, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Harris EC, Serra C, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Freimann T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW, Urquhart DM, Derrett S, McBride D, Herbison P, Gray A, Vega EJS. Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study. PLoS One 2016; 11:e0153748. [PMID: 27128094 PMCID: PMC4851348 DOI: 10.1371/journal.pone.0153748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/04/2016] [Indexed: 11/18/2022] Open
Abstract
Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.
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Affiliation(s)
- Sergio Vargas-Prada
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - David Coggon
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
| | - Karen Walker-Bone
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
| | - Keith T. Palmer
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
| | - Vanda E. Felli
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | - Raul Harari
- Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral–IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador
| | - Lope H. Barrero
- Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sarah A. Felknor
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
- Center for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, Georgia, United States of America
| | - David Gimeno
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Anna Cattrell
- North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, United Kingdom
| | - Matteo Bonzini
- Epidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy
| | - Eleni Solidaki
- Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Eda Merisalu
- Institute of Technology, Estonian University of Life Sciences, Tartu, Estonia
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farideh Sadeghian
- Department of Occupational Health, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - M. Masood Kadir
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sudath S. P. Warnakulasuriya
- Department of Medical Education and Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Ko Matsudaira
- Department for Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Busisiwe Nyantumbu
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Malcolm R. Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Harcombe
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ken Cox
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | | - Maria H. Marziale
- School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Florencia Harari
- Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral–IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador
| | - Rocio Freire
- Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral–IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador
| | - Natalia Harari
- Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral–IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador
| | - Magda V. Monroy
- Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo A. Quintana
- Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Marianela Rojas
- Program Health, Work and Environment in Central America, Institute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica
| | - E. Clare Harris
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
| | - Consol Serra
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- Occupational Health Service, Parc de Salut MAR, Barcelona, Spain
| | - J. Miguel Martinez
- Servicio de Investigación y Análisis IT/EP, Departamento de Investigación y Análisis de Prestaciones, MC Mutual, Barcelona, Spain
| | - George Delclos
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Fernando G. Benavides
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Michele Carugno
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Marco M. Ferrario
- Epidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy
| | - Angela C. Pesatori
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Leda Chatzi
- Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Panos Bitsios
- Department of Psychiatry, Medical School, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Kristel Oha
- North Estonia Medical Centre, Tallinn, Estonia
| | | | | | - Roshini J. Peiris-John
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nalini Sathiakumar
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | | | - Noriko Yoshimura
- Department of Joint Disease Research, 22nd Century Medical and Research Center, University of Tokyo, Tokyo, Japan
| | - Helen L. Kelsall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Victor C. W. Hoe
- Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - David McBride
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Herbison
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Eduardo J. Salazar Vega
- Health Safety and Environment Department, AkzoNobel, Houston, Texas, United States of America
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Yamada K, Matsudaira K, Imano H, Kitamura A, Iso H. Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain. BMJ Open 2016; 6:e010356. [PMID: 27113235 PMCID: PMC4854002 DOI: 10.1136/bmjopen-2015-010356] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Working is a common cause of chronic pain for workers. However, most of them need to continue working despite the pain in order to make a living unless they get a sick leave or retirement. We hypothesised that the therapeutic effect of vocational rehabilitation may depend on psychosocial factors related to the workplace. To test this hypothesis, we examined the association of work-related psychosocial factors with the prevalence of chronic pain or health-related quality of life (HRQoL) among workers with chronic pain. METHODS We examined 1764 workers aged 20-59 years in the pain-associated cross-sectional epidemiological survey in Japan. The outcomes were (1) chronic pain prevalence among all workers and (2) low Euro QoL (EQ-5D <0.76; mean value of the current study) prevalence among workers with chronic pain according to the degree of workplace social support and job satisfaction. Workplace social support and job satisfaction were measured using the Brief Job Stress Questionnaire. Multivariable-adjusted ORs were calculated using a logistic regression model including age, sex, smoking, exercise, sleep time, work hours, body mass index, personal consumption expenditure, intensity of pain and the presence of severe depressive symptoms. RESULTS Chronic pain prevalence was higher among males reporting job dissatisfaction compared with those reporting job satisfaction. No difference was observed among women. Chronic pain prevalence did not differ between workers of either sex reporting poor workplace social support compared with those reporting sufficient support. Among workers with chronic pain, low HRQoL was more frequent in those reporting job dissatisfaction. Similarly, low HRQoL was more frequent in patients with chronic pain reporting poor social support from supervisors or co-workers compared with patients reporting sufficient support. CONCLUSIONS Work-related psychosocial factors are critical for HRQoL in patients with chronic pain.
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Affiliation(s)
- Keiko Yamada
- Department of Public Health and Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
| | - Ko Matsudaira
- Faculty of Medicine, Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
- Japan Labour Health and Welfare Organization, Tokyo, Japan
| | - Hironori Imano
- Department of Public Health and Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
| | - Akihiko Kitamura
- Department of Public Health and Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
| | - Hiroyasu Iso
- Department of Public Health and Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
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Whibley D, Martin KR, Lovell K, Jones GT. A systematic review of prognostic factors for distal upper limb pain. Br J Pain 2015; 9:241-55. [PMID: 26526466 DOI: 10.1177/2049463715590885] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Musculoskeletal pain in the distal upper limb is relatively common, can be a cause of disability, presents a high cost to society and is clinically important. Previous reviews of prognostic factors have focused on pain in the proximal upper limb, whole upper extremity or isolated regions of the distal upper limb. AIM To identify factors that predict outcome of distal upper limb pain. STUDY DESIGN Systematic review. METHOD Eight bibliographic databases were searched from inception to March 2014. Eligible articles included adults with pain anywhere in the distal upper limb at baseline from randomised controlled trials with a waiting list, expectant policy or usual care group, or observational studies where no treatment or usual care was provided. Data describing the association between a putative prognostic factor and pain or functional outcome at follow-up were required. Quality was assessed using the Quality in Prognostic Studies tool. RESULTS Seven articles reporting on six studies were identified. Heterogeneity of study populations and outcome measures prevented a meta-analysis so a narrative synthesis of results was undertaken. Three factors (being female, a longer duration of the complaint at initial presentation and having musculoskeletal pain in multiple locations) were significantly associated with poor pain outcome in more than one study. Being female was the only factor significantly associated with poor functional outcome in more than one study. CONCLUSIONS A range of sociodemographic, pain-related, occupational and psychosocial prognostic factors for distal upper limb pain outcomes were investigated in studies included in the review. However, due to the lack of commonality of factors investigated and lack of consistency of results across studies, there is limited evidence for predictors of distal upper limb pain outcomes. Further research is required to identify prognostic factors of distal upper limb pain, particularly modifiable factors that may influence management.
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Affiliation(s)
- Daniel Whibley
- Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
| | - Kathryn R Martin
- Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Gareth T Jones
- Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
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Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Rev Saude Publica 2015; 49:S0034-89102015000100408. [PMID: 26487293 PMCID: PMC4603263 DOI: 10.1590/s0034-8910.2015049005874] [Citation(s) in RCA: 465] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/31/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.
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Affiliation(s)
- Rodrigo Dalke Meucci
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
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15
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Vargas-Prada S, Coggon D. Psychological and psychosocial determinants of musculoskeletal pain and associated disability. Best Pract Res Clin Rheumatol 2015; 29:374-90. [PMID: 26612236 DOI: 10.1016/j.berh.2015.03.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although much attention has been given to the physical determinants of common musculoskeletal complaints such as back and arm pain, research points to a stronger influence of psychological factors. Multiple studies have implicated poor mental health and somatisation (a tendency to worry about the common somatic symptoms) in the incidence and chronicity of musculoskeletal pain and associated disability. Also important are adverse beliefs about the prognosis of such disorders, and about the role of physical activity in their development and persistence. Differences in societal beliefs may have contributed to major variation in the prevalence of disabling musculoskeletal pain that has been observed between countries and in the same countries over time. Psychosocial aspects of work have also been linked with musculoskeletal pain, although relative risks have generally been smaller. There is a need to take account of psychological factors in the clinical management of patients with back, neck and arm pain.
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Affiliation(s)
- Sergio Vargas-Prada
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - David Coggon
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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Sommer TG, Frost P, Svendsen SW. Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures. Int Arch Occup Environ Health 2015. [PMID: 25731853 DOI: 10.1007/s00420–015–1036-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Pain in more than one site is common in working populations. We aimed to characterise combined pain (pain in the upper and lower body) and to evaluate whether the prevalence of combined pain is positively related to combined occupational mechanical exposures to the upper and lower body and to high psychosocial job strain. METHODS This cross-sectional study was based on questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. The study included 14,081 men and 20,173 women. Occupational exposures were assessed by job exposure matrices. We analysed the prevalence of pain limited to the upper body, pain limited to the lower body, and combined pain in relation to occupational exposures using Poisson regression. RESULTS During the last year, 23.2 % of the men and 33.9 % of the women reported combined pain, which was characterised by somatisation, illness worrying, and low SF-36 scores. For men, the adjusted prevalence ratio for combined pain was 1.51 [95 % confidence interval (95 % CI) 1.40-1.64] in relation to exposures limited to the upper body and 2.24 (95 % CI 2.11-2.39) in relation to combined exposures. For women, the corresponding adjusted prevalence ratios were 1.56 (95 % CI 1.50-1.63) and 1.55 (95 % CI 1.50-1.61). High job strain was related to pain among men, only. CONCLUSION Combined pain may in part be explained by local effects of occupational mechanical exposures acting at more than one site.
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Affiliation(s)
- Tine Gjedde Sommer
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Nørrebrogade 44, building 2C, 8000, Aarhus C, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
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Sommer TG, Frost P, Svendsen SW. Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures. Int Arch Occup Environ Health 2015; 88:1099-110. [DOI: 10.1007/s00420-015-1036-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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Meucci RD, Fassa AG, Faria NMX, Fiori NS. Chronic low back pain among tobacco farmers in southern Brazil. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:66-73. [PMID: 25633930 PMCID: PMC4273522 DOI: 10.1179/2049396714y.0000000094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group. METHODS This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression. RESULTS Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP. CONCLUSIONS This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP.
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Howard JT, Potter LB. An assessment of the relationships between overweight, obesity, related chronic health conditions and worker absenteeism. Obes Res Clin Pract 2014; 8:e1-15. [PMID: 24548572 DOI: 10.1016/j.orcp.2012.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 09/08/2012] [Accepted: 09/09/2012] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Worker absenteeism is an important area of study within the field of occupational health. Prior studies have linked the presence of obesity to higher rates of absenteeism, but have not examined whether or not the relationship is moderated by the presence of other chronic health conditions or whether or not the relationships have been stable over time. METHODS Data from the 2000 and 2010 National Health Interview Survey, a nationally representative sample of the US population, were analyzed to determine the extent to which the presence of 5 obesity-related chronic health conditions moderates the relationship between overweight/obesity and worker absenteeism, and whether or not these relationships are stable over time. Logistic regression was used to examine the relationships between overweight/obesity, the obesity-related chronic health conditions and worker absenteeism, while controlling for demographic, socio-economic, occupational, health related and behavioral variables. RESULTS The findings suggest that obesity (p < 0.01) is related to higher rates of worker illness absence, and that the presence of diabetes positively moderates this relationship (p < 0.05) within the severely obese population (class III - BMI ≥ 40). Other health conditions, including hypertension, coronary heart disease, other heart disease and stroke, were not found to have significant moderating effects. CONCLUSION The evidence suggests that obesity is associated with a higher likelihood of worker illness absenteeism, and that the effect is doubled for those with both class III obesity (BMI ≥ 40) and diabetes. The moderating effect between class III obesity and diabetes was observed only in 2010, indicating that this may be a relatively new phenomenon.
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Affiliation(s)
- Jeffrey T Howard
- Department of Demography, University of Texas at San Antonio and Institute for Demographic and Socioeconomic Research, United States.
| | - Lloyd B Potter
- Department of Demography, University of Texas at San Antonio and Institute for Demographic and Socioeconomic Research, United States
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Bonzini M, Bertu' L, Veronesi G, Conti M, Coggon D, Ferrario MM. Is musculoskeletal pain a consequence or a cause of occupational stress? A longitudinal study. Int Arch Occup Environ Health 2014; 88:607-12. [PMID: 25261316 DOI: 10.1007/s00420-014-0982-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Longitudinal studies have linked stress at work with a higher incidence of musculoskeletal pain. We aimed to explore the extent to which musculoskeletal pain is a cause as opposed to a consequence of perceived occupational stress. METHODS As part of the international cultural and psychosocial influences on disability study, we collected information from 305 Italian nurses, at baseline and again after 12 months, about pain during the past month in the low-back and neck/shoulder, and about effort-reward imbalance (ERI) (assessed by Siegrist's ERI questionnaire). Poisson regression was used to assess the RR of ERI >1 at follow-up according to the report of pain and of ERI >1 at baseline. RESULTS Among nurses with ERI ≤1 at baseline, ERI >1 at follow-up was associated with baseline report of pain in the low-back (RR 2.7, 95 % CI 1.4-5.0) and neck/shoulder (RR 2.6, 95 % CI 1.3-5.1). However, there was no corresponding association with persistence of ERI in nurses who already had ERI >1 at baseline. Associations of ERI at baseline with pain at follow-up were weak. CONCLUSION Our results suggest that the well-documented association between job stress and musculoskeletal pain is not explained entirely by an effect of stress on reporting of pain. It appears also that workers who report musculoskeletal pain are more likely to develop subsequent perceptions of stress. This may be because pain renders people less tolerant of the psychological demands of work. Another possibility is that reports of pain and stress are both manifestations of a general tendency to be aware of and complain about symptoms and difficulties.
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Affiliation(s)
- Matteo Bonzini
- Epidemiology and Preventive Medicine Research Centre, University of Insubria, Varese, Italy,
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Fishbain DA, Gao J, Lewis JE, Bruns D, Meyer LJ, Disorbio JM. Prevalence comparisons of somatic and psychiatric symptoms between community nonpatients without pain, acute pain patients, and chronic pain patients. PAIN MEDICINE 2014; 16:37-50. [PMID: 25138039 DOI: 10.1111/pme.12527] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Somatic/psychiatric symptoms are frequently found in chronic pain patients (CPPs). The objectives of this study were to determine 1) which somatic/psychiatric symptoms are more commonly found in acute pain patients (APPs) and CPPs vs community nonpatients without pain (CNPWPs) and 2) if somatic/psychiatric symptom prevalence differs between APPs and CPPs. DESIGN The above groups were compared statistically for endorsement of 15 symptoms: fatigue, numbness/tingling, dizziness, difficulty opening/closing mouth, muscle weakness, difficulty staying asleep, depression, muscle tightness, nervousness, irritability, memory, falling, nausea, concentration, and headaches. RESULTS After controlling for age, gender, and level of pain, APPs and CPPs had a statistically significantly greater prevalence (at a P < 0.01 level) for 11 and 13 symptoms, respectively, vs CNPWPs. After controlling for age, gender, and level of pain, CPPs had a statistically significantly greater prevalence (at a P < 0.01 level) for eight symptoms vs APPs. Symptoms were highly correlated in both APPs and CPPs. CONCLUSIONS CPPs are characterized to a significantly greater extent than comparison groups by somatic/psychiatric symptoms that are highly intercorrelated. This has implications for clinical practice and future research.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Psychiatry, Miami Veterans Administration Hospital, Miami, Florida, USA
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Oha K, Animägi L, Pääsuke M, Coggon D, Merisalu E. Individual and work-related risk factors for musculoskeletal pain: a cross-sectional study among Estonian computer users. BMC Musculoskelet Disord 2014; 15:181. [PMID: 24884911 PMCID: PMC4049436 DOI: 10.1186/1471-2474-15-181] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 05/14/2014] [Indexed: 12/02/2022] Open
Abstract
Background Occupational use of computers has increased rapidly over recent decades, and has been linked with various musculoskeletal disorders, which are now the most commonly diagnosed occupational diseases in Estonia. The aim of this study was to assess the prevalence of musculoskeletal pain (MSP) by anatomical region during the past 12 months and to investigate its association with personal characteristics and work-related risk factors among Estonian office workers using computers. Methods In a cross-sectional survey, the questionnaires were sent to the 415 computer users. Data were collected by self-administered questionnaire from 202 computer users at two universities in Estonia. The questionnaire asked about MSP at different anatomical sites, and potential individual and work related risk factors. Associations with risk factors were assessed by logistic regression. Results Most respondents (77%) reported MSP in at least one anatomical region during the past 12 months. Most prevalent was pain in the neck (51%), followed by low back pain (42%), wrist/hand pain (35%) and shoulder pain (30%). Older age, right-handedness, not currently smoking, emotional exhaustion, belief that musculoskeletal problems are commonly caused by work, and low job security were the statistically significant risk factors for MSP in different anatomical sites. Conclusions A high prevalence of MSP in the neck, low back, wrist/arm and shoulder was observed among Estonian computer users. Psychosocial risk factors were broadly consistent with those reported from elsewhere. While computer users should be aware of ergonomic techniques that can make their work easier and more comfortable, presenting computer use as a serious health hazard may modify health beliefs in a way that is unhelpful.
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Affiliation(s)
- Kristel Oha
- North Estonia Medical Centre, J, Sütiste tee 19, 13419 Tallinn, Estonia.
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Parsons S, McBeth J, Macfarlane GJ, Hannaford PC, Symmons DPM. Self-reported pain severity is associated with a history of coronary heart disease. Eur J Pain 2014; 19:167-75. [PMID: 24890750 PMCID: PMC4322478 DOI: 10.1002/ejp.533] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have found an association between chronic pain and cardiovascular (CV) mortality. OBJECTIVE To explore the relationship between the severity of pain and non-fatal CV disease. METHODS A total of 45,994 adults randomly selected from general practice registers in Manchester and Aberdeen were posted a survey, which included a Chronic Pain Grade questionnaire, pain manikin and questions about lifestyle and medical history. A single component measuring pain severity was extracted using factor analysis. Logistic regression was used to test for an association between quintiles of pain severity and a history of CV disease, adjusting for confounders. RESULTS Of the 15,288 responders, 61% (n = 9357) reported pain for ≥ 1 day in the past month. Compared with the first (lowest) pain severity quintile, the fully adjusted odds ratio for heart attack in the second severity quintile was 1.25 (95% confidence interval 0.68, 2.30); third quintile: 1.65 (0.93, 2.94); fourth quintile: 1.76 (1.00, 3.11) and fifth (highest) quintile 2.47 (1.43, 4.28). Corresponding figures for angina (excluding heart attack) were: 1.79 (0.93, 3.45), 1.91 (1.00, 3.62), 1.03 (0.50, 2.11) and 3.17 (1.71, 5.85). CONCLUSION A history of CV disease is reported more often in those with severe pain than would be expected by chance, even when adjusting for shared risk factors.
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Affiliation(s)
- S Parsons
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, UK
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Creed FH, Tomenson B, Chew-Graham C, Macfarlane GJ, Davies I, Jackson J, Littlewood A, McBeth J. Multiple somatic symptoms predict impaired health status in functional somatic syndromes. Int J Behav Med 2014; 20:194-205. [PMID: 22932928 DOI: 10.1007/s12529-012-9257-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The relationship between functional somatic syndromes and multiple somatic symptoms is unclear. PURPOSE We assessed whether the number of somatic symptoms is a predictor of health status in three functional somatic syndromes (FSS). METHODS In a population-based study of 990 UK adults we assessed chronic widespread pain (CWP), chronic fatigue (CF) and irritable bowel syndrome (IBS) by questionnaire and medical record data. We assessed health status (Short Form 12 and EQ-5D), number of somatic symptoms (Somatic Symptom Inventory) and anxiety/depression (Hospital Anxiety and Depression Scale) both at baseline and at follow-up 1 year later. RESULTS The proportion of people with an FSS who also have multiple somatic symptoms (52-55 %) was similar in the three functional syndromes. The presence of multiple somatic symptoms was associated with more impaired health status both at baseline and at follow-up. This finding was not explained by severity of FSS. In the absence of multiple somatic symptoms, the health status of the FSS was fair or good. In multiple regression analysis, the number of somatic symptoms, the presence of a functional syndrome (CWP or CF) and anxiety/depression were predictors of EQ-5D thermometer at follow-up after adjustment for confounders. CONCLUSIONS Multiple somatic symptoms in people with an FSS are associated with impaired health status and this cannot be explained by more severe functional syndrome or the presence of anxiety and depression.
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Affiliation(s)
- F H Creed
- School of Community Based Medicine, University of Manchester, Oxford Road, Manchester, UK.
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Jones GT, Mertens K, Macfarlane GJ, Palmer KT, Coggon D, Walker-Bone K, Burton K, Heine PJ, McCabe C, McNamee P, McConnachie A. Maintained physical activity and physiotherapy in the management of distal upper limb pain - a protocol for a randomised controlled trial (the arm pain trial). BMC Musculoskelet Disord 2014; 15:71. [PMID: 24612447 PMCID: PMC3975277 DOI: 10.1186/1471-2474-15-71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/26/2014] [Indexed: 11/28/2022] Open
Abstract
Background Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period. Methods/Design Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis. Discussion Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms. Trial registration Registered on http://www.controlled-trials.com (reference number: ISRCTN79085082).
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Affiliation(s)
- Gareth T Jones
- Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
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Sadeghian F, Hosseinzadeh S, Aliyari R. Do Psychological Factors Increase the Risk for Low Back Pain Among Nurses? A Comparing According to Cross-sectional and Prospective Analysis. Saf Health Work 2014; 5:13-6. [PMID: 24932414 PMCID: PMC4048008 DOI: 10.1016/j.shaw.2013.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/11/2013] [Accepted: 11/18/2013] [Indexed: 12/05/2022] Open
Abstract
Background This study assesses influences of baseline psychological risk factors on prevalence of low back pain (LBP) at baseline and follow-up among nurses. Methods A prospective longitudinal study was performed at two phases, baseline and 1-year follow-up among 246 nurses of university hospitals in Shahroud, Iran. A standardized Cultural and Psychosocial Influences on Disability questionnaire was used for data collection. Logistic regression was performed for analysis. Results At the baseline of the study, 58.9% of nurses reported back pain in the previous 12 months. Age (p = 0.001), belief that work causes pain (p = 0.022), and somatization tendency (p = 0.002) significantly increased risk of LBP. At 1-year follow-up, prevalence of LBP was 45.7% and expectation of back pain at baseline (p = 0.016) significantly increased risk of LBP in this phase (p < 0.05). Conclusion Results indicate that risk factors for prevalence of back pain at baseline and 1-year follow-up are different. At baseline, the risk factors are age, belief that work causes pain, and somatization tendency, and at follow-up, expectation of pain is the major risk factor.
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Affiliation(s)
- Farideh Sadeghian
- Department of Occupational Health, Faculty of Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics Department, Social Welfare and Rehabilitation Sciences University, Tehran, Iran
| | - Roqayeh Aliyari
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahroud University of Medical Sciences, Shahroud, Iran
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Coggon D, Ntani G, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Serra C, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Masood Kadir M, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Marziale MH, Sarquis LM, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Salazar Vega EJ, Harris EC, Vargas-Prada S, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Sirk T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW, Urquhart DM, Derrett S, McBride D, Herbison P, Gray A. Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture? Pain 2014; 154:856-63. [PMID: 23688828 PMCID: PMC3675684 DOI: 10.1016/j.pain.2013.02.008] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/11/2013] [Accepted: 02/19/2013] [Indexed: 11/05/2022]
Abstract
To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed.
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Affiliation(s)
- David Coggon
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK.
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Farioli A, Mattioli S, Quaglieri A, Curti S, Violante FS, Coggon D. Musculoskeletal pain in Europe: the role of personal, occupational, and social risk factors. Scand J Work Environ Health 2013; 40:36-46. [PMID: 24009006 DOI: 10.5271/sjweh.3381] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The prevalence of musculoskeletal pain in European countries varies considerably. We analyzed data from the fifth European Working Conditions Survey (EWCS) to explore the role of personal, occupational, and social risk factors in determining the national prevalence of musculoskeletal pain. METHODS Over the course of 2010, 43 816 subjects from 34 countries were interviewed. We analyzed the one-year prevalence of back and neck/upper-limb pain. Individual-level risk factors studied included: sex; age; educational level; socioeconomic status; housework or cooking; gardening and repairs; somatizing tendency; job demand-control; six physical occupational exposures; and occupational group. Data on national socioeconomic variables were obtained from Eurostat and were available for 28 countries. We fitted Poisson regression models with random intercept by country. RESULTS The main analysis comprised 35 550 workers. Among individual-level risk factors, somatizing tendency was the strongest predictor of the symptoms. Major differences were observed by country with back pain more than twice as common in Portugal (63.8%) than Ireland (25.7%), and prevalence rates of neck/upper-limb pain ranging from 26.6% in Ireland to 67.7% in Finland. Adjustment for individual-level risk factors slightly reduced the large variation in prevalence between countries. For back pain, the rates were more homogenous after adjustment for national socioeconomic variables. CONCLUSIONS Our analysis indicates substantial variation between European countries in the prevalence of back and neck/upper-limb pain. This variation is unexplained by established individual risk factors. It may be attributable in part to socioeconomic differences between countries, with higher prevalence where there is less risk of poverty or social exclusion.
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Affiliation(s)
- Andrea Farioli
- Occupational Health Unit, University of Bologna, Sant'Orsola Malpighi Hospital, via Palagi 9, IT-40138 Bologna, Italy.
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Vargas-Prada S, Martínez JM, Coggon D, Delclos G, Benavides FG, Serra C. Health beliefs, low mood, and somatizing tendency: contribution to incidence and persistence of musculoskeletal pain with and without reported disability. Scand J Work Environ Health 2013; 39:589-98. [PMID: 23955508 DOI: 10.5271/sjweh.3377] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aims to investigate whether associations of psychological risk factors with the incidence and persistence of disabling musculoskeletal pain differ from those for non-disabling musculoskeletal pain. METHODS As part of the international Cultural and Psychosocial Influences in Disability (CUPID) study, 1105 Spanish nurses and office workers were asked at baseline about health beliefs concerning pain, mental health, and somatizing tendency. Musculoskeletal pain in the past months at ten anatomical sites (back, neck, and left and right shoulder, elbow, wrist/hand, and knee) was ascertained at baseline and one year later. Pain was classed as disabling if it made ≥1 specified everyday activities difficult or impossible. Multilevel multinomial logistic regression modeling was used to explore associations of baseline risk factors with pain outcomes at follow-up, conditioned on pain status at baseline. RESULTS A total of 971 participants (87.9%) completed follow-up. Among anatomical sites that were pain-free at baseline, the development of disabling musculoskeletal pain was predicted by pessimistic beliefs about pain prognosis [odds ratio (OR) 1.5, 95% confidence interval (95% CI) 1.0-2.1], poor mental health (OR 2.0, 95% CI 1.3-3.0), and somatizing tendency (OR 4.0, 95% CI 2.5-6.4). Adverse beliefs about prognosis were also associated with the transition from non-disabling to disabling musculoskeletal pain (OR 3.7, 95% CI 1.1-12.5) and the persistence of disabling musculoskeletal pain (OR 2.5, 95% CI 1.2-5.5), which was already present at baseline. Associations with non-disabling musculoskeletal pain were weaker and less consistent. CONCLUSION Our findings suggest that established psychological risk factors relate principally to the disability that arises from musculoskeletal pain.
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Affiliation(s)
- Sergio Vargas-Prada
- Center for Research in Occupational Health (CiSAL). Universitat Pompeu Fabra, C/ Doctor Aiguader 88 - Primera planta, Despacho 171.03, 08003 Barcelona, Spain.
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Coggon D, Ntani G, Harris EC, Linaker C, Van der Star R, Cooper C, Palmer KT. Differences in risk factors for neurophysiologically confirmed carpal tunnel syndrome and illness with similar symptoms but normal median nerve function: a case-control study. BMC Musculoskelet Disord 2013; 14:240. [PMID: 23947720 PMCID: PMC3765327 DOI: 10.1186/1471-2474-14-240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/09/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To explore whether risk factors for neurophysiologically confirmed carpal tunnel syndrome (CTS) differ from those for sensory symptoms with normal median nerve conduction, and to test the validity and practical utility of a proposed definition for impaired median nerve conduction, we carried out a case-control study of patients referred for investigation of suspected CTS. METHODS We compared 475 patients with neurophysiological abnormality (NP+ve) according to the definition, 409 patients investigated for CTS but classed as negative on neurophysiological testing (NP-ve), and 799 controls. Exposures to risk factors were ascertained by self-administered questionnaire. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression. RESULTS NP+ve disease was associated with obesity, use of vibratory tools, repetitive movement of the wrist or fingers, poor mental health and workplace psychosocial stressors. NP-ve illness was also related to poor mental health and occupational psychosocial stressors, but differed from NP+ve disease in showing associations also with prolonged use of computer keyboards and tendency to somatise, and no relation to obesity. In direct comparison of NP+ve and NP-ve patients (the latter being taken as the reference category), the most notable differences were for obesity (OR 2.7, 95 % CI 1.9-3.9), somatising tendency (OR 0.6, 95% CI 0.4-0.9), diabetes (OR 1.6, 95% CI 0.9-3.1) and work with vibratory tools (OR 1.4, 95% CI 0.9-2.2). CONCLUSIONS When viewed in the context of earlier research, our findings suggest that obesity, diabetes, use of hand-held vibratory tools, and repeated forceful movements of the wrist and hand are causes of impaired median nerve function. In addition, sensory symptoms in the hand, whether from identifiable pathology or non-specific in origin, may be rendered more prominent and distressing by hand activity, low mood, tendency to somatise, and psychosocial stressors at work. These differences in associations with risk factors support the validity of our definition of impaired median nerve conduction.
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Affiliation(s)
- David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - E Clare Harris
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Cathy Linaker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Richard Van der Star
- Department of Clinical Neurophysiology, Wessex Neurological Centre, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
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Carugno M, Pesatori AC, Ferrario MM, Ferrari AL, Silva FJD, Martins AC, Felli VEA, Coggon D, Bonzini M. Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses. CAD SAUDE PUBLICA 2013; 28:1632-42. [PMID: 23033179 DOI: 10.1590/s0102-311x2012000900003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/09/2012] [Indexed: 11/21/2022] Open
Abstract
As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.
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Affiliation(s)
- Michele Carugno
- Department of Occupational and Environmental Health, University of Milan, Italy.
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Paudyal P, Ayres JG, Semple S, Macfarlane GJ. Low back pain among textile workers: a cross-sectional study. Occup Med (Lond) 2013; 63:129-34. [PMID: 23359395 DOI: 10.1093/occmed/kqs231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most prevalent occupational health problems in industrialized countries. Little is known about the epidemiology of LBP in developing countries. AIMS To determine the prevalence of LBP among Nepalese textile workers and to investigate the influence of exposure to mechanical and other factors on LBP reporting. METHODS Interviewers completed questionnaires with study subjects, and work-related mechanical exposures were measured by self-completed questionnaires. Associations of LBP with mechanical factors and somatic symptoms were determined by logistic regression and reported as odds ratios (ORs) with 95% confidence intervals (CI). RESULTS Nine hundred and thirty-eight workers took part, a participation rate of 92%. The 1 month period prevalence of LBP was 35% (n = 324), being higher in females than males (45% versus 28%; P < 0.001). Several work-related mechanical factors were associated with increased odds of reporting LBP: lifting heavy weights with one hand (OR 1.7; 95% CI 1.1-2.8), pushing weights (OR 1.6; 95% CI 1.2-2.3 and pulling weights (OR 1.6; 95% CI 1.1-2.1). No association was found with working posture. Strong associations were found for reporting one (OR 2.4; 95% CI 1.7-3.4) or two somatic symptoms (OR 2.7; 95% CI 1.4-5.1). On multivariable analysis, reporting of somatic symptoms (OR 2.8; 95% CI 1.5-5.4), female gender (OR 2.2; 95% CI 1.5-3.1) and increasing age were significantly associated with increased risk of reporting LBP (OR 1.7; 95% CI 1.2-2.5), but no associations were found with mechanical factors. CONCLUSIONS This study suggests that mechanical load may not be the leading cause of LBP and adds to evidence that psychological factors play an important role in LBP in non-industrialized countries.
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Affiliation(s)
- P Paudyal
- PenCLAHRC, University of Plymouth, Plymouth PL4 8AA, UK.
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Laisné F, Lecomte C, Corbière M. Biopsychosocial predictors of prognosis in musculoskeletal disorders: a systematic review of the literature (corrected and republished). Disabil Rehabil 2012; 34:1912-41. [DOI: 10.3109/09638288.2012.729362] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pfitzner T, Geissler S, Duda G, Perka C, Matziolis G. Increased BMP expression in arthrofibrosis after TKA. Knee Surg Sports Traumatol Arthrosc 2012; 20:1803-8. [PMID: 22089372 DOI: 10.1007/s00167-011-1774-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 11/08/2011] [Indexed: 01/13/2023]
Abstract
PURPOSE Because of the multiple possible aetiologies of painful total knee arthroplasty (TKA), the diagnosis and treatment of such patients are challenging. In a considerable number of patients, an intraarticular pathology is present, although not verifiable with clinical and diagnostic imaging techniques as in cases of primary arthrofibrosis. In these patients, the differentiation between intra- and extraarticular causes of pain remains difficult. Until now, little attention has been paid to changes of the synovial fluid and tissue in these knees. The objective of this study was to analyse the changes of the synovial environment in patients suffering from arthrofibrosis after TKA in comparison with knees with referred pain suffering from hip arthritis. The changes of the synovial environment probably provide additional diagnostic information to verify an intraarticular pathology. METHODS The synovial fluid of 10 consecutive knees in 10 patients presenting with a primary arthrofibrosis after TKA without signs of infection, instability, malalignment, or loosening was analysed and compared to the synovial fluid of 10 knees with referred pain serving as controls. The BMP-2 concentration was measured in the synovial fluid, and the presence of cytokines leading to an overexpression of BMP-2 was detected by measuring the change of BMP-2 expression in a synoviocyte cell line following exposing to the synovial fluid of the patients. RESULTS The concentration of BMP-2 in the synovial fluid was significantly higher in arthrofibrotic TKA knees (24.3 ± 6.9 pg/mL), compared with the control group 5.9 ± 4.8 pg/mL (P < 0.001). Corresponding to this finding, BMP-2 expression in synoviocytes was upregulated 11.5-fold (P < 0.05) by synovial fluid of patients suffering from arthrofibrosis after TKA, compared with the control group with referred pain. CONCLUSION BMP-2 is overexpressed and its concentrations are consequently higher in patients suffering from arthrofibrosis after TKA. The synovial BMP-2 concentration may be a potential marker for differentiating between intra- and extraarticular causes of pain. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Tilman Pfitzner
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Chariteplatz 1, 10117 Berlin, Germany.
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Solidaki E, Chatzi L, Bitsios P, Coggon D, Palmer KT, Kogevinas M. Risk factors for new onset and persistence of multi-site musculoskeletal pain in a longitudinal study of workers in Crete. Occup Environ Med 2012; 70:29-34. [PMID: 22864252 DOI: 10.1136/oemed-2012-100689] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore occupational and psychological risk factors for the incidence and persistence of multi-site musculoskeletal pain. METHODS We conducted a longitudinal investigation of three occupational groups in Crete, Greece. Baseline information was obtained at interview about pain in the past year at each of six anatomical sites, and about possible risk factors for subsequent symptoms. Twelve months later, subjects were re-interviewed about pain at the same anatomical sites in the past month. Pain at two or more sites was classed as multi-site. Associations with new development and persistence of multi-site pain at follow-up were assessed by logistic regression. RESULTS Analysis was based on 518 subjects (87% of those originally selected for study). At follow-up, multi-site pain persisted in 217 (62%) of those who had experienced it in the year before baseline, and was newly developed in 27 (17%) of those who had not. Persistence of multi-site pain was significantly related to physical loading at work, somatising tendency and beliefs about work as a cause of musculoskeletal pain, with OR (95% CI) for the highest relative to the lowest exposure categories of 2.3 (1.0 to 5.6), 2.6 (1.5 to 4.6) and 1.9 (1.1 to 3.3) respectively. Development of new multi-site pain was most strongly associated with working for ≥40 h per week (OR 5.0, 95% CI 1.1 to 24.0). CONCLUSIONS Our findings confirm the importance of both physical loading at work and somatising tendency as risk factors for multi-site pain, and suggest that persistence of pain is also influenced by adverse beliefs about work causation.
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Affiliation(s)
- Eleni Solidaki
- Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece
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Coggon D, Ntani G, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Serra C, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir M, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Marziale MH, Sarquis LM, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Salazar Vega EJ, Harris EC, Vargas-Prada S, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Sirk T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kielkowski D, Kelsall HL, Hoe VCW, Urquhart DM, Derrett S, McBride D, Gray A. The CUPID (Cultural and Psychosocial Influences on Disability) study: methods of data collection and characteristics of study sample. PLoS One 2012; 7:e39820. [PMID: 22792189 PMCID: PMC3391206 DOI: 10.1371/journal.pone.0039820] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/28/2012] [Indexed: 11/20/2022] Open
Abstract
Background The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. Methods/Principal Findings A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as “repetitive strain injury” (RSI). Conclusions/Significance The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.
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Affiliation(s)
- David Coggon
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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HOWARD KRISTAJ, ELLIS HENRYB, WANG JAMES, VON DER GRUEN JENNIFERK, BUCHOLZ ROBERT. Evaluating the Effects of Somatization Disorder for Patients With Severe End-Stage Lower-Extremity Osteoarthritis. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1751-9861.2012.00079.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Laisné F, Lecomte C, Corbière M. Biopsychosocial predictors of prognosis in musculoskeletal disorders: a systematic review of the literature. Disabil Rehabil 2011; 34:355-82. [DOI: 10.3109/09638288.2011.591889] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soltis-Jarrett VM. His-story or her-story: deconstruction of the concepts of somatization towards a new approach in advanced nursing practice care. Perspect Psychiatr Care 2011; 47:183-93. [PMID: 21950365 DOI: 10.1111/j.1744-6163.2010.00288.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This article will endeavor to present an alternative view of somatoform disorders, assist in understanding the possible underlying comorbid psychiatric symptoms, and identify psychopharmacological options for treatment. CONCLUSIONS Recognizing symptom clusters is a useful strategy when considering psychotropic options for treatment and management. PRACTICE IMPLICATIONS The alternative strategies presented and discussed in this article can contribute to a useful and positive experience for both the clinician and the individual suffering from medically unexplained physical symptoms as they promote the care, health, and well-being of the individual rather than a cure, illness, and/or disease state that needs rendering, mending, and/or surgery.
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Ordia J, Vaisman J. Post-surgical spine syndrome. Surg Neurol Int 2011; 2:132. [PMID: 22059127 PMCID: PMC3205485 DOI: 10.4103/2152-7806.85475] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/16/2011] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joe Ordia
- Pain and Wellness Center, Peabody, Massachusetts
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Shambrook J, McNee P, Harris EC, Kim M, Sampson M, Palmer KT, Coggon D. Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging. Pain 2011; 152:1659-1665. [PMID: 21514999 PMCID: PMC3369404 DOI: 10.1016/j.pain.2011.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 11/26/2022]
Abstract
We hypothesised that the relative importance of physical and psychological risk factors for mechanical low back pain (LBP) might differ importantly according to whether there is underlying spinal pathology, psychological risk factors being more common in patients without demonstrable pathology. If so, epidemiological studies of LBP could benefit from tighter case definitions. To test the hypothesis, we used data from an earlier case-control study on patients with mechanical LBP who had undergone magnetic resonance imaging (MRI) of the lumbosacral spine. MRI scans were classified for the presence of high-intensity zone (HIZ), disc degeneration, disc herniation, and nerve root displacement/compression. Information about symptoms and risk factors was elicited by postal questionnaire. Logistic regression was used to assess associations of MRI abnormalities with symptoms and risk factors, which were characterised by odds ratios (ORs) and 95% confidence intervals (CIs). Among 354 patients (52% response), 306 (86.4%) had at least 1, and 63 (17.8%) had all 4 of the MRI abnormalities. Radiation of pain below the knee (280 patients) and weakness or numbness below the knee (257 patients) were both associated with nerve root deviation/compression (OR 2.5, 95% CI 1.4 to 4.5; and OR 1.8, 95% CI 1.1 to 3.1, respectively). However, we found no evidence for the hypothesised differences in risk factors between patients with and without demonstrable spinal pathology. This suggests that when researching the causes and primary prevention of mechanical LBP, there may be little value in distinguishing between cases according to the presence or absence of the more common forms of potentially underlying spinal pathology.
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Affiliation(s)
| | | | - E Clare Harris
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Miranda Kim
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Westgaard RH, Winkel J. Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review. APPLIED ERGONOMICS 2011; 42:261-296. [PMID: 20850109 DOI: 10.1016/j.apergo.2010.07.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 07/09/2010] [Accepted: 07/11/2010] [Indexed: 05/29/2023]
Abstract
This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.
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Affiliation(s)
- R H Westgaard
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
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Agius R. Occupational Medicine in the first decade of this millennium: looking to the future. Occup Med (Lond) 2010; 60:585-8. [DOI: 10.1093/occmed/kqq185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
In this article, the epidemiology of back pain and the use of a variety of treatments for back pain in the United States are reviewed. The dilemma faced by medical providers caring for patients with low back pain is examined in the context of epidemiologic data. Back pain is becoming increasingly common and a growing number of treatment options are being used with increasing frequency in clinical practice. However, limited evidence exists to demonstrate the effectiveness of these treatments. In addition, health-related quality of life for persons with back pain is not improving despite the availability and use of an expanding array of treatments. This dilemma poses a difficult challenge for medical providers treating individual patients who suffer from back pain.
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Affiliation(s)
- Janna Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Solidaki E, Chatzi L, Bitsios P, Markatzi I, Plana E, Castro F, Palmer K, Coggon D, Kogevinas M. Work-related and psychological determinants of multisite musculoskeletal pain. Scand J Work Environ Health 2009; 36:54-61. [PMID: 20011982 DOI: 10.5271/sjweh.2884] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Musculoskeletal pain is associated with occupational physical activities and psychosocial risk factors. We evaluated the relative importance of work-related and psychological determinants of the number of -anatomical sites affected by musculoskeletal pain in a cross-sectional survey. METHODS The survey focused on musculoskeletal pain in six body regions (low-back, neck, shoulder, elbow, wrist-hand, and knee) among 224 nurses, 200 office workers and 140 postal clerks in Crete, Greece (response rate 95%). Information was collected about demographic characteristics, occupational physical load, psycho-social aspects of work, perceptions about the causes of pain, mental health, somatization, and experience of pain in the past 12 months. We used Poisson regression to assess associations of risk factors with the number of painful anatomical sites and explored interactions using classification and regression trees (CART). RESULTS Two-thirds of the study sample reported pain in >or=2 body sites during the past 12 months, and in 23%, >3 sites were affected. The number of painful anatomical sites was strongly related to both physical load at work and somatization (with relative risks increased 5-fold or more for frequent and disabling multisite pain) and was also significantly associated with work-related psychosocial factors and beliefs about work causation. The CART analysis suggested that somatization was the leading determinant of the number of painful body sites. CONCLUSION In the population studied, pain at multiple anatomical sites was common and strongly associated with somatization, which may have a more important influence on multisite pain than pain that is limited to a single anatomical site.
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Affiliation(s)
- Eleni Solidaki
- Department of Social Medicine, University of Crete, Heraklion, Crete, Greece
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Fishbain DA, Lewis JE, Gao J, Cole B, Steele Rosomoff R. Is chronic pain associated with somatization/hypochondriasis? An evidence-based structured review. Pain Pract 2009; 9:449-67. [PMID: 19735366 DOI: 10.1111/j.1533-2500.2009.00309.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN This is an evidence-based structured review. OBJECTIVES The objectives of this review were to answer the following questions: (1) Are somatization/hypochondriasis associated with chronic pain? (2) Is the degree of somatization/hypochondriasis related to pain levels? (3) Does pain treatment improve somatization/hypochondriasis? (4) Are some pain diagnoses differentially associated with somatization/hypochondriasis? METHODS Fifty-seven studies which fulfilled inclusion criteria and had high quality scores were sorted by the above-mentioned objectives. Agency for health care policy and research guidelines were utilized to type and characterize the strength/consistency of the study evidence within each objective. RESULTS Somatization and hypochondriasis were both consistently associated with chronic pain (consistency ratings B and A, respectively). Study evidence indicated a correlation between pain intensity and presence of somatization and hypochondriasis (consistency rating A and B, respectively). Pain treatment improved somatization and hypochondriasis (consistency rating B and A, respectively). Some chronic pain diagnostic groups somatized more (consistency rating B). CONCLUSIONS Somatization is commonly associated with chronic pain and may relate to pain levels.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Madan I, Reading I, Palmer KT, Coggon D. Cultural differences in musculoskeletal symptoms and disability. Int J Epidemiol 2008; 37:1181-9. [PMID: 18511493 DOI: 10.1093/ije/dyn085] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To test the hypothesis that cultural factors such as health beliefs and expectations have an important influence on common musculoskeletal symptoms and associated disability, we compared prevalence rates in groups of workers carrying out similar physical activities in different cultural settings. METHODS We conducted a cross-sectional survey at factories and offices in Mumbai, India and in the UK. A questionnaire about symptoms, disability and risk factors was administered at interview to six occupational groups: three groups of office workers who regularly used computer keyboards (165 Indian, 67 UK of Indian subcontinental origin and 172 UK white), and three groups of workers carrying out repetitive manual tasks with the hands or arms (178 Indian, 73 UK of Indian subcontinental origin and 159 UK white). Modified Cox regression was used to calculate hazard ratios (HRs) for the prevalence of symptoms and disability by occupational group, adjusted for differences in sex, age, mental health and job satisfaction. RESULTS Reported occupational activities were similar in the three groups of office workers (frequent use of keyboards) and in the three groups of manual workers (frequent movements of the wrist or fingers, bending of the elbow, work with the hands above shoulder height and work with the neck twisted). In comparison with the Indian manual workers, the prevalence of back, neck and arm pain was substantially higher in all of the other five occupational groups. The difference was greatest for arm pain lasting >30 days in the past year in UK white manual workers (HR 17.8, 95% CI 5.4-59.1) and UK manual workers of Indian subcontinental origin (HR 20.5, 95% CI 5.7-73.1). Office workers in India had lower rates of pain in the wrist and hand than office workers in the UK. Only 1% of the Indian manual workers and 16% of the Indian office workers had ever heard of 'RSI' or similar terms, as compared with 80% of the UK workers. CONCLUSIONS Our findings support the hypothesized impact of cultural factors on common musculoskeletal complaints. Current controls on hazardous physical activities in the workplace may not have the benefits that would be predicted from observational epidemiology.
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Affiliation(s)
- Ira Madan
- Guy's and St Thomas' NHS Foundation Trust and Division of Health and Social Care, King's College London, London, UK
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Palmer KT, Reading I, Calnan M, Coggon D. How common is repetitive strain injury? Occup Environ Med 2007; 65:331-5. [PMID: 18056747 DOI: 10.1136/oem.2007.035378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Statistics from Labour Force Surveys are widely quoted as evidence for the scale of occupational illness in Europe. However, occupational attribution depends on whether participants believe their health problem is caused or aggravated by work, and personal beliefs may be unreliable. The authors assessed the potential for error for work-associated arm pain. METHODS A questionnaire was mailed [corrected] to working-aged adults, randomly chosen from five British general practices. They were asked about: occupational activities; mental health; self-rated health; arm pain; and beliefs about its causation. Those in work (n = 1769) were asked about activities likely to cause arm pain, from which the authors derived a variable for exposure to any "arm-straining" occupational activity. The authors estimated the relative risk (RR) from arm-straining activity, using a modified Cox model, and derived the population attributable fraction (PAF). They compared the proportion of arm pain cases reporting their symptom as caused or made worse by work with the calculated PAF, overall and for subsets defined by demographic and other characteristics. RESULTS Arm pain in the past year was more common in the 1143 subjects who reported exposure to arm-straining occupational activity (RR 1.2, 95% CI 1.1 to 1.5). In the study sample as a whole, 53.9% of 817 cases reported their arm pain as work-associated, whereas the PAF for arm-straining occupational activity was only 13.9%. The ratio of cases reported as work-related to the calculated attributable number was substantially higher below 50 years (5.4) than at older ages (3.0) and higher in those with worse self-rated and mental health. CONCLUSIONS Counting people with arm pain which they believe to be work-related can overestimate the number of cases attributable to work substantially. This casts doubt on the validity of a major source of information used by European governments to evaluate their occupational health strategies.
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Affiliation(s)
- K T Palmer
- MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton SO16 6YD, UK.
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Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all? Knee 2007; 14:417-23. [PMID: 17596949 DOI: 10.1016/j.knee.2007.06.001] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 06/04/2007] [Indexed: 02/02/2023]
Abstract
Total knee replacement (TKR) is considered an effective intervention for the treatment of chronic knee pain and disability. Yet there is increasing evidence, based on research using patient-based outcome measures, that a significant proportion of patients experience chronic knee pain, functional disability, a poor quality of life and dissatisfaction after TKR. Although some poor outcomes after TKR are due to surgical technique and implant factors, much of the pain and disability after surgery is medically unexplained. A range of possible patient factors could contribute to a poor outcome after TKR. Socio-demographic factors that have been found to correlate with a poor outcome after TKR include female gender, older age and low socio-economical status. Medical factors that are highly predictive of pain and disability after TKR are a greater number of co-morbidities and a worse pre-operative status. A range of psychological factors could be predictive of a poor outcome after surgery including depression, low self-efficacy, poor pain coping strategies, somatization, low social support and patient expectations. It is also proposed that a biological explanation for continuing pain after TKR could involve central sensitisation, a dysfunction of pain modulation by the central nervous system. To improve patient selection for TKR, future research needs to focus on developing a pre-operative screening protocol to identify those patients at risk of medically unexplained pain and disability after TKR.
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Affiliation(s)
- V Wylde
- University of Bristol, Department of Orthopaedic Surgery, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
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Frost P, Haahr JP, Andersen JH. Reduction of pain-related disability in working populations: a randomized intervention study of the effects of an educational booklet addressing psychosocial risk factors and screening workplaces for physical health hazards. Spine (Phila Pa 1976) 2007; 32:1949-54. [PMID: 17700439 DOI: 10.1097/brs.0b013e3181342659] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cluster randomized controlled trial with 6 and 8 quarters of follow-up. OBJECTIVE To test the effects of giving evidence-based information addressing psychosocial risk factors for pain-related disability and of screening workplaces for physical health hazards at work on reducing new episodes and duration of pain-related and general absence taking. SUMMARY OF BACKGROUND DATA The "flag strategy" for handling low back pain problems is recommended in many Western countries but, so far, randomized intervention studies addressing psychosocial risk factors for disability related to low back pain show mixed results. METHODS We followed employees from 39 different work sites in western Denmark, who had received interventions consisting of either a carefully prepared booklet providing evidence-based information on common musculoskeletal pain problems alone or in combination with systematic workplace screening for physical work hazards. Absence due to pain for at least 7 days and the cumulative numbers of absence days were the main outcome measures. General absence taking was analyzed, too. Company registrations of sickness absence in combination with self-report on the cause of a given absence spell was used to inform absence spells. RESULTS A total of 3808 of 4006 eligible employees provided information. Among 1063 participants in the control arm, 1458 in the information arm, and 1287 in the information and workplace screening arm, 4.6%, 6.9%, and 4.6%, respectively, experienced pain-related absence, and 27.8%, 27.2%, and 24.0%, respectively, experienced general absence taking during follow-up. No positive effect on the risk of the 2 measures of absence or on the cumulative duration of absence among cases was seen. CONCLUSION Results did not support population-based interventions addressing psychosocial risk factors for pain-related disability alone or in combination with workplace screening as effective in reducing the risk of pain-related absence taking or the duration of absence.
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Affiliation(s)
- Poul Frost
- Department of Occupational Medicine, Arhus University Hospital, Arhus C, Denmark.
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