Prevalence of musculoskeletal disorders is systematically higher in women than in men

Worker and work-related factors influence on musculoskeletal symptoms among veterinary surgeons

Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons. In this study, 212 board-certified members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all body regions, reported pain increased from before to after a typical day of surgery (p <.01). Gender, weight, age, and years performing surgery were worker factors that were related to pain (p <.05), while number of procedures, practice focus, and proportion of minimally invasive surgery were work factors related to pain (p <.05). Our findings suggest that musculoskeletal symptoms are prevalent among veterinary surgeons and may help provide evidence for guidelines for minimising musculoskeletal injuries in veterinary surgery.Practitioner summary: Little is known about the risk factors for musculoskeletal symptoms (MSS) among veterinary surgeons. This cross-sectional survey of veterinary surgeons investigates worker and work factors related to MSS. We show that MSS are prevalent and identify key factors providing evidence that MSS are a concern in veterinary surgery.

Comparing and characterizing scapular muscle activation ratios in males and females during execution of common functional movements

Background

The shoulder complex relies on scapular movement controlled by periscapular muscles for optimal arm function. However, minimal research has explored scapular muscle activation ratios during functional tasks, nor how they might be influenced by biological sex. This investigation aims to characterize how sex impacts scapular muscle activation ratios during functional tasks.

Methods

Twenty participants (ten females, ten males) were assessed with surface electromyography (EMG) and motion tracking during seven functional tasks. Activation ratios were calculated from normalized EMG for the three trapezius muscles and serratus anterior. Scapular angles were calculated using a YXZ Euler sequence. Two-way mixed methods ANOVAs (p < .05) were used to assess the effects of sex and humeral elevation level on ratios and angles.

Results

Sex-based differences were present in the Tie Apron task, with males exhibiting higher upper trapezius/lower trapezius and upper trapezius/middle trapezius ratios than females. Males also demonstrated decreased internal rotation in this task. Other tasks showcased significant sex-based differences in scapular upward rotation but not in activation ratios. Humeral elevation generally demonstrated an inverse relationship with scapular muscle activation ratios.

Conclusions

This study highlights sex-based differences in scapular muscle activation ratios during specific functional tasks, emphasizing the need to consider sex in analyses of shoulder movements. Normative activation ratios for functional tasks were provided, offering a foundation for future comparisons with non-normative groups. Further research is warranted to confirm and explore additional influencing factors, advancing our understanding of shoulder activation and movement in diverse populations.

Prevalence of functional disorders across Europe: a systematic review and meta-analysis

Functional Disorders (FD) refer to persistent somatic symptoms caused by changes in the functioning of bodily processes. Previous findings suggest that FD are highly prevalent, but overall prevalence rates for FD in European countries are scarce. Therefore, the aim of the present work was to estimate the point prevalence of FD in adult general populations. PubMed and Web of Science were searched from inception to June 2022. A generalized linear mixed-effects model for statistical aggregation was used for statistical analyses. A standardized quality assessment was performed, and PRISMA guidelines were followed. A total of 136 studies were included and systematically synthesized resulting in 8 FD diagnoses. The large majority of studies was conducted in the Northern Europe, Spain, and Italy. The overall point prevalence for FD was 8.78% (95% CI from 7.61 to 10.10%) across Europe, with the highest overall point prevalence in Norway (17.68%, 95% CI from 9.56 to 30.38%) and the lowest in Denmark (3.68%, 95% CI from 2.08 to 6.43%). Overall point prevalence rates for specific FD diagnoses resulted in 20.27% (95% CI from 16.51 to 24.63%) for chronic pain, 9.08% (95% CI from 7.31 to 11.22%) for irritable bowel syndrome, and 8.45% (95% CI from 5.40 to 12.97%) for chronic widespread pain. FD are highly prevalent across Europe, which is in line with data worldwide. Rates implicate the need to set priorities to ensure adequate diagnosis and care paths to FD patients by care givers and policy makers.

Association between commuting time and work-related low back pain with respect to sports and leisure activities in Korean workers

Long commuting times can induce work-related low back pain (LBP), which can be exacerbated by reduced sports and leisure activities. However, there is a lack of empirical research on commuting time and work-related LBP in Korea. In this study, we aimed to investigate the relationship between commuting time and work-related LBP as well as the effect of sports and leisure activities on Korean workers. We utilized data from the sixth Korean Working Conditions Survey to analyze the relationship between commuting time and work-related LBP using multivariable logistic regression. The total number of included workers was 28,202. Workers without sports and leisure activities, and long commuting times (40-59, 60-79, and ≥80 min) showed significantly higher odds ratios for work-related LBP (1.29 [95% Confidence intervals=1.12-1.49], 1.42 [1.22-1.65], and 1.96 [1.68-2.28], respectively). However, in workers with sports and leisure activities, the results were significant only for commuting times of 60-79 and ≥80 min (1.41 [1.13-1.75], 1.60 [1.28-1.99], respectively). Long commuting times were associated with work-related LBP, and engagement in sports and leisure activities was found to play a role in mitigating the impact among Korean wage workers.

Severity of premenstrual symptoms among women with musculoskeletal pain: relation to vitamin D, calcium, and psychological symptoms

Premenstrual syndrome (PMS) has various symptoms that occur during the luteal phase of the menstrual cycle and subside after menstruation. Anxiety and depression are prevalent in women with PMS and may exacerbate the severity of PMS. Vitamin D and calcium deficiency may have a role in developing anxiety, depression, and musculoskeletal pain (MSP). The aim of this study was to evaluate selected premenstrual symptoms in relation to serum vitamin D levels, daily calcium consumption, and psychological symptoms among women with MSP. The study population consisted of 108 women with MSP and 108 healthy controls. Information about premenstrual symptoms and calcium consumption were collected. Psychological symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Vitamin D was determined by electrochemiluminescence immunoassay. Women with MSP had lower serum vitamin D levels, lower daily calcium consumption, higher HADS scores for anxiety and depression, and higher frequency of severe premenstrual symptoms including fatigue, headache, irritability, mood swings, anxiety, depression, and social withdrawal compared to controls (P < 0.01). Abnormal HADS scores for anxiety and depression were associated with increased severity of premenstrual symptoms (P < 0.05). Deficient vitamin D and calcium consumption were associated with abnormal HADS scores for anxiety and depression (P < 0.05) and with increased severity of premenstrual headache, irritability, anxiety, and depression (P < 0.05). Low calcium consumption was associated with increased severity of premenstrual irritability, anxiety, depression, and social withdrawal (P < 0.05). The results suggest that vitamin D deficiency, low calcium consumption, psychological symptoms, and MSP could be interrelated and implicated in the etiology severe premenstrual symptoms. Further studies are necessary to assess whether vitamin D and calcium supplements can relieve MSP and premenstrual symptoms.

Impact of Musculoskeletal Pain on Health-Related Quality of Life Among Adults in Saudi Arabia

Background Musculoskeletal pain (MSP) is widely recognized as a prevalent public health issue that affects individuals of various genders and age groups. The aim of this study is to assess the influence of musculoskeletal pain on the quality of life (QoL) of adult individuals living in Saudi Arabia. Method This is a cross-sectional study using an online-administered questionnaire that was distributed via online platforms in Saudi Arabia for the duration between January and August 2023. Three questionnaire instruments were used in this study. The 36-item Short Form Health Survey questionnaire (SF-36), The 5-level EQ-5D version (EQ-5D-5L), and Roland-Morris Disability Questionnaire. Binary logistic regression analysis was used to identify predictors of better QoL and having mild to moderate disability. Results A total of 8359 participants were involved in this study. The most commonly reported sites of musculoskeletal pain were the lower back, neck, and shoulder, accounting for 36.8% (n= 3072), 30.5% (n= 2549), and 30.1% (n= 2514), respectively. The mean pain score for the study participants was 4.3 (SD: 2.3), which indicates mild degree of pain. The median EQ-5D-5L index value for the study participants was 0.827 (0.756-1.00), which demonstrates a high quality of life. The mean SF-36 score for the study participants was 63.11 (17.4), which demonstrates moderate quality of life. The median Roland-Morris Disability score for the study participants was 1.00 (0.00-7.00), which demonstrates a low level of pain-related disability. Male gender, younger age (30-39 years), having higher education attainment, having higher monthly income (more than SAR 20000), and having lower BMI (less than 25.8 kg/cm2) were predictors of better QoL (p<0.05). Conclusion Musculoskeletal pain is a multifactorial condition influenced by structural, physical, psychological, social, lifestyle, and comorbid health elements. It ranges from acute to chronic pain and, despite rarely being fatal, has a significant impact on QoL. Musculoskeletal discomfort varies in terms of intensity, affected regions, and demographic and lifestyle factors. This study sheds light on the multifaceted nature of MSP, its impact on QoL, and the significance of early intervention and individualized management strategies to improve the QoL of those affected.

Protocol for an observational study of working conditions and musculoskeletal health in Swedish online retail warehousing from the perspective of sex/gender and place of birth

European and International sustainable development agendas aim to reduce inequalities in working conditions and work-related health, yet disparate occupational health outcomes are evident between both men and women and domestic- and foreign-born workers. In Sweden, major growth in online retail warehousing has increased occupational opportunities for foreign-born workers. The rapid change has left research lagging on working conditions, i.e., employment conditions, facility design, work organisation, physical and psychosocial work environment conditions, and their effects on worker health. Further, no known studies have considered patterns of inequality related to these factors. The overall aim of this study is to describe working conditions and musculoskeletal health in online retail warehousing, determine the extent to which differences exist related to sex/gender and place of birth (as a proxy for race/ethnicity), and examine factors at the organisational and individual levels to understand why any differences exist. Three online retail warehouses, each employing 50-150 operations workers performing receiving, order picking, order packing and dispatching tasks will be recruited. Warehouses will, to the extent possible, differ in their extent of digital technology use. Employment conditions, facility design (including digital tool use), work organisation, physical and psychosocial work environment conditions and worker health will be assessed by survey, interview and technical measurements. Analysis of quantitative data stratified by sex and place of birth will consider the extent to which inequalities exist. Focus group interviews with operations employees and in-depth interviews with managers, union and health and safety representatives will be conducted to assess how employee working conditions and musculoskeletal health are related to inequality regimes of sex/gender and/or race/ethnicity in organisational processes and practices in online retail warehousing. The study is pre-registered with the Open Science Framework. This study will describe working conditions and health in online retail warehouse workers and consider the extent to which patterns of inequality exist based on sex/gender and place of birth.

Do Sex and Age Influence Scapular and Thoracohumeral Kinematics During a Functional Task Protocol?

There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19-63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P < .001), and less scapular anterior tilt angles in the forward transfer task (6°, P < .001) than males. Age was positively associated with humeral elevation (R2 = .330, P < .001) and scapular rotation (R2 = .299, P < .001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development.

Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study

Introduction

musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population.

Methods

a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ).

Results

among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score.

Conclusion

this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being.

Patterns of multimorbidity in primary care electronic health records: A systematic review

Background

Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data.

Methods

Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale.

Results

Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine).

Discussion

These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations.

The effects of head mounted weight on comfort for helmets and headsets, with a definition of "comfortable wear time"

BACKGROUND

There are difficult tradeoffs when designing head-mounted equipment such as helmets, lights, cameras, or virtual or augmented reality displays. Increased functionality and battery life adds weight, which in turn reduces comfort. A successful product must balance both comfort and functionality to achieve its product engagement goals.

OBJECTIVE

This study defines "comfortable wear time" as a new metric, and applies it to the domain of headsets in determining the relationship between headset weight and comfort.

METHODS

Sixteen study participants wore four otherwise identical headsets weighted between 500g-600 g for up to two hours each in an office environment. If participants experienced more than "mild discomfort" (>3 on an NRS-11 discomfort scale), the trial ended early, and the comfortable wear time was recorded. Intensity and location of discomfort was rated at trial conclusion, and qualitative feedback collected.

RESULTS

Higher weights were associated with shorter comfortable wear times. Not everyone could wear even the lightest headset (500 g) for the full two hours. Qualitatively, discomfort took many forms beyond the expected neck fatigue or contact pressure and included symptoms commonly associated with motion sickness, such as headache and dizziness. Finally, there were pronounced gender differences with females experiencing more severe discomfort with earlier onset.

CONCLUSION

Heavier headsets were less comfortable for the lower quartile of participants -yielding an average of 11 fewer minutes of comfortable wear time per 33 g of weight added. Understanding the discomfort costs from adding weight empowers product teams to find the correct balance to meet their product engagement targets.

Inequalities in employment and gender differences in the prevalence of work-related musculoskeletal disorders cases: a nationwide survey from Brazil, 2019

OBJECTIVES

The present study aimed to investigate the prevalence of work-related musculoskeletal disorders (WRMDs) and to determine whether differences regarding the employment status (standard and non-standard), according to gender, increased the probability of WRMDs.

STUDY DESIGN

Cross-sectional study.

METHODS

Data from the 2019 National Health Survey (NHS) in Brazil were used. In total, 50,066 participants, both women and men, aged 18-65 years were included. Data were analysed for self-reported WRMDs. The binary logistic regression model, adjusting for possible covariables, was used to evaluate the association between working in the labour market and the occurrence of WRMDs. For covariates in the multivariate analysis, a P-value of <0.20 was considered in the univariate analysis. The variables with a P-value of <0.05 remained in the model. The odds ratio (OR), together with their confidence intervals at 95% (95% CI), were estimates both in the univariate and multivariate models.

RESULTS

The prevalence of WRMDs was higher in women (4.2%) than men (1.9%). The likelihood of WRMDs was associated with the employment status only among men and proved to be lower for non-standard employment than standard employment (OR = 0.61; 95% CI = 0.43-0.87). Only among women, an increase in the likelihood of WRMDs associated with exposure to occupational noise was observed (OR = 1.77; 95% CI = 1.31-2.38) and a less favourable self-reported health (OR = 1.66; 95% CI = 1.08-2.54). Results showed higher change of WRMD for men and women associated with rheumatoid arthritis (men: OR = 3.94; 95% CI = 2.10-7.38; women: OR = 2.39; 95% CI = 1.68-3.39), depression (men: OR = 2.62; 95% CI = 1.54-4.45; women: OR = 2.39; 95% CI = 1.68-3.39) and occupational accidents (men: OR = 4.36; 95% CI = 2.34-8.14; women: OR = 2.20; 95% CI = 1.19-4.07).

CONCLUSIONS

It is possible that the "double presence" that involves both the productive and reproductive spheres explains the higher prevalence of WRMDs among women Indicators that are sensitive to the effects of gender norms are necessary to understand the context of inequalities in the prevalence of WRMDs. The results of this study should be considered when developing strategies in the workplace and public health policies to reduce the prevalence of WRMDs.

Effects of Online Pilates and Face-to-Face Pilates Intervention on Body Composition, Muscle Mechanical Properties, Cardiometabolic Parameters, Mental Health, and Physical Fitness in Middle-Aged Women with Obesity

With the emergence of coronavirus disease 2019, individuals have been participating in online exercises to maintain their health while avoiding infection. Among these online exercises, Pilates intervention is a popular modality. This study aimed to examine the differences between online and face-to-face Pilates interventions in terms of various physiological parameters and included 30 middle-aged individuals (age 43.3 ± 5.5 years) with obesity. These individuals were randomly divided into a face-to-face Pilates group (FPG), an online Pilates group (OPG), and a control group (CG). The FPG and OPG performed a 60-min mat Pilates program with a Borg scale of 11-17, three times a week for 12 weeks. The participants in the CG maintained their daily routines. Body composition, mechanical muscle properties, cardiometabolic parameters, mental health, and physical fitness were assessed before and after 12 weeks of intervention. No significant differences in body composition or cardiometabolic parameters were observed between groups. However, the FPG and OPG showed greater improvements than the CG in terms of muscle mechanical properties, cardiometabolic parameters, mental health, and physical fitness. In addition, the FPG showed greater improvement than the OPG. In conclusion, face-to-face Pilates is a more effective modality than online Pilates, although both modalities improve health-related parameters.

Clinical characteristics of patients with hypermobile type Ehlers-Danlos syndrome (hEDS) and generalized hypermobility spectrum disorders (G-HSD): an online survey

To examine the perspective of individuals with Hypermobile Ehlers-Danlos Syndrome (hEDS) and Generalized Hypermobility Spectrum Disorder (G-HSD), needed to help identify priorities and improve the lives of people living with these conditions. We conducted an online survey between November 2021 and January 2023. Participants were recruited through the Ehlers-Danlos Society's Research Surveys website. We obtained 483 responses and 396 were analyzed. 80% of the survey's respondents were individuals with hEDS, 90% were females, 30% were between 21 and 30, and 76% lived in North America, with 85% of the participants living in North America indicated being White or European American. Participants reported exercising from none to less than three times per week, with no physical therapy treatment. Ninety-eight percent of participants reported pain mainly at the neck (76%), lower (76%) and upper back (66%), knees (64%), shoulders (60%), and hips (60%). Approximately 80% of participants reported fatigue, joint hypermobility, joint instability, interference with daily activities, gastrointestinal problems, orthostatic hypotension, muscle weakness, and emotional distress. About 60% of respondents indicated walking issues, balance issues, and reduced joint proprioception. Nearly 40% of participants reported pelvic floor dysfunction and cardiovascular problems. Participants with hEDS and G-HSD reported pain on an average (SD) of 6.4 (± 1.3) and 5.9 (± 1.5) days in a typical week, respectively. People with hEDS and G-HSD desperately need more effective treatment options, a better diagnostic process, and education among health care providers.

Has the COVID-19 outbreak altered the prevalence of low back pain among physiotherapy students?

OBJECTIVE

To evaluate the prevalence of low back pain (LBP) among physiotherapy students during the COVID-19 lockdown in the State of Israel.

PARTICIPANTS/METHODS

One hundred and sixty four physiotherapy students from all four-year student levels were invited to participate. One hundred and thirty-seven students (83.5%) were recruited in the study with 79 females (57.7%) and 58 males (42.3%). We used a structured anonymous questionnaire that sought standard information on age, height, weight, sports activity and low back pain (LBP) prevalence during three periods.

RESULTS

No significant differences were noted in the prevalence of LBP between the lockdown period compared to 12-month period in all four-year levels. More so, our findings showed that LBP prevalence among physiotherapy students was greater during the 12-month period compared to the lifetime period.

CONCLUSIONS

This study indicates that COVID-19 lockdown has no negative impact on the prevalence of LBP among physiotherapy students.

Clinical conversations in the management of chronic musculoskeletal pain in vulnerable patient populations: a meta-ethnography

PURPOSE

The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations.

MATERIALS AND METHODS

A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks.

RESULTS

The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations.

CONCLUSION

The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes.IMPLICATIONS FOR REHABILITATIONHealthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions.Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain.Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain.Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain.This may include cultural training for healthcare providers that is informed by patients.

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

OBJECTIVES

1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period.

METHODS

Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0-3 months post-visit) and a Markov model (3-24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED's pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories.

CONCLUSION

This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.

Cross-Cultural Adaptation and Validation of a Marathi Version of the Versus Arthritis Musculoskeletal Health Questionnaire (MSK-HQ)

Introduction Musculoskeletal (MSK) well-being plays a crucial role in determining one's quality of life. Musculoskeletal Health Questionnaire (MSK-HQ) score is a tool recently developed by the Versus Arthritis group of Oxford University in English to measure MSK health. Marathi is a regional language in western India spoken by more than 100 million people. There is a scarcity of valid and reliable tools to measure MSK health in this language. Hence, we decided to cross-culturally adapt and translate MSK-HQ to Marathi. Method We translated MSK-HQ score to Marathi (MSK-HQ-Ma) as per the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. We tested its internal consistency, construct validity and reproducibility. It was compared with other health status scores EQ-5D-5L and overall health using the Visual Analogue Scale (VAS). Test-retest reliability was tested in those subjects who were having stable MSK health after two weeks. Results We recruited 158 consecutive subjects attending musculoskeletal clinics who had Marathi as their native language. Mean age was 44.8±17 years, females were 78 (49%). It showed good internal consistency (Cronbach's alpha = 0.95). For construct validity we found a strong correlation between MSK-HQ-Ma and EQ-5D-5L values (Spearman's r = 0.82, p<0.001). There was also a good correlation between MSK-HQ-Ma and overall health by VAS (Spearman's r = 0.76, p<0.001). An excellent test-retest reliability (Spearman's r = 0.94, p<0.001) was seen in 105 subjects who had stable MSK condition after two weeks of first appearance. Conclusion The MSK-HQ-Ma instrument has demonstrated good consistency, reliability and construct validity when evaluating the musculoskeletal health of individuals who can understand the Marathi language. Hence it can be used as a validated tool for the evaluation of musculoskeletal health in western India where Marathi is a commonly used language.

The one-week prevalence of neck pain and low back pain in post-secondary students at two Canadian institutions

BACKGROUND

Low back and neck pain are common in the general population, but the prevalence among Canadian post-secondary students is not well known. We aimed to determine the one-week prevalence of neck pain (NP) and low back pain (LBP) among postsecondary students in Canada.

METHODS

We conducted a cross-sectional study of students enrolled in the Faculty of Health Sciences and Faculty of Education at Ontario Tech University, and the Canadian Memorial Chiropractic College (CMCC) in the Fall of 2017. Neck and low back pain intensity in the past week were measured with the 11-point numerical rating scale. We report the cumulative, gender- and institution-specific one-week prevalence (95% CI) of any pain (1-10/10) and moderate to severe pain (≥ 3/10).

RESULTS

The one-week prevalence of any neck pain ranged from 45.4% (95% CI: 38.4, 52.4) in the Faculty of Education to 76.9% (95% CI: 72.9, 80.4) at CMCC. The one-week prevalence of neck pain ≥3/10 ranged from 44.4% (95% CI: 37.5, 51.4) in the Faculty of Education to 58.4% (95% CI: 54.0, 62.7) at CMCC. The one-week prevalence of any low back pain ranged from 60.9% (95% CI: 53.8, 67.5) in the Faculty of Education to 69.0% (95% CI: 64.8, 73.0) at CMCC, and the one-week prevalence of low back pain ≥ 3/10 ranged from 47.8% (95% CI: 43.4, 52.2) at CMCC to 55.1% (95% CI: 51.2, 58.9) in the Faculty of Health Sciences. The prevalence of any back or neck pain and pain ≥ 3/10 was consistently higher in females than males, with the largest difference seen for neck pain at CMCC.

CONCLUSION

Most post-secondary students in our samples experienced LBP and NP in the past week. Overall, the one-week prevalence of NP and LBP was higher among chiropractic students and among females. This study should draw attention to school administrators about the burden of NP and LBP in post-secondary students.

Acute exercise of painful muscles does not reduce the hypoalgesic response in young healthy women - a randomized crossover study

OBJECTIVES

Exercise-induced hypoalgesia (EIH) is characterized by an increase in pain threshold following acute exercise. EIH is reduced in some individuals with chronic musculoskeletal pain, although the mechanisms are unknown. It has been hypothesized that this may relate to whether exercises are performed in painful or non-painful body regions. The primary aim of this randomized experimental crossover study was to investigate whether the presence of pain per se in the exercising muscles reduced the local EIH response. The secondary aim was to investigate if EIH responses were also reduced in non-exercising remote muscles.

METHODS

Pain-free women (n=34) participated in three separate sessions. In session 1, the maximal voluntary contraction (MVC) for a single legged isometric knee extension exercise was determined. In sessions 2 and 3, pressure pain thresholds (PPT) were assessed at the thigh and shoulder muscles before and after a 3-min exercise at 30 % of MVC. Exercises were performed with or without thigh muscle pain, which was induced by either a painful injection (hypertonic saline, 5.8 %) or a non-painful injection (isotonic saline, 0.9 %) into the thigh muscle. Muscle pain intensity was assessed with an 11-point numerical rating scale (NRS) at baseline, after injections, during and after exercises.

RESULTS

PPTs increased at thigh and shoulder muscles after exercise with painful (14.0-24.9 %) and non-painful (14.3-19.5 %) injections and no significant between-injection EIH differences were observed (p>0.30). Muscle pain intensity was significantly higher following the painful injection compared to the non-painful injection (p<0.001).

CONCLUSIONS

Exercising painful muscles did not reduce the local or remote hypoalgesic responses, suggesting that the pain-relieving effects of isometric exercises are not reduced by exercising painful body regions.

ETHICAL COMMITTEE NUMBER

S-20210184.

TRIAL REGISTRATION NUMBER

NCT05299268.

Correspondence Analysis to Demonstrate the Relationship Between Musculoskeletal Pain and Body Mass Index

Background As obese people frequently experience persistent musculoskeletal pain (MSP), understanding the relationship between obesity and pain may help develop therapeutic and preventative approaches to treat discomfort from MSP. MSP can negatively impact such individuals' quality of life and their ability to perform daily tasks. Therefore, more thorough investigations are required to fully understand the connection between obesity and MSP. Aims To assess the relationship between musculoskeletal pain(MSP) and body mass index (BMI) among women in the age group of 25 to 65 years. Methods From July to December 2022, a cross-sectional study among women between the ages of 25 and 65 was carried out near the Rural Health Training Centre (RHTC) of a medical college in the Lucknow District of Uttar Pradesh, India. In total, 443 women took part in the study. BMI was computed, weight and height were recorded, and MSP at any site (i.e., neck, shoulders, upper back, upper arms, lower back, forearms, wrists, hip/buttocks, thighs, knees, lower legs, and ankles) was noted. The data were analyzed through correspondence analysis. Results Of the 443 women that participated in the study, 224 (50.6%) had MSP, and 9.3% and 28.2% were obese or overweight, respectively. Obese and overweight women were found to be at a higher risk of upper and lower back pain. Conclusion In our study, a significant relationship between MSP and BMI was confirmed and visualized by correspondence analysis.

Bruxism as a new Risk Factor of Musculo-Skeletal Disorders?

OBJECTIVES

Musculoskeletal disorders (MSDs), particularly neck and low back pain, constitute a major public health issue worldwide with a heavy morbidity and economic impact. However, the relationships between the stomatognathic system and MSDs are subjected to debate, data sorely lacking. The study objective was to investigate the association between bruxism (BR) and MSDs. Secondary objective includes the study of the association between tooth wear (TW) and MSDs.

METHODS

This is a cross-sectional study on 425 participants frequenting a university dental clinic. The presence of MSDs was evaluated with the standardized Nordic questionnaire. The sleep and awake BR assessments were based on clinical examination and self-report. TW was measured with the BEWE index. Socio-demographic factors, medical history, life habits and stress were analyzed as potential confounding variables.

RESULTS

91% of patients reported at least one MSD during the preceding 12 months and 78.8% were diagnosed as bruxers. In multivariate analyses, BR was associated with a 5-fold increased risk of prevalent MSD (OR=5.88 (2.7-12.5), p<0.0001). Regarding TW, for a one-point increase in anterior BEWE score, the risk to present an MSD was increased by 53% (OR=1.53 (1.12-2.08), p=0.0076). Moreover, BR was independently associated with neck, shoulder, upper back, low back, hip & thigh and knee MSDs. Anterior TW was independently associated with neck, low back and hip & thigh MSDs, and global TW with knee MSDs.

CONCLUSIONS

BR and TW were shown to be associated with MSDs. The cause-and-effect relationships between those factors needs to be analyzed to optimize prevention and therapeutic care.

CLINICAL SIGNIFICANCE

Results suggest that the body is a whole, a balanced muscular system, where every part constitutes a link of the chain. MSDs management and prevention may require a multidisciplinary team approach and future perspectives include defining the dentist's role in this context, particularly with respect to BR diagnostic and treatment.

The health and economic burden of musculoskeletal disorders in Belgium from 2013 to 2018

INTRODUCTION

Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the musculoskeletal (MSK) disorders causing the greatest disability in terms of Years Lived with Disability. The current study aims to analyze the health and economic impact of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018, as well as direct and indirect costs from 2013 to 2017.

METHODS

The health burden of LBP, NKP, OST and RHE in Belgium from 2013 to 2018 was summarized in terms of prevalence and disability-adjusted life years (DALY) using data from the Belgian health interview surveys (BHIS), the INTEGO database (Belgian registration network for general practitioners) and the Global Burden of Diseases study 2019. The economic burden included estimates of direct medical costs and indirect costs, measured by cost of work absenteeism. For this purpose, data of the respondents to the BHIS-2013 were linked with the national health insurance data (intermutualistic agency [IMA] database) 2013-2017.

RESULTS

In 2018, 2.5 million Belgians were affected by at least one MSK disorder. OST represented the disorder with the highest number of cases for both men and women, followed by LBP. In the same year, MSK disorders contributed to a total of 180,746 DALYs for female and 116,063 DALYs for men. LBP appeared to be the largest contributor to the health burden of MSK. Having at least one MSK disorder costed on average 3 billion € in medical expenses and 2 billion € in indirect costs per year, with LBP being the most costly.

CONCLUSION

MSK disorders represent a major health and economic burden in Belgium. As their burden will probably continue to increase in the future, acting on the risk factors associated to these disorders is crucial to mitigate both the health and economic burden.

Suffering out of sight but not out of mind - interpreting experiences of sick leave due to chronic pain in a community setting: a qualitative study

OBJECTIVE

Chronic pain is a complex health problem affecting about one-fifth of the European population. It is a leading cause of years lived with disability worldwide, with serious personal, relational and socioeconomic consequences. Chronic pain and sick leave adversely affect health and quality of life. Thus, understanding this phenomenon is essential for reducing suffering, understanding the need for support and promoting a rapid return to work and an active lifestyle. This study aimed to describe and interpret persons' experiences of being on sick leave due to chronic pain.

DESIGN

A qualitative study with semistructured interviews analysed using a phenomenological hermeneutic approach.

SETTING

Participants were recruited from a community setting in Sweden.

PARTICIPANTS

Fourteen participants (12 women) with experiences of part-time or full-time sick leave from work due to chronic pain were included in the study.

RESULTS

Suffering out of sight but not out of mind was the main theme of the qualitative analysis. This theme implies that the participants' constant suffering was invisible to others, causing them to feel they were not being justly treated in society. Feeling overlooked led to a continuous struggle for recognition. Moreover, the participants' identities and their trust in themselves and their bodies were challenged. However, our study also revealed a nuanced understanding of the experiences of sick leave as a consequence of chronic pain, where the participants learnt important lessons, including coping strategies and re-evaluated priorities.

CONCLUSIONS

Being on sick leave due to chronic pain threatens a person's integrity and leads to substantial suffering. An enhanced understanding of the meaning of sick leave due to chronic pain provides important considerations for their care and support. This study highlights the importance of feeling acknowledged and being met with justice in encounters with others.

Interdisciplinary Multimodal Pain Rehabilitation in Patients with Chronic Musculoskeletal Pain in Primary Care-A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Chronic pain is a major public health issue. Mounting evidence suggests that interdisciplinary multimodal pain rehabilitation programs (IMMRPs) performed in specialist pain care are an effective treatment for patients with chronic pain, but the effects of such treatment if performed in primary care settings have been less studied. The aims of this pragmatic study were to (1) describe characteristics of patients participating in IMMRPs in primary care; (2) examine whether IMMRPs in primary care improve pain, disability, quality of life, and sick leave 1-year post discharge in patients with chronic pain; and (3) investigate if outcomes differ between women and men. Data from 744 (645 women and 99 men, age range 18-65 years) patients with non-malignant chronic pain included in the Swedish Quality Registry for Pain Rehabilitation Primary Care were used to describe patient characteristics and changes in health and sick leave. At 1-year follow-up, the patients had improved significantly (p < 0.01) in all health outcome measures and had reduced sick leave except in men, where no significant change was shown in physical activity level. This study indicates that MMRPs in primary care improved pain and physical and emotional health and reduced sick leave, which was maintained at the 1-year follow-up.

Identification of prescription opioid misuse and abuse behaviors and risk factors in chronic pain patients using the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ)

OBJECTIVES

To identify patient risk factors associated with prescription opioid misuse and abuse as well as groupings of misuse and abuse behaviors as measured by the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ).

METHODS

Adults with chronic pain requiring long-term treatment with opioids completed the POMAQ and other study questionnaires. Latent class analysis (LCA) was used to examine underlying subgroups exhibiting particular risk profiles. Patient demographic and clinical characteristics were examined as covariates and the concordance between the identified latent classes at-risk classifications and the POMAQ clinical scoring algorithm was assessed.

RESULTS

Analysis of data from 809 patients revealed four classes: "chronic pain, low risk" (n = 473, low to no prevalence of POMAQ behaviors), "chronic pain, comorbid condition" (n = 152, high prevalence of anti-anxiety, sleeping pill, and antihistamine use), "at risk" (n = 154, taking more opioids than prescribed and drinking alcohol with opioids more frequently than other groups), and "high risk" (n = 30, highest prevalence of each behavior). The "high risk" group was associated with being younger, less educated, and unemployed compared to other groups. When examining the LCA classes by groups defined by the original POMAQ clinical scoring algorithm, the "high risk" class had the highest proportion of participants identified with abuse behaviors (46.7%), compared to just 4.7% in the "chronic pain, low risk" group.

CONCLUSIONS

Findings suggest there are four distinct subgroups of patients defined by chronic opioid misuse and abuse behaviors and support the use of the POMAQ to identify risk factors associated with prescription opioid misuse and abuse.

Impact on productivity impairment of a digital care program for chronic low back pain: A prospective longitudinal cohort study

BACKGROUND

Low back pain (LBP) is the leading cause of disability in the United States and the main reason for absenteeism. Successful management of chronic LBP (CLBP) is dependent on multimodal evidence-based interventions. Digital interventions (DI) may ease accessibility to such treatments, increasing adherence, while reducing healthcare-related costs.

OBJECTIVES

Assess the impact of a completely remote multimodal DI on productivity impairment in a real-work context cohort of patients with CLBP.

DESIGN

Longitudinal study.

METHODS

Ad-hoc analysis of an interventional, single-arm study of individuals with CLBP undergoing a DI for 12 weeks. Outcomes included the mean change in work productivity and activity impairment (including overall and non-work related activities), pain, depression, anxiety, fear-avoidance beliefs, analgesic usage, and engagement. Minimal clinically important change (MCIC) was calculated for productivity using anchor- and distribution-based methods.

RESULTS

From 560 patients at program start, 78.4% completed the DI. A significant improvement in overall productivity (20.21, 95%CI: 16.48-23.94) and in non-work related activities (21.36, 95%CI: 17.49-25.22) was observed, corresponding to a responder rate of 57.1-83.3% and 60.5-79.8%, respectively, and depending on the MCIC method. Significant improvements were reported for pain (2.32 points, 95%CI: 2.02-2.61), anxiety (5.24, 95%CI: 4.18-6.29), depression (6.38, 95%CI: 4.78-7.98) and fear-avoidance beliefs (8.11, 95%CI: 6.20-10.02). Both engagement (sessions per week) and patient satisfaction scores were high, 2.9 (SD 1.0) and 8.8/10 (SD 1.6), respectively.

CONCLUSIONS

This study demonstrated the utility of a multimodal DI to address productivity impairment. DIs have great potential to ease the burden of CLBP, providing an accessible and cost-effective modality of care.

TRIAL REGISTRATION

The study was approved by the New England IRB (protocol number 120190313) and prospectively registered in ClinicalTrials.gov, NCT04092946, on September 17th, 2019.

Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program

Background

Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking.

Purpose

To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions.

Patients and Methods

This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement.

Results

At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p<0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment.

Conclusion

This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.

Epidemiological study of work-related musculoskeletal disorders and related risk factors among automobile maintenance workers

BACKGROUND

The automotive industry is labor-intensive, and workers are involved in highly repetitive tasks, long hours, and medium to low workloads, resulting in work-related musculoskeletal disorders (WMSDs), which have become a major health concern for workers in this industry. China is a major automotive country with tens of thousands of auto repair workers, but their conditions of WMSDs have been poorly reported.

OBJECTIVE

This work aimed to analyze the current prevalence of WMSDs and their associated risk factors among automobile maintenance workers.

METHODS

A total of 539 respondents from 50 automotive repair and maintenance companies in China were selected to investigate the prevalence of WMSDs via the modified Nordic Musculoskeletal Disorders Questionnaire. Chi-square test and logistic regression models were applied to analyze their associated risk factors.

RESULTS

The total prevalence of WMSDs among 539 workers was 32.8%. The top three body parts for prevalence were the lower back (17.1%), neck (16.3%), and shoulders (14.5%). The highest prevalence of WMSDs was found in the neck (23.6%) and lower back (14.3%) for sheet metal workers and mechanics, respectively, whereas painters had the highest prevalence of WMSDs in the lower back and feet (both at 15.4%). Logistic regression analysis showed that females were at higher risk of WMSDs than males (OR 5.027, [95% CI] [1.278-19.772], p < 0.05). Workers subjected to uncomfortable positions were at increased risk of WMSDs (OR 1.79, [95% CI] [1.333-2.410], p < 0.01).

CONCLUSION

The prevalence of WMSDs is high among automotive maintenance workers, with the highest prevalence in the lower back (17.1%). Uncomfortable working postures and frequent repetitive movements with lower limbs and ankles at work may be important risk factors.

Prevalence of laboratory-related musculoskeletal disorders among biomedical scientists

BACKGROUND

Laboratory- related musculoskeletal disorders (LMSDs) are injuries resulting from working in the laboratory. Biomedical scientists (BMSs) play an important role in any health care system. However, they are at high risk of exposure to the LMSDs.

OBJECTIVE

This study aimed to estimate the prevalence and the associated risk factors of LMSDs among this group of healthcare professionals.

METHODS

We conducted a cross-sectional survey using the Nordic Musculoskeletal Questionnaire to estimate the prevalence of the LMSDs among the BMSs. BMSs with occupational or non-occupational accidents that affected their musculoskeletal system were excluded from the study. A Chi-square test was performed to measure the significant association between different risk factors (age, gender, weight, height, nationality, specialty, educational level, nature of the job, and the number of experience years) and the prevalence of the LMSDs among the BMSs.

RESULTS

The study included 83 BMSs. Females represented 63.9% and 36.1% were in the age group of 35- 44. The overall prevalence of the LMSDs was 77.1%. The most prevalent LMSDs were neck, shoulders, and lower back with 50.6%, 49.4%, and 43.4%, respectively. A total of 65.57% of BMSs had irregular symptoms of LMSDs.

CONCLUSION

The study found that the prevalence of LMSDs among the BMSs was high. Good practice and training in ergonomics may minimize the prevalence of LMSDs among the BMSs.

Assessing the relationship between domestic work experience and musculoskeletal health among rural Nigerian women

BACKGROUND

Women performing strenuous domestic tasks (especially those in developing countries) are at risk of experiencing musculoskeletal pain (MSP). Physical, psychosocial, and social conditions of work in rural environments contribute to women's domestic work experiences (DWEs) and the risk of MSP. The impact of DWEs on women's health is especially severe in water-insecure countries like Nigeria. This study examines the relationship between a recently developed measure of DWEs and self-reported pain in the lower back (LBP), neck/shoulder (NSP), and elbow/hand/wrist regions (EHWP) among rural Nigerian women.

METHODS

Interviewer-administered survey data were collected from 356 women in four rural communities of Ibadan, Nigeria. Binary and ordinal logistic regression models were used to examine the relationship between DWE factor scores, sociodemographic characteristics, and musculoskeletal pain symptoms and severity after controlling for sociodemographic covariates. Effect estimates of association were presented using the odds ratio (OR), and the corresponding 95% confidence interval (CI) at p-value of 0.05.

FINDINGS

Among 356 participants, the 2-month prevalence of LBP was 58%, NSP was 30%, and EWHP 30%. High DWE scores were significantly associated with higher odds of experiencing and having more severe LBP, NSP, and EHWP. Specifically, the odds of LBP [(OR = 2.88; 95% CI = 1.64-5.11), NSP (OR = 4.58; 95% CI = 2.29-9.40) and EHWP (OR = 1.88; 95% CI = 1.26-3.77)] were significantly higher among women who perceived their domestic work responsibilities as very stressful (i.e., 'high stress appraisal') compared to those with lower stress appraisal scores. Those who were time-pressured and had less autonomy over familial duties (i.e., 'high demand/low control') had significantly higher odds of LBP [(OR = 2.58; 95% CI = 1.64-4.09) and NSP (OR = 1.49; 95% CI = 1.24-2.58)]. Frequently fetching and carrying water over long distances and time (i.e., 'high water sourcing and carriage') was also associated with higher odds of LBP [(OR = 1.31; 95% CI = 1.09-1.79) and NSP (OR = 1.20; 95% CI = 1.08-1.76).

CONCLUSION

Strenuous and stressful DWEs were associated with MSP among rural Nigerian women. This study provides new evidence on how the physical, social, and psychosocial factors of domestic work can increase women's risk of MSP.

Exploring the contributions of sex and traditionally genderized interpersonal-expressive traits to variability in post-trauma pain ratings

OBJECTIVES

Multiple intra- and inter-individual variabilities sculpt the experience of pain. However, integration of sex and gender has been under-explored in explanatory models of pain. This study aimed to examine the role of sex and traditionally genderized interpersonal-expressive traits, and their interactions in explaining the variability of pain ratings.

METHODS

Data from 113 participants following acute non-catastrophic musculoskeletal (MSK) injuries were included. Participants completed the Brief Pain Inventory (BPI) and the Gender, Pain and Expectations Scale (GPES). An independent T-test was used to compare differences in BPI subscales between the sexes. Pearson correlations explored the associations between BPI and GPES subscale scores for the overall sample and also for the sample when disaggregated by sex. Multiple linear regression was used to investigate the interaction of sex and gender traits in explaining the BPI scores.

RESULTS

No differences were found between the sexes in mean BPI Severity and Interference. Across sexes, Relationship-oriented was positively associated with greater BPI Severity (r = 0.20) and Emotive was positively associated with BPI Interference (r = 0.24). In sex-disaggregated analyses, these associations were significant in females only. Goal-oriented was associated with neither BPI Severity nor Interference. In multivariate regression, only Emotive was a significant predictor of BPI Interference.

DISCUSSION

The findings suggest that variances in pain-related interference are partially explained by scores on a scale measuring self-perceptions of Emotive qualities. Sex was not predictive of either pain outcome in both bivariate and multivariate analyses. Researchers and clinicians are encouraged to consider both sex- and gender-based variables when interpreting patient pain reports.

Long-Term Clinical Outcomes of a Remote Digital Musculoskeletal Program: An Ad Hoc Analysis from a Longitudinal Study with a Non-Participant Comparison Group

Digital solutions have emerged as an alternative to conventional physiotherapy, particularly for chronic musculoskeletal pain (CMP) management; however, its long-term effects remain largely unexplored. This study focuses on patients reporting CMP, assessing 1-year clinical outcomes after a multimodal digital care program (DCP) versus non-participants, who enrolled in the program but never engaged in a single exercise session or partook of the educational content made available to them. In this longitudinal study ad-hoc analysis, pain and functionality outcomes at 1-year reassessment were studied, focusing on the odds of reaching minimal clinically important difference (MCID) and, overall average reduction in both outcomes. Healthcare utilization was additionally studied within the same period. From 867 individuals allocated to the study, 460 completed the 1-year reassessment (intervention group: 310; comparison group: 150). The intervention group presented sustained and greater pain reduction until 1-year reassessment than the comparison group, reflecting greater odds ratio of achieving the MCID both in pain and functionality (1.90 95% CI: 1.27-2.86, p = 0.002 and 2.02 95% CI: 1.31-3.12, p = 0.001, respectively). A lower healthcare utilization during the 1-year follow-up was observed in the intervention group than in the comparison group. This study suggests that a digital CMP program may have a lasting impact on improved pain and functionality in patients with CMP.

Do men and women have different musculoskeletal symptoms at the same musculoskeletal discomfort level?

Owing to biological and social factors, illness-related musculoskeletal symptoms tend to vary between men and women. However, in the past, conceptualised discomfort metrics were applied uniformly to both genders. This study aimed to develop a scale to measure musculoskeletal discomfort that compares the symptoms between men and women. The scale aimed to determine the gender-based response patterns related to symptoms. A total of 707 men and 1302 women reported their symptoms on a body map. Factor analysis and item response theory were used to differentiate the identified symptoms in the construction of a musculoskeletal discomfort scale. Differences in work exposure appeared to explain the symptom patterns between men and women. The scale had eight levels, and it was found that at the same level of discomfort, men and women reported symptoms in different body regions.Practitioner summary: On this discomfort scale, the response patterns of men and women were categorised into eight levels. Symptoms differed by gender at the same musculoskeletal discomfort level. This is in contrast to previous studies in which scales were devised without considering differences between the genders.Abbreviations: WMSDs: work-related musculoskeletal disorders; BMI: body mass index; FA: factor analysis; IRT: item response theory; KMO: Kaiser-Meyer-Olkin; BST: Bartlett's test of sphericity; F: factor loading; h2: communality; α: Cronbach's alpha; ωt: McDonald's omega; ai: parameters of discrimination of the items; bik: parameters of difficulty of response categories; θj: latent trait; RMSEA: root mean square error of approximation; CFI: comparative fit index; TLI: Tucker-Lewis index; odu: musculoskeletal discomfort units; RA: rarely; OF: often; AL: always.

CHOIRBM: An R package for exploratory data analysis and interactive visualization of pain patient body map data

Body maps are commonly used to capture the location of a patient's pain and thus reflect the extent of pain throughout the body. With increasing electronic capture body map information, there is an emerging need for clinic- and research-ready tools capable of visualizing this data on individual and mass scales. Here we propose CHOIRBM, an extensible and modular R package and companion web application built on the grammar of graphics system. CHOIRBM provides functions that simplify the process of analyzing and plotting patient body map data integrated from the CHOIR Body Map (CBM) at both individual patient and large-dataset levels. CHOIRBM is built on the popular R graphics package, ggplot2, which facilitates further development and addition of functionality by the open-source development community as future requirements arise. The CHOIRBM package is distributed under the terms of the MIT license and is available on CRAN. The development version of the package with the latest functions may be installed from GitHub. Example analysis using CHOIRBM demonstrates the functionality of the modular R package and highlights both the clinical and research utility of efficiently producing CBM visualizations.

Mediation Effect of Musculoskeletal Pain on Burnout: Sex-Related Differences

Burnout occurs when people are exposed to emotionally demanding work situations over an extended period, resulting in physical, emotional, and mental exhaustion. This study adopted the personal burnout (PB) and work-related burnout (WB) scales of the Copenhagen Burnout Inventory to measure burnout levels. Musculoskeletal (MS) pain is one factor influencing burnout. Previous studies have demonstrated that male and female hormones may contribute to sex-related differences in MS pain. This was an observational and cross-sectional study conducted at a medical-university-affiliated hospital in Taichung, Taiwan, in 2021. Data were collected for demographic characteristics, family structure, living habits, occupation, physical health, Nordic Musculoskeletal Questionnaire score, and Copenhagen Burnout Inventory score. Of the 2531 questionnaires that were distributed, 1615 (63.81%) valid questionnaires remained after those with missing data were excluded. The results demonstrated neck and shoulder pain (NBSP) is commonly associated with burnout among healthcare workers, with a higher prevalence among women than among men. With confounders being controlled for, women were found to experience substantially higher levels of personal and work-related burnout than men did. NBSP is a mediating factor; therefore, it is a key reason why women are more likely than men to experience burnout.

Health at age 17 in Norwegian adolescents: Mental and physical status in the national cohort born in 2001

AIMS

We present self-reported data on physical and mental health at age 17 years from 82% of Norwegians born in 2001.

METHODS

In Norway, the Armed Forces require that each resident who reaches the age of 17 years completes a self-administered declaration of health that is used for military selection. The declaration collects information on height and weight, various clinically diagnosed diseases, mental and behavioural disorders, and other health conditions where clinical diagnosis is not required. In 2018, there were 65,913 adolescents born in 2001 living in Norway, of whom 10,223 were exempt from completing the declaration; declarations were therefore sent to 55,690 participants. We included 54,132 participants who completed the declaration (response rate 97.2%): 27,220 male and 26,912 female respondents.

RESULTS

We found that 18% of male and 28% of female respondents reported at least one clinically diagnosed disease, mental disorder or behavioural disorder. Among health condition where clinical diagnosis was not required, 19% of male and 37% of female respondents reported anxiety/depression affecting daily life and 10 versus 18% reported migraines/recurring headaches. The respondents probably represent the healthiest part of the total cohort of 17-year-old Norwegians because those who are exempt from completing the declaration are already considered unfit for military service.

CONCLUSIONS

These data represent a rich resource for further research. Similar data exist for the birth cohorts in 1993-2003. We encourage further research that can help decision-makers identify areas of concern that should be targeted for interventions.

Depression and work productivity: insights from a longitudinal cohort study on digital care programs for Musculoskeletal conditions

BACKGROUND

Comorbidity between musculoskeletal (MSK) pain and depression is highly common and associated with greater symptom burden and greater loss of work productivity. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement.

OBJECTIVE

Assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels.

METHODS

The present study is an ad-hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP. Three subgroups with different baseline depression severity levels were created based on the Patient Health Questionnaire (PHQ-9): cluster 1 (<5: minimal depression); cluster 2 (5-10: mild depression) and cluster 3 (≥10: moderate depression). The mean change between baseline and end-of-program (8-12 weeks) on depression, anxiety, fear-avoidance beliefs, work productivity and activity impairment and adherence was assessed across subgroups. Outcome changes were analyzed by latent growth curve analysis.

RESULTS

From a total of 7785 eligible participants, 6137 (78.8%) were included in Cluster 1, 1158 (14.9%) in cluster 2 and 490 (6.3%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (5 and 10 for clusters 2 and 3, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95%CI -20.32 to -13.42 in cluster 1 to -20.10, 95%CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74).

CONCLUSIONS

A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain.

CLINICALTRIAL

ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.

Older Female Farmers and Modeling of Occupational Hazards, Wellbeing, and Sleep-Related Problems on Musculoskeletal Pains

Musculoskeletal pains seem to be the most prevalent among occupational diseases in older female farmers. This study analyzes the relationships between exposure to ergonomic or environmental hazards, sleep-related problems, wellbeing, and musculoskeletal pains in older female farmers. In this study, older farmer means a farmer aged ≥60, and 2005 older female farmers were selected. A structural equation model (SEM) was used to investigate the relationships. In the results of SEM, musculoskeletal pains were more affected by the level of wellbeing (standardized path coefficient = −0.149) than the level of sleep-related problems (standardized path coefficient = 0.131) or the exposure level of ergonomic hazards (standardized path coefficient = 0.086). Among the ergonomic risk factors felt by elderly female farmers, the influence level of “awkward posture” (0.735), “repetitive motion” (0.718), or “standing posture” (0.693) was greater than that of “manual material handling” (0.661). “Vibration” (0.786) and “noise” (0.683) were influential variables of environmental hazards. In addition, “upper limb pain” (0.796) and “lower limb pain” (0.751) variables were more influential variables of musculoskeletal pains than the “backache” (0.472) variable. This study shows that strategies to improve wellbeing or sleep problems are important to alleviate or prevent musculoskeletal pains among older female farmers.

Gender Differences in Seeking Health Care and Postintervention Pain Outcomes in Foot and Ankle Orthopedic Patients

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Reliability of a self-administrated musculoskeletal questionnaire: The fourth Trøndelag health study

BACKGROUND

The reliability of the Nordic Musculoskeletal Questionnaire (NMQ) has not been evaluated in an unselected general population. The aim of this population-based follow-up study was to estimate the reliability between a self-administered NMQ-based questionnaire and a face-to-face interview performed approximately two months later. To interpret the results, we assessed the 1-year prevalence of various pain musculoskeletal pain locations.

METHODS

A random sample of 1201 participants in the fourth wave of the Trøndelag Health Survey were invited to a follow-up interview focusing on sleep and pain. A total of 232 (19%) participated a semi-structured interview, and the agreement with the corresponding answers in the musculoskeletal questionnaire in HUNT4 were evaluated by Cohen's kappa statistics with 95% confidence interval (CI). The 1-year prevalence of the various pain sites was stratified by age and gender.

RESULTS

The reliability was good for chronic musculoskeletal pain (CMSP), chronic widespread musculoskeletal pain (CWMSP) and pain in hip and knee (kappa values between 0.63 and 0.68). Moderate kappa values between 0.51 and 0.60 were found for pain in the neck, shoulder, elbow, wrist/hand, upper back, lower back, calf, ankle/feet, and ≥7 pain sites. The 1-year prevalence was 54.3% for CMSP and 17.2 for CWMSP, substantially higher for women and among those aged 50 years or more.

CONCLUSION

In this population-based study the reliability between interview and questionnaire was good to moderate for most pain locations. In particular, the self-administered musculoskeletal questionnaire seems to be a useful tool in identifying individuals with CMSP, CWMSP, and pain in hip and knee.

Assessment of the influence of psychosocial factors on musculoskeletal disorder symptom intensity

BACKGROUND

Previous studies have observed that psychosocial factors are associated with an increase in work-related musculoskeletal disorders (WMSDs) in European countries. However, the influence of psychosocial factors on the WMSD symptoms has not been studied in detail. Additionally, working conditions differ between developing and developed countries.

OBJECTIVE

In this study, the influence of psychosocial factors on WMSD symptoms among men and women in the footwear industry in northeastern Brazil is investigated.

METHODS

A questionnaire survey was conducted to evaluate workers' perceptions of psychosocial factors and WMSD symptoms. The influence of psychosocial factors on WMSD symptom trends was observed through ordinal logistic regression models.

RESULTS

It was found that different psychosocial factors are related to WMSD symptom intensification. Factors such as "job insecurity" and "low social support," which are not associated with the worsening of WMSD symptoms in developed countries, showed a noticeable influence in the sample analyzed.

CONCLUSION

These findings may be associated with differences in working conditions and economic problems in developing countries, suggesting that some psychosocial factors have a different effect on workers' perceptions in developing countries.

STarT MSK tool: Translation, adaptation and validation in Hebrew

BACKGROUND

The Keele STarT MSK Tool divides musculoskeletal patients into three prognostic groups for risk-stratified care. It has shown good predictive and discriminative ability in development and validation samples.

OBJECTIVES

This study aimed to translate and validate the STarT MSK in a Hebrew version, among Israeli people living with musculoskeletal (MSK) pain.

METHOD

A cross-sectional study, with nested prospective sub-sample. The STarT MSK was translated into Hebrew using published guidelines. A total of 153 adults (18+) who reported living with MSK pain were administered the STarT MSK. Clinical measures included for validity testing included the 12-Item Short-Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS).

RESULTS

The STarT MSK was forward and backward translated, with minor changes to ensure cultural adaptation. The test-retest reliability of the STarT MSK total score was excellent (intraclass correlation coefficient 0.92). Internal consistency for the MSK scale was (α = 0.612). The Spearman's correlation coefficients between STarT MSK total score and the validation measures confirmed the hypotheses and were significant.

CONCLUSION

The Israeli translation and validation of the STarT MSK suggest that it is a valid and reliable instrument. The STarT MSK discriminated low-, medium- and high-risk groups.

Drug utilization pattern and rational drug use at orthopedics and traumatology outpatient clinics: A cross-sectional study

Objectives

The aim of the present study was to assess the prescriptions of patients who were admitted to the orthopedics and traumatology outpatient clinic of a tertiary care hospital according to the WHO prescribing indicators.

Patients and methods

Between January 2020 and March 2020, a total of 1,024 patients (273 males, 751 females; mean age: 51.9±13.9 years; range, 19 to 103 years) were included in the study. Only patients who were prescribed drugs and 18 years of age or older were included in the study. The WHO core prescribing indicators were utilized for the assessment of rational drug use. The WHO prescribing indicators percentages between the age categories were analyzed. The average number of drugs between the age categories was also examined.

Results

The average number of drugs per encounter was 2.9. The percentage of encounters with an antibiotic prescribed was 2.6% and with an injection prescribed was 10.7%. The percentage of drugs prescribed from essential drugs list was 33.8%. There were no prescriptions consisting generic name of drugs (0%). Polypharmacy was significantly higher in the ≥65 age group compared to the 18-44 age group (p=0.001).

Conclusion

The percentage of encounters with an antibiotic and injection prescribed were optimal according to WHO standards, while the average number of drugs per encounter was higher than the WHO ideal ranges. Unfortunately, the parameters such as the percentage of prescribing with generic name and from essential drug list was far more behind the optimal range.

Predictors of return to work among women with long-term neck/shoulder and/or back pain: A 1-year prospective study

Background

Sick leave due to musculoskeletal pain, particularly in the neck/shoulders and back, is one of the major public health problems in Western countries such as Sweden. The aim of this study was to identify predictors of return to work (RTW) among women on sick leave due to long-term neck/shoulder and/or back pain.

Methods

This was a prospective cohort study with a 1-year follow-up. The study participants were recruited from a local Swedish Social Insurance Agency register and had all been on sick leave for ≥ 1 month due to long-term (≥ 3 months) neck/shoulder and/or back pain. Data on predictors and outcome were collected using a self-administered questionnaire. A total of 208 women aged 23–64 years were included at baseline, and 141 responded at the 1-year follow-up. Cluster analyses were performed to identify one predictor from each cluster for use in the regression model.

Results

At the 1-year follow-up, 94 of the 141 women had RTW and 47 had not. Women who engaged in more coping through increasing behavioral activities (OR: 1.14, 95% CI: 1.03–1.25) and those who more strongly believed they would return to the same work within 6 months (OR: 1.22, 95% CI: 1.10–1.37) had an increased probability of RTW. Receiving more social support outside work (OR: 0.50, 95% CI: 0.28–0.92) decreased the odds of RTW at the 1-year follow-up.

Conclusions

Behavioral activities, beliefs about returning to the same work, and social support outside work were predictors of RTW at the 1-year follow-up. Healthcare professionals should consider these predictors in their efforts to prevent prolonged sick leave and to promote RTW in this population.

Gait Characteristics and Fatigue Profiles When Standing on Surfaces with Different Hardness: Gait Analysis and Machine Learning Algorithms

Simple Summary

The purpose of this study was to explore if an anti-fatigue soft mat could improve the gait performance after standing for long periods and to examine if a machine-learning algorithm could evaluate fatigue state objectively. Compared with standing directly on the hard ground, using an anti-fatigue mat could reduce the negative effect of standing for a long time (4 h). The machine-learning algorithm demonstrated moderate accuracy in measuring fatigue. The accuracy of gait parameters used to consider a non-fatigued state following the use of an anti-fatigue mat was higher than that of the fatigue state. The results may indicate that it is beneficial to use anti-fatigue mats when standing for long periods, and it is feasible to use gait parameters and machine-learning algorithms to detect fatigue.

Abstract

Background: Longtime standing may cause fatigue and discomfort in the lower extremities, leading to an increased risk of falls and related musculoskeletal diseases. Therefore, preventive interventions and fatigue detection are crucial. This study aims to explore whether anti-fatigue mats can improve gait parameters following long periods of standing and try to use machine learning algorithms to identify the fatigue states of standing workers objectively. Methods: Eighteen healthy young subjects were recruited to stand on anti-fatigue mats and hard ground to work 4 h, including 10 min rest. The portable gait analyzer collected walking speed, stride length, gait frequency, single support time/double support time, swing work, and leg fall intensity. A Paired sample t-test was used to compare the difference of gait parameters without standing intervention and standing on two different hardness planes for 4 h. An independent sample t-test was used to analyze the difference between males and females. The K-nearest neighbor (KNN) classification algorithm was performed, the subject’s gait characteristics were divided into non-fatigued and fatigue groups. The gait parameters selection and the error rate of fatigue detection were analyzed. Results: When gender differences were not considered, the intensity of leg falling after standing on the hard ground for 4 h was significantly lower than prior to the intervention (p < 0.05). When considering the gender, the stride length and leg falling strength of female subjects standing on the ground for 4 h were significantly lower than those before the intervention (p < 0.05), and the leg falling strength after standing on the mat for 4 h was significantly lower than that recorded before the standing intervention (p < 0.05). The leg falling strength of male subjects standing on the ground for 4 h was significantly lower than before the intervention (p < 0.05). After standing on the ground for 4 h, female subjects’ walking speed and stride length were significantly lower than those of male subjects (p < 0.05). In addition, the accuracy of testing gait parameters to predict fatigue was medium (75%). After standing on the mat was divided into fatigue, the correct rate was 38.9%, and when it was divided into the non-intervention state, the correct rate was 44.4%. Conclusion: The results show that the discomfort and fatigue caused by standing for 4 h could lead to the gait parameters variation, especially in females. The use of anti-fatigue mats may improve the negative influence caused by standing for a long period. The results of the KNN classification algorithm showed that gait parameters could be identified after fatigue, and the use of an anti-fatigue mat could improve the negative effect of standing for a long time. The accuracy of the prediction results in this study was moderate. For future studies, researchers need to optimize the algorithm and include more factors to improve the prediction accuracy.

Prevalence and factors associated with joint pain in Nepal: findings from a countrywide cross-sectional STEPS survey

OBJECTIVE

This study aims to determine the prevalence of joint pain and its association with demographic, socioeconomic and behavioural factors in Nepal.

DESIGN

The study was a national cross-sectional population-based study.

SETTING

We used the most recent nationally representative population-based cross-sectional health survey, The WHO STEPwise approach to surveillance (STEPS) survey, 2019 from all seven provinces of Nepal including both urban and rural areas.

PARTICIPANTS

The participants were men and women aged 15-69 years, who were usual residents of the households for at least 6 months and have stayed the night before the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome in this study was prevalence of joint pain. The secondary outcome measure was factors associated with joint pain in Nepal. Joint pain in our study was based on any self-reported symptoms of joint pain, stiffness and swelling lasting for more than 1 month in the past 12 months. Data were weighted to generate national estimates.

RESULTS

The prevalence of self-reported joint pain in Nepal was 17% (95% CI 14.3% to 20.2%) with higher prevalence for older adults, females, ever married, none/less than primary education, smoker, lowest wealth quintile, homemaker, those with sufficient physical activity and those living in the Karnali province of Nepal. In multivariable analysis self-reported joint pain was found to be associated with advanced age (adjusted OR (AOR)=2.36; 95% CI 1.56 to 3.55), sex (AOR=1.47; 95% CI 1.19 to 1.82) and sufficient physical activity (AOR=0.40; 95% CI 0.25 to 0.65).

CONCLUSIONS

The results showed a high prevalence of joint pain in Nepal. Considering the process of ageing and rapid growth in non-communicable disease, this study warrants the need for health policies directed to prevention, treatment and rehabilitation for people affected by chronic musculoskeletal conditions addressing related disabilities and loss of work in Nepal.

Evaluation of work-related musculoskeletal problems in pediatric surgeons

PURPOSE

Pediatric surgeons are exposed to intense work-related activities, depending on their profession, including residency training. This study aims to investigate the musculoskeletal symptoms and analyze the relationship between musculoskeletal symptoms and the demographics, physical activity levels, and body mass index (BMI) of pediatric surgeons.

METHODS

A total of 82 pediatric surgeons (female, 20; male, 62) were included in this study. The musculoskeletal symptoms were determined using the Cornell Musculoskeletal Discomfort Questionnaire. The levels of physical activity were determined using the International Physical Activity Questionnaire.

RESULTS

The mean age of the participants was 48.97 ± 8.894 years, the mean BMI was 26.72 ± 4.12 kg/m², and the mean working time after acquiring their specialty was 18.65 ± 9.83 years. The average surgery counts per week were 15.22 ± 12.17. Pediatric surgeons mostly complained from lower back pain, upper back pain, neck pain, and right and left shoulder pain. Surgeons with higher BMI had higher pain scores and received more treatment sessions.

CONCLUSIONS

Pediatric surgeons' complaints are related to their total numbers of surgery. Higher BMI and lower physical activity seem to be the major contributing factors for developing musculoskeletal symptoms. The study results indicated that surgeons should keep their BMI levels to the optimum and increase their physical activity levels.

Prevalence and risk factors of musculoskeletal pain in patients with chronic obstructive pulmonary disease: A systematic review

OBJECTIVES

This systematic review aimed to discuss the prevalence and the risk factors of the musculoskeletal pain in chronic obstructive pulmonary disease (COPD).

DATA SOURCE AND STUDY SELECTION

Four databases were analysed (Scopus, PubMed, Cochrane and EMBASE). We excluded systematic reviews, meta-analyses, conference abstracts and case reports. Two authors independently checked for the eligibility of the relevant articles. The risk of bias was evaluated using the Newcastle Ottawa Quality Assessment Scale and the Joanna Briggs Institute critical appraisal checklist. The selection and evaluation of studies followed the PRISMA guidelines.

RESULTS

Twenty studies were retrieved, including from 21 to 7952 patients with COPD. The prevalence of pain was highly heterogeneous across studies: 7-89.7%. Pain was mostly reported in the lumbar (7-69%) and cervical spine (11-48.3%) and the chest (44-82.8%). The main risk factors for developing pain were old age, sex (female), level of physical activity (low) and comorbidities.

CONCLUSION

Pain is a very common symptom in patients with COPD. Despite this, few clinical trials have investigated the pain. It appears to be located primarily in the lumbar, cervical and thoracic regions and facilitated by being a female, a low level of physical activity, comorbidity(ies) and old age.