Do workers with self-reported symptoms have an elevated risk of developing upper extremity musculoskeletal disorders three years later?

Exploring Musculoskeletal Complaints in a Needle Manufacturing Industry: A Cross-Sectional Study

Musculoskeletal disorders (MSD) encompass a variety of conditions affecting muscles, joints, and nerves. In Portugal, MSDs are the most prevalent occupational health problem in companies. Based on the relevance of work-related MSD (WMSD), this study aims to assess the prevalence of MSD complaints in a needle manufacturing industry in Northern Portugal, following a cross-sectional approach. Thus, 526 workers from five departments (i.e., operator, tuning, maintenance, administration, and logistics) answered a sociodemographic questionnaire and the Nordic Musculoskeletal Questionnaire (NMQ). Within the last 12 months, females exhibited a higher frequency of complaints than males across all body parts except for ankles/feet. The body parts eliciting the most percentage of complaints for both genders include the lower back (54.2%), neck (42.2%), shoulders (39.0%), ankles/feet (38.2%), and wrists/hands (35.7%). No significant association was found between Body Mass Index (BMI) and body part complaints. Tuners reported the highest complaint rate, with occupations as substantial predictors of complaints in certain body parts. Likewise, complaints tend to increase with age. The findings advocate for ergonomic interventions that are gender-, age-, and job-sensitive.

Dimensional assessment of self-reported musculoskeletal symptoms by workers: A multi-case study

BACKGROUND

Work-related musculoskeletal disorders (WMSD) encompass a range of conditions affecting muscles, tendons, and nerves. Visual diagrams are widely used to identify symptoms and to generate musculoskeletal discomfort metrics. However, there is no consensus on the number of discomfort dimensions that can originate from self-reported musculoskeletal symptoms by individuals.

OBJECTIVE

This study aimed to test the fit of WMSD symptom models from workers in two samples of different sizes.

METHODS

A combination of Full-Information Item Factor Analysis (FIFA) and Item Response Theory (IRT) was utilized to analyze and test the models. The study was conducted in two samples of workers (n1 = 6944 and n2 = 420) who had their symptoms identified with the aid of a human body diagram. An analysis was conducted considering each sample's unidimensional and three multidimensional models.

RESULTS

The unidimensional model (general musculoskeletal discomfort), bi-dimensional model (discomfort in upper and lower body), and tridimensional model (discomfort in the upper limbs, lower limbs, and trunk) showed good values of factor loading and communalities, along with satisfactory item discrimination ability. Regardless of sample size, parameter estimation for IRT and FIFA proceeded without issues, presenting suitable fit parameters.

CONCLUSION

Three models were valid and reliable for more extensive and smaller samples. However, the tridimensional model was best for generating discomfort scores in body regions. Companies and safety professionals can use these findings to devise strategies to mitigate musculoskeletal pains based on perceived symptom locations.

Shoulder Pain — Where Are We Now?

Purpose of Review

Shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified.

Recent Findings

Imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit.

Summary

Much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.

Shoulder disorders and occupation

Shoulder pain is very common, and it causes substantial morbidity. Standardised classification systems based upon presumed patho-anatomical origins have proved poorly reproducible and hampered epidemiological research. Despite this, there is evidence that exposure to combinations of physical workplace strains such as overhead working, heavy lifting and forceful work as well as working in an awkward posture increases the risk of shoulder disorders. Psychosocial risk factors are also associated. There is currently little evidence to suggest that either primary prevention or treatment strategies in the workplace are very effective, and more research is required, particularly around the cost-effectiveness of different strategies.

The predictive validity of the RSI QuickScan questionnaire with respect to arm, shoulder and neck symptoms in computer workers

The aim of this study was to determine whether results from the RSI QuickScan questionnaire on risk factors for arm, shoulder and neck symptoms can predict future arm, neck and shoulder symptoms in a population of computer workers. For this prospective cohort study, with a follow-up of 24 months, 3383 workers who regularly worked with a computer were approached. Generalised estimating equations (GEE) with 6, 12, 18 and 24 months time lags were used to determine whether high exposure was related to symptoms at follow-up. The results showed that high scores on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up. These results provide support for the predictive validity of the RSI QuickScan questionnaire.

PRACTITIONER SUMMARY

The results showed that high scores on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up. The RSI QuickScan questionnaire may be recommended as a tool in the identification of computer workers who should be targeted with interventions aimed at prevention of future symptoms.

Psychosocial precursors and physical consequences of workplace violence towards nurses: a longitudinal examination with naturally occurring groups in hospital settings

BACKGROUND

Workplace violence towards nurses is prevalent and consequential, contributing to nurses' reduced health and safety, worsened job attitudes, and compromised productivity.

OBJECTIVES

To examine if organizational violence prevention climate as perceived by nurses predicts nurses' physical violence exposure and if physical violence exposure predicts nurses' somatic symptoms and musculoskeletal disorder symptoms.

DESIGN

A two-wave longitudinal design with naturally occurring groups, with a 6-month interval.

METHODS

Analysis of covariance and logistic regression were applied to test the proposed hypotheses among 176 nurses from two hospitals in the U.S. who participated in both surveys required by this study. All nurses from the two hospitals were recruited to participate voluntarily. The response rate was 30% for the first survey and 36% for the follow-up survey. Among the subjects, only 8 were male. On average, the subjects were about 45 years old, had a job tenure of about 17 years, and worked approximately 37 h per week.

RESULTS

Violence prevention climate, specifically the dimension of perceived pressure against violence prevention, predicted nurses' chance of being exposed to physical violence over six months (odds ratio 1.69), with no evidence found that violence exposure affected change in climate reports. In addition, results supported that nurses' physical violence exposure had effects on somatic symptoms, and upper body, lower extremity, and low back pain over six months.

CONCLUSIONS

Findings of this study suggest that reducing organizational pressure against violence prevention will help decrease the chance of nurses' physical violence exposure and benefit their health and safety.

Correlates of upper extremity disability in medical transcriptionists

OBJECTIVE

To investigate the association between disability and personal/lifestyle, medical, and psychosocial risk factors for upper extremity musculoskeletal symptoms and disorders (UEMSDs) in medical transcriptionists.

METHODS

A web-based survey involving the Disabilities of the Arm, Shoulder and Hand (DASH), Perceived Stress Scale (PSS) and Overall Job Satisfaction (OJS) questionnaires of all medical transcriptionists working at a large healthcare facility.

RESULTS

Responses were received from 80% (251 of 314) possible participants. Mean DASH, PSS, and OJS scores for those working at their current position for at least 1 year were 8.5 +/- 10.1, 14.3 +/- 6.7 and 5.3 +/- 0.9. Personal/lifestyle factors including age (P < 0.001), lower educational level (P = 0.014), current or previous smoking (P = 0.012), and limited exercise (P = 0.013); medical conditions including diabetes mellitus (P = 0.015), carpal tunnel syndrome (P < 0.001), prior treatment for upper extremity symptoms (P < 0.001); prior workstation evaluation (P < 0.001) and psychosocial factors of perceived stress (P < 0.001), are associated with increased DASH scores. In these workers, multivariate analysis suggests that medical conditions (finger or other upper extremity symptoms requiring treatment or workstation evaluation; and diabetes mellitus) have a larger effect on the DASH than personal/lifestyle or psychosocial factors (age; previous or current smoking; and perceived stress).

CONCLUSIONS

Prior upper extremity musculoskeletal symptoms requiring treatment or ergonomic assessment, high perceived stress and a history of smoking are associated with self-reported disability. Diabetics have significantly higher levels of upper extremity disability than non-diabetics. Prospective studies are needed to see if interventions addressing these factors will prevent future work disability.

Description of outcomes of upper-extremity musculoskeletal disorders in workers highly exposed to repetitive work

PURPOSE

The outcomes of workers with upper-extremity musculoskeletal (UEMS) symptoms or disorders were evaluated over a 3-year period in a population highly exposed to repetitive work.

METHODS

Data were derived from a survey focused on the health effects of repetitive tasks, with a standardized physical examination by an occupational physician, in 1993 to 1994 and again in 1996 to 1997. All workers with UEMS symptoms or disorders in 1993 to 1994 were included. We classified 3-year outcomes into 3 categories in 1996 to 1997: neither UEMS disorder nor symptoms, UEMS symptoms only, and UEMS disorder.

RESULTS

A total of 464 workers were included (125 men and 339 women). At baseline, most of them experienced a UEMS disorder (n = 421). The 3-year recovery rate differed according to the site of the disorders: high for elbow disorders only (10 of 21), moderate for neck or shoulder, or hand or wrist disorders only (17 of 74 and 22 of 119, respectively), and low for multiple sites of UEMS disorders (25 of 207).

CONCLUSIONS

In this population exposed to repetitive work, a large proportion of workers have persistent UEMS symptoms or disorders, with recovery rates differing according to the site involved and the presence of multiple disorders.

Specific and non-specific upper extremity musculoskeletal disorder syndromes in automobile manufacturing workers

OBJECTIVE

A longitudinal cohort of automobile manufacturing workers (n = 1,214) was examined for: (1) prevalence and persistence of specific upper extremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain's disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and (2) disorder prognoses based on symptom characteristics and other factors.

METHODS

Eight specific disorders were identified through case definitions based on upper extremity physical examinations and symptom surveys administered on three occasions over 6 years.

RESULTS

At baseline, 41% of the cohort reported upper extremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs.

CONCLUSIONS

Upper extremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification. Am. J. Ind. Med. 52:124-132, 2009. (c) 2008 Wiley-Liss, Inc.

Psychosocial factors and shoulder symptom development among workers

BACKGROUND

Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand-control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand-control model and the incidence of shoulder symptoms in a working population.

METHODS

After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand-control model quadrants.

RESULTS

Cases were more likely to be female and report other upper extremity symptoms at baseline (P < 0.05). From the hazard models, being in either a passive or high strain job quadrant was associated with the incidence of shoulder symptoms. Hazard ratios were 2.17, 95% CI 1.02-4.66 and 2.19, 95% CI 1.08-4.42, respectively.

CONCLUSIONS

Using self-reporting to determine demand-control quadrants was successful in identifying subjects at risk of developing work-related shoulder symptoms. Research is needed to determine if this relationship holds with clinically diagnosed shoulder and other upper extremity musculoskeletal disorders. This may be part of a simple tool for assessing risk of developing these UEMSDs.