A strong association between non-musculoskeletal symptoms and musculoskeletal pain symptoms: results from a population study

Prevalence of disability and associated functional limitations among older adults in Brazil

INTRODUCTION

Disabilities are a serious public health, social and human rights issue. Few studies address the relationship between disabilities and functioning among older adults. The study aimed to estimate the prevalence of disability and its' association with comorbidities and functional limitations in Brazilian elderly individuals.

METHODS

Data from the National Health Survey-PNS 2019 was used. Prevalence rates with its corresponding 95% confidence intervals (CI) were estimated for variables of interest. Chi-squared tests and multiple logistic regression were conducted to investigate associations and estimate crude and adjusted odds ratios (OR) using Stata 17.0 software. The critical value (p<0.05) was considered.

RESULTS

The overall prevalence of disability was 58.3% (95% CI 57.2-59.4). Moderate/severe disabilities accounted for 24.1 (95% CI 23.1-25.1) and was high among elderly people females (27.9%, 95% CI 26.5-29.3), unemployed (28.4%, 95% CI 27.3-29.6), with an income of up to one minimum wage (30.6%, 95% CI 29.1-32.2), lower education (28.7%, 95% CI 27.5-29.9) and not married (28.5%, 95% CI 27.1-29.9). Crude odds ratios of having functional limitations were 4.5 times higher among individuals with three or more comorbidities, and 32.5 times higher among those with two or more disabilities, compared to those without these conditions.

CONCLUSION

Having a disability is an important predictor of functional limitations, especially among women, and people with lower income and education. To address this problem, public health policies such as encouraging physical activity among the elderly in Brazil should be implemented.

The use of healthcare services and disabling chronic pain: results from the cross-sectional population-based Andalusian Health Survey

BACKGROUND

Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP).

METHODS

Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors.

RESULTS

People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP.

CONCLUSIONS

Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources.

Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study

BACKGROUND

The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain.

METHODS

This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression.

RESULTS

Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups.

CONCLUSION

Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.

Association between the number of chronic pain sites and neuropathic-like symptoms in community-dwelling older adults with chronic pain: a cross-sectional study

OBJECTIVES

We investigated the relationship between the number of chronic pain sites and the prevalence and severity of neuropathic-like symptoms in community-dwelling older Japanese adults with chronic pain.

DESIGN

Cross-sectional study.

SETTING

The data analysed are from a study conducted in the city of Itoshima, Japan in 2017.

PARTICIPANTS

The study population was 988 participants (age 65-75 years) not in need of long-term care who completed questionnaires assessing sociodemographic factors, psychological factors and chronic pain.

PRIMARY OUTCOME MEASURES

The primary outcome was the participants' neuropathic-like symptoms evaluated by the PainDETECT Questionnaire (PD-Q). We classified the participants into mild and moderate-to-severe pain groups according to the pain intensity on the PD-Q. The number of chronic pain sites was categorised into groups with 1, 2-3 and ≥4 sites.

RESULTS

The age-adjusted and sex-adjusted prevalence of neuropathic-like symptoms was significantly higher among the participants with 2-3 or ≥4 sites compared with the single-site group. In the binomial logistic regression analyses, the multivariable-adjusted ORs and 95% CIs for neuropathic-like symptoms among the participants with 2-3 and ≥4 sites were 1.94 (1.13 to 3.33) and 3.90 (2.22 to 6.85), respectively compared with the participants with single-site pain. The ORs for moderate-to-severe neuropathic-like symptoms increased significantly with the increase in the number of chronic pain sites.

CONCLUSIONS

The number of chronic pain sites was positively associated with the presence and severity of neuropathic-like symptoms in community-dwelling older Japanese adults with chronic pain.

An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP

Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.

Concordance between clinician- and 2016 criteria-based diagnoses of fibromyalgia

OBJECTIVES

The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently recommended for both clinical and research purposes. The present study aims to examine whether there is concordance between clinician-based and FSD-2016 criteria-based diagnoses of FM, and secondly, to examine how the illness severity and physical function relate to the criteria-based diagnosis among patients referred to a rheumatism hospital.

METHODS

Participants with a clinician-based diagnosis of FM were included consecutively when referred to a patient education programme for patients with FM. Illness severity was assessed with the Fibromyalgia Survey Questionnaire (FSQ). Based on the FSQ, the fulfilment of the FSD-2016 criteria was evaluated. Physical function was assessed using the Fibromyalgia Impact Questionnaire (FIQ) function scale and self-reported employment status.

RESULTS

The sample included 130 patients (84% women) from 20 to 66 years of age. Eighty-nine per cent met the FSD-2016 criteria, and 44% of the patients were fully or partially employed. Great variability in illness severity was seen irrespective of employment status. There was an association between illness severity and physical function (r=0.4, p<0.001). For 95% of the patients, the FSQ illness severity scores classify as severe or very severe, and even for those not fulfilling the diagnostic criteria the scores were moderate and severe.

CONCLUSIONS

There was relatively high agreement between clinician- and criteria-based diagnoses. The illness severity overlapped irrespective of different employment status and fulfilment of FSD-2016 criteria.

Significant other interactions in people with chronic low back pain: Subgrouping and multidimensional profiles

Background: Back pain is complex. Social support and significant other interactions influence the pain experience. Purpose: To statistically derive subgroups of people with chronic low back pain based upon their interactions with significant others, and profile subgroups across multidimensional variables. Research Design: Longitudinal cohort study. Study Sample: People with chronic axial low back pain ( n = 262). Data Collection and Analysis: Latent class analysis of significant other interaction data was used to derive subgroups of people with chronic low back pain. Subgroups were profiled across baseline multidimensional variables and one-year follow-up pain intensity, disability and bothersomeness. Results: Three clusters were identified: Cluster 1 (7.6%) characterised by the lowest distracting, punishing and solicitous interactions. Cluster 2 (16.0%) characterised by the highest distracting and solicitous responses and social support. Cluster 3 (76.3%) characterised by the highest punishing and lowest social support. Cluster 1 reported less disability than Clusters 2 and 3. Mindfulness was significantly different across all subgroups with Cluster 1 being most mindful and Cluster 3 least mindful. Depression, anxiety and stress were significantly higher in Cluster 3 than Cluster 1. Pain catastrophising was higher for Cluster 2 than Clusters 1 and 3. Cluster 2 had lower pressure pain threshold than Clusters 1 and 3. Conclusions: These results support the association between significant other interactions and the experience of back pain. Considering significant other interactions in clinical practice may be important for managing some people’s presentation.

Sleep, health, and well-being in elite athletes from different sports, before, during, and after international competition

Objectives: Limited research has been conducted on sleep problems in elite athletes at international competition, and how this relates to their general health and well-being. Methods: Sixty-five elite international athletes (37 males, 28 females, 21.8 ± 2.1 years) from different sports completed validated sleep (Athlete Sleep Screening Questionnaire), health (Subjective Health Complaints Inventory) and well-being (Sports Profile of Mood States) questionnaires; 1 month pre-competition, at the end of international competition, and 1 month post-competition. Results: Twenty-three percent of the elite athletes were identified as having a moderate or severe clinically significant sleep problem during competition, with 82% reporting less than 8 h of sleep per night. Athletes with a moderate or severe clinically significant sleep problem during competition had significantly greater general health complaints (p = 0.002), mood disturbance (p = 0.001) and poorer sleep hygiene (p = 0.002). Swimmers had more sleep difficulty pre and during competition compared to athletics and soccer (p = 0.009). Conclusion: Sleep disturbance during international competition is common and associated with poorer health and lower mood. Swimmers may be more at risk of sleep difficulty pre and during competition compared to those competing in athletics and soccer. Sleep services may be required to support elite athletes at international competition.

Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain - A Population-Based Cohort Study

Background and Aim

Chronic musculoskeletal pain is common and associated with more general healthcare-seeking. However, musculoskeletal-related healthcare utilization is under-explored. This study aimed to explore, describe and profile trajectories of long-term musculoskeletal healthcare for people reporting chronic musculoskeletal pain.

Methods

This exploratory prognostic cohort study combined survey and national health register data from a representative group of adult Danes reporting chronic musculoskeletal pain (N = 2929). Trajectories of long-term musculoskeletal healthcare use were generated using latent class growth analysis. Types of healthcare-seeking, individual, sociodemographic, health, belief and work-related factors were used to describe and profile identified trajectories.

Results

We identified five distinct trajectories of long-term musculoskeletal healthcare utilization (low stable, low ascending, low descending, medium stable and high stable). The low stable trajectory group (no or almost no annual contacts) represented 39% of the sample, whereas the high stable trajectory group (consistent high number of annual contacts) represented 8%. Most healthcare-seeking was in primary healthcare settings (GP/physiotherapy/chiropractor). Opioid consumption was primarily in the high stable trajectory group, and surgery was rare. There were statistically significant differences across the five trajectory groups in individual, sociodemographic, health, belief and work-related profiles.

Conclusion

Long-term use of musculoskeletal healthcare services varied in this chronic musculoskeletal pain population. Almost 40% coped without seeking care, whereas 8% had consistent high use of healthcare services. Chronic musculoskeletal pain was mostly managed in primary care settings, which aligns with musculoskeletal guidelines, as did the use of pain medication and surgery. People with different musculoskeletal healthcare trajectories had different individual, sociodemographic, health, belief and work-related profiles.

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Number of musculoskeletal pain sites leads to increased long-term healthcare contacts and healthcare related costs - a Danish population-based cohort study

BACKGROUND

People with musculoskeletal pain seek more healthcare than the general population, however little is known about the long-term effect on healthcare use. The aim of this study was to examine the consequences of number of musculoskeletal pain sites on long-term care-seeking and healthcare-related costs and explore how health anxiety influences this relationship.

METHODS

We conducted a Danish population-based longitudinal cohort study of 4883 participants combining self-reported survey data from 2008 with ten-year follow-up data from national health registers. Using a causal inference framework, we examined associations between number of pain sites (range 0-7)/level of health anxiety (high/low level) and face-to-face healthcare contacts/healthcare-related costs. Data were analyzed using negative binomial regression with generalized estimating equations. Regression models were adjusted for sex, age, duration of pain, level of education, comorbidity, personality traits, risk of depression, marital status, physical job exposure, and previous healthcare utilization.

RESULTS

For each additional pain site general healthcare contacts (Incidence Rate Ratio (IRR): 1.04 (95% CI: 1.03-1.05)), healthcare-related costs (IRR: 1.06 (95% CI: 1.03-1.08) and musculoskeletal healthcare contacts (IRR: 1.11 (95% CI:1.09-1.14) increased. Those with high levels of health anxiety at baseline had a slightly higher number of general healthcare contacts (IRR 1.06 (1.01-1.11), independent of number of pain sites. However, level of anxiety did not influence the effect of number of pain sites on any healthcare use or cost outcomes.

CONCLUSIONS

We found evidence for a causal association between increasing number of pain sites and greater healthcare use and cost, and high levels of health anxiety did not increase the strength of this association. This suggests that number of pain sites could be a potential target for biopsychosocial interventions in order to reduce the need for future care-seeking.

The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty

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There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA).

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Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes.

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The Tampa Scale of Kinesiophobia and the Central Sensitization Inventory have demonstrated value in the diagnosis of kinesiophobia and central sensitization. Higher preoperative indices of kinesiophobia and central sensitization predict worse patient-reported outcomes postoperatively.

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Although evidence is limited, cognitive-behavioral therapy for kinesiophobia and duloxetine for central sensitization may help to diminish the negative impact of these preoperative comorbidities. It is important to note, however, that outside the realm of TKA, cognitive-behavioral therapy has been recognized as a more effective treatment for central sensitization than medical treatment.

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Awareness of these issues will allow surgeons to better prepare patients regarding postoperative expectations in the setting of a comorbid psychosocial risk factor. Further research into the role of preoperative assessment and possible treatment of these conditions in patients undergoing TKA is warranted.

Injury risk profile of amateur Irish women soccer players and players' opinions on risk factors and prevention strategies

OBJECTIVE

To explore injury profile, opinions on risk factors and injury prevention, among Irish amateur women soccer players.

DESIGN

A cross-sectional online survey.

SETTING

Irish amateur winter league.

PARTICIPANTS

Active players ≤18 years of age.

MAIN OUTCOMES

Differences were found between injured and uninjured groups, and risk factors that significantly predict soccer injury were identified.

RESULTS

168 injuries were reported by 83 respondents during the winter season. An increased prevalence of competition anxiety was observed in (53.8%:n = 85 of respondents) compared to other risk factors. There was a negative association between injuries and players' general health state (OR = 0.820, 95% CI 0.7-0.9, p = 0.007). Players' knowledge about some risk factors including playing position, joint hypermobility, and playing during menses contradicts current evidence. 50%; n = 67 of the respondents had not received any education on injury risk or prevention.

CONCLUSION

This study identified that Irish amateur women soccer players that responded have different characteristics, prevalence of risk factors and injury profiles to women players from different levels and countries. The findings suggest that some players may not be aware of the existing evidence base pertaining to common risk factors for injury. Further research is required to confirm the findings and explore the implementation of injury prevention strategies.

[Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey]

The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.

Predictors of Pain, Function, and Change in Patellofemoral Pain

BACKGROUND

Identification of factors predictive of outcome and change is important to improve treatment for patellofemoral pain (PFP). Few studies have examined the predictive value of psychological factors in PFP, although they have been reported to be important predictors in other musculoskeletal pain conditions.

PURPOSE

To evaluate predictors of pain, function, and change 1 year after an exercise-based intervention in PFP.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

In sum, 112 patients were recruited to a randomized controlled trial; 98 attended 1-year follow-up. There were no between-group differences in the trial; thus, the material was analyzed as 1 cohort. Nine baseline factors-sex, bilateral pain, worst pain, pain duration, Anterior Knee Pain Scale (AKPS), kinesiophobia, anxiety and depression, self-efficacy, and number of pain sites throughout the body-were investigated for their predictive ability on outcome at 1 year (AKPS, worst pain) and for change at 1 year (global change score, change in AKPS, and change in worst pain). Multivariable linear regression models with stepwise backward removal method were used to find predictors of poor outcome.

RESULTS

Number of pain sites at baseline was a significant predictor of worse outcome for AKPS (B = -2.7; 95% CI, -4.0 to -1.3; P < .01), worst pain (B = 0.5; 95% CI, 0.2-0.8; P < .01), global change (B = -0.8; 95% CI, -1.2 to -0.5; P < .01), change in AKPS (B = -2.7; 95% CI, -4.0 to -1.3; P < .01), and change in worst pain (B = 0.5, 95% CI, 0.2-0.8; P < .01) at 1 year. Baseline scores for AKPS and worst pain predicted respective 1-year levels and change scores (P < .01). Lower self-efficacy and male sex predicted less global change (P < .01). Longer pain duration predicted final score and change score for worst pain (P < .01). The predictive models had reasonable fit with adjusted R² from 0.22 to 0.35.

CONCLUSION

Higher number of pain sites throughout the body was a consistent predictor of poor outcome and less change at 1 year. Baseline levels for AKPS and worst pain predicted respective final scores and change scores.

REGISTRATION

NCT02114294 ( ClinicalTrials.gov identifier).

Musculoskeletal pain in Primary Care Physiotherapy: Associations with demographic and general health characteristics

BACKGROUND

Many patients reporting musculoskeletal pain present to Primary Care Physiotherapy with costly comorbid overlapping complaints that remain medically unexplained. These subjective health complaints (SHC) incorporate coexisting multi-site musculoskeletal pain and varied non-musculoskeletal complaints (e.g. anxiety, tiredness). The role of these non-musculoskeletal complaints is acknowledged in spinal musculoskeletal disorders, but less so for peripheral musculoskeletal disorders.

OBJECTIVE

This cross-sectional study explored the relationships between self-reported musculoskeletal pain sites, non-musculoskeletal complaints and disability among people reporting spinal or peripheral musculoskeletal pain.

METHODS

Fifty individuals with spinal musculoskeletal pain and fifty with peripheral musculoskeletal pain provided data on disability, number of musculoskeletal pain sites and non-musculoskeletal complaints. Relationships between these variables were examined for each group using Pearson's correlation coefficient and linear regression analysis.

RESULTS

Participants with spinal musculoskeletal pain recorded significantly more pain sites and non-musculoskeletal complaints than participants with peripheral musculoskeletal pain. However, there was no significant difference in disability between the groups. Non-musculoskeletal complaints were significantly associated with disability (correlation = 0.41, p < 0.01) and number of pain sites (correlation = 0.42, p < 0.01). Number of pain sites and disability were not significantly associated in either group. Participants with spinal musculoskeletal pain reported more tiredness, dizziness, anxiety and sleep problems. Participants reporting dizziness, anxiety, sadness/depression and sleep problems had higher disability.

CONCLUSION

Further studies must confirm the robustness of these associations, to permit comparisons between clinical and general populations and aid identification of causal factors. Considering SHC within individualised management programmes may improve outcomes.

Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study

BACKGROUND

Musculoskeletal pain is a societal epidemic because it is highly prevalent and a leading contributor to disability; however, physical therapists are still challenged when predicting which patients are at high risk for persistent symptoms.

OBJECTIVE

The objectives of this study were to identify patient characteristics predictive of persistent musculoskeletal pain 12 months following physical therapist care and to determine the influence of anatomical region.

DESIGN

The design included a secondary analysis of a cohort study.

METHODS

Participants ranged in age from 18 to 65 years, had a primary report of knee, shoulder, back, or neck pain, were receiving physical therapy, and were enrolled in the Orthopedic Physical Therapy Investigative Network (OPT-IN) Optimal Screening for Prediction of Referral and Outcome (OSPRO) validation cohort study. Candidate predictor variables included demographic and clinical characteristics, comorbidities, and OSPRO Review of Systems (OSPRO-ROS) and OSPRO Yellow Flag (OSPRO-YF) tool scores. Persistent musculoskeletal pain was assessed by self-report responses to questions on the duration of pain and activity limitation. Logistic regression was used for completed cases to identify predictors of persistent pain at 12 months in full and parsimonious models.

RESULTS

Follow-up assessment at 12 months was performed for 63.4% of participants (279/440). Participants with persistent pain at 12 months (n = 101; 36.2%) had more comorbidities, higher numerical pain rating scale scores, and higher OSPRO-ROS and OSPRO-YF tool scores at baseline than those without persistent pain, and the findings were independent of anatomical region. The number of comorbidities (odds ratio [OR] range = 0.30-0.46), numerical pain rating scale scores (OR at baseline = 1.44-1.75; OR at 4 weeks = 1.37-1.39), and OSPRO-ROS (plus additional items) scores (OR = 1.33-1.54) were predictors in full and parsimonious models.

LIMITATIONS

Convenience sampling was used, with a follow-up rate at 12 months (63.4%) that was lower than anticipated, and an operational definition for chronic low back pain was applied to persistent musculoskeletal pain in other body regions.

CONCLUSIONS

The OSPRO-ROS tool may be used to improve the prediction of persistent musculoskeletal pain at 12 months in conjunction with comorbidities and pain intensity (baseline and 4 weeks). These are potentially important findings because persistent pain was not commonly evaluated in previous screening studies; however, it is a relevant outcome in an era of front-line nonpharmacological pain management.

Poor sleep is related to lower general health, increased stress and increased confusion in elite Gaelic athletes

OBJECTIVES

Persistent poor sleep is associated with a range of adverse health outcomes. Sleep is considered the main method of recovery in athletes; however, studies report that a significant number of athletes are getting insufficient sleep. The purpose of this study was to assess the sleep profiles of elite Gaelic athletes and to compare wellbeing in those with poor sleep and those with good sleep.

METHODS

69 elite Gaelic athletes completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Subjective Health Complaints Inventory (SHC), Nordic Musculoskeletal Questionnaire (NMQ), stress subscale of the Depression Anxiety Stress Scale (DASS), the tension-anxiety, anger-hostility and confusion-bewilderment subscales of the Profile of Mood States (POMS) as well as the catastrophising subscale of the Coping Strategies Questionnaire (CSQ). Participants were categorised into poor sleepers (PSQI ≥5) and good sleepers (PSQI <5) and outcome measures of health and wellbeing were analysed between the two groups.

RESULTS

47.8% of athletes were poor sleepers. Self-reported sleep duration was 7.5 ± 0.6 h per night. 63.7% of poor sleepers took >30 min to fall asleep, compared to 5.6% of good sleepers. Poor sleepers had significantly lower general health (SHC) (p = 0.029), increased stress (DASS) (p = 0.035) and increased confusion (POMS-subscale) (p = 0.005). There was no significant difference between groups for number of painful body parts (NMQ) (p = 0.052), catastrophising (CSQ) (p = 0.287), overall mood (POMS) (p = 0.059), or POMS subscales of anger (p = 0.346) or tension (p = 0.593).

CONCLUSION

Nearly 50% of elite Gaelic athletes report poor sleep. There is a significant relationship between poor sleep and lower general health, increased stress and increased confusion, and these factors may interact with each other. Monitoring of and interventions to enhance sleep may be required to improve athletes' wellbeing.

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

OBJECTIVE

Promptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment.

DESIGN

Prospective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts.

SETTING

Norwegian general practice.

SUBJECTS

A total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study.

MAIN OUTCOME MEASURES

Individual symptoms, symptom load and general function.

RESULTS

Mild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM.

CONCLUSION

The symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function.

IMPLICATION

Monitoring patients' symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB. Key points Erythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment. This increase does not affect general function. The levels of subjective health complaints in patients treated for erythema migrans are comparable to the background population.

Screening instruments for predicting return to work in long-term sickness absence

Background

Multiple somatic symptoms are common and may cause prolonged sickness absence (SA) and unsuccessful return to work (RTW).

Aims

To compare three instruments and their predictive and discriminative abilities regarding RTW.

Methods

A longitudinal cohort study of participants recruited from two municipal job centres, with at least 8 weeks of SA. The instruments used were the Symptom Check List of somatic distress (SCL-SOM) (score 0-48 points), the Bodily Distress Syndrome Questionnaire (BDSQ) (0-120 points) and the one-item self-rated health (SRH) (1-5 points). The instruments' predictive value was explored in a time-to-event analysis. Different cut-points were analysed to find the highest number of correctly classified RTW cases, identified in a register on public transfer payments.

Results

The study involved 305 subjects. The adjusted relative risk regarding prediction of RTW was 0.89 [95% confidence interval (CI) 0.83-0.95], 0.89 (95% CI 0.83-0.95) and 0.78 (95% CI 0.70-0.86) per 5-, 10- and 1-point increase in the SCL-SOM, BDSQ and SRH, respectively. After mutual adjustment for the three instruments, only the prediction of RTW from SRH remained statistically significant 0.81 (95% CI 0.72-0.92). The highest sensitivity (86%) was found by SRH at the cut-point ≤5, at which 62% were correctly classified.

Conclusions

All three instruments predicted RTW, but only SRH remained a significant predictor after adjustment for the SCL-SOM and BDSQ. The SRH provides an efficient alternative to more time-consuming instruments such as SCL-SOM or BDSQ for estimating the chances of RTW among sickness absentees.

The Constellation of Chronic Low Back Pain and Other Subjective Symptoms: Does the View Differ From China?

STUDY DESIGN

This was a pilot, cross-sectional study. Its site was West China Hospital in Chengdu, Sichuan Province.

OBJECTIVE

An objective was to explore whether, in China, chronic low back pain (cLBP) characteristically is one symptom among co-occurring subjective symptoms. More basic objectives were to test a supplemented list of symptoms and to reconfigure findings from the literature on co-occurrence of symptoms so that they pertain specifically to cLBP. The governing metaphor was a constellation of symptoms in which cLBP is located.

SUMMARY OF BACKGROUND DATA

With the exception of small, isolated societies, previous studies of co-occurrence of symptoms were conducted in the affluent West. Although China's population is larger than the combined populations of affluent countries of the West, research on co-occurring symptoms has been neglected in China. Unknown is whether results from studies conducted in the affluent West may be extended to China.

METHODS

A survey with the supplemented symptom list was cross-culturally adapted into Chinese and administered to cLBP patients (N = 72) and normal controls (N = 102). Multiple regression analysis was used to determine the effects of covariates (age, gender, education) on symptom reporting.

RESULTS

cLBP patients reported higher median numbers of symptoms than normal controls, including total symptoms (9 vs. 3), musculoskeletal symptoms (4 vs. 1), and nonmusculoskeletal symptoms (6 vs. 2.5); differences between cLBP and normal controls were highly significant (p < 0.001). Covariates had a little effect on symptom reporting.

CONCLUSION

cLBP characteristically was one symptom in a constellation of symptoms. This finding came from one research site in China. Nevertheless, consistency between studies is notable, with findings from the affluent West supporting the finding from the Chinese site. The tendency to concentrate on a discrete clinical entity, cLBP itself, may obscure the constellation of symptoms. The more expansive view of cLBP has implications for clinical practice and research.

LEVEL OF EVIDENCE

N/A.

Somatic Symptoms: Prevalence, Co-Occurrence and Associations with Self-Perceived Health and Limitations Due To Physical Health - A Danish Population-Based Study

A high number of somatic symptoms have been associated with poor health status and increased health care use. Previous studies focused on number of symptoms without considering the specific symptoms. The aim of the study was to investigate 1) the prevalence of 19 somatic symptoms, 2) the associations between the symptoms, and 3) the associations between the somatic symptoms, self-perceived health and limitations due to physical health accounting for the co-occurrence of symptoms. Information on 19 somatic symptoms, self-perceived health and limitations due to physical health was achieved from a population-based questionnaire survey of 36,163 randomly selected adults in the Capital Region of Denmark in 2006/07. Chain graph models were used to transparently identify and describe the associations between symptoms, self-perceived health and limitations due to physical health. In total, 94.9% of the respondents were bothered by one or more of the 19 somatic symptoms. The symptoms were associated in a complex structure. Still, recognisable patterns were identified within organ systems/body parts. When accounting for symptom co-occurrence; dizziness, pain in legs, respiratory distress and tiredness were all strongly directly associated with both of the outcomes (γ>0.30). Chest pain was strongly associated with self-perceived health, and other musculoskeletal symptoms and urinary retention were strongly associated with limitations due to physical health. Other symptoms were either moderate or not statistically associated with the health status outcomes. Opposite, almost all the symptoms were strongly associated with the two outcomes when not accounting for symptom co-occurrence. In conclusion, we found that somatic symptoms were frequent and associated in a complex structure. The associations between symptoms and health status measures differed between the symptoms and depended on the co-occurrence of symptoms. This indicates an importance of considering both the specific symptoms and symptom co-occurrence in further symptom research instead of merely counting symptoms.

Multimorbidity patterns are differentially associated with functional ability and decline in a longitudinal cohort of older women

BACKGROUND

we aimed to identify multimorbidity patterns and relate these patterns to functional ability and decline.

METHODS

we included 7,270 participants of the older cohort of the Australian Longitudinal Study on Women's Health, who were surveyed every 3 years from 2002 to 2011. We used factor analysis to identify multimorbidity patterns from 31 self-reported chronic conditions among women aged 76-81 in 2002. We applied a linear increments model to account for attrition and related the multimorbidity patterns to functional ability and decline at subsequent surveys, as measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). For each pattern, we determined mean ADL and IADL scores in the middle and highest third of factor score in comparison to a reference group.

RESULTS

we identified three multimorbidity patterns, labelled musculoskeletal/somatic (MSO), neurological/mental health (NMH) and cardiovascular (CVD). High factor scores for NMH, MSO and CVD were associated with significantly higher mean ADL and IADL scores (poorer functional ability) in 2005 compared with the reference group of low factor scores for all three factors. The CVD pattern was associated with the greatest decline in ADL between 2005 and 2011, whereas the NMH pattern was associated with the greatest decline in IADL.

CONCLUSIONS

distinct multimorbidity patterns were differentially associated with functional ability and decline. Given the paucity of studies on multimorbidity patterns, future studies should seek to assess the reproducibility of our findings in other populations and settings, and investigate the potential implications for improved prediction of functional decline.

Prevalence comparisons of somatic and psychiatric symptoms between community nonpatients without pain, acute pain patients, and chronic pain patients

OBJECTIVES

Somatic/psychiatric symptoms are frequently found in chronic pain patients (CPPs). The objectives of this study were to determine 1) which somatic/psychiatric symptoms are more commonly found in acute pain patients (APPs) and CPPs vs community nonpatients without pain (CNPWPs) and 2) if somatic/psychiatric symptom prevalence differs between APPs and CPPs.

DESIGN

The above groups were compared statistically for endorsement of 15 symptoms: fatigue, numbness/tingling, dizziness, difficulty opening/closing mouth, muscle weakness, difficulty staying asleep, depression, muscle tightness, nervousness, irritability, memory, falling, nausea, concentration, and headaches.

RESULTS

After controlling for age, gender, and level of pain, APPs and CPPs had a statistically significantly greater prevalence (at a P < 0.01 level) for 11 and 13 symptoms, respectively, vs CNPWPs. After controlling for age, gender, and level of pain, CPPs had a statistically significantly greater prevalence (at a P < 0.01 level) for eight symptoms vs APPs. Symptoms were highly correlated in both APPs and CPPs.

CONCLUSIONS

CPPs are characterized to a significantly greater extent than comparison groups by somatic/psychiatric symptoms that are highly intercorrelated. This has implications for clinical practice and future research.

How common are symptoms? Evidence from a New Zealand national telephone survey

OBJECTIVE

To assess the frequency of symptoms in a general population sample over the previous week and the associations between symptom reporting and demographic factors, medical visits and medication use.

DESIGN

A representative general population sample (n=1000) was recruited using random digit dialling. Participants were asked whether they had experienced any of a list of 46 symptoms in the previous 7 days and if so, whether the symptom was mild, moderate or severe. Demographic data and information on medical visits and medication use were also collected.

RESULTS

Symptom reporting was very common. The median number of symptoms reported by participants in the previous week was 5 with only 10.6% of participants reporting no symptoms. The five most common symptoms in the previous 7 days were: back pain (38%), fatigue (36%), headache (35%), runny or stuffy nose (34%) and joint pain (34%). The five symptoms rated highest in terms of severity were sexual difficulties, vomiting, tremor, suicidal thoughts and sleep problems. Symptom reporting was significantly positively associated with medical visits in the previous year and current medication taking. Women reported a significantly greater number of symptoms. We found no significant association between age or household size and symptom reporting.

CONCLUSIONS

This population-based study found that symptoms are more commonly experienced in the general population than previously estimated and are strongly associated with healthcare visits. Appreciation of the high prevalence of symptoms may help normalise the experience of symptom reports among the general population.

Medically unexplained conditions considered by patients in general practice

BACKGROUND

Patients frequently present with multiple and 'unexplained' symptoms, often resulting in complex consultations. To better understand these patients is a challenge to health care professionals, in general, and GPs, in particular.

OBJECTIVES

In our research on symptom reporting, we wanted to explore whether patients consider that they may suffer from conditions commonly regarded as unexplained, and we explored associations between these concerns and symptom load, life stressors and socio-demographic factors.

METHODS

Consecutive, unselected patients in general practice completed questionnaires addressing eight conditions commonly regarded as unexplained (amalgam poisoning, Candida syndrome, fibromyalgia, food intolerance, electromagnetic hypersensitivity, burnout syndrome, chronic fatigue syndrome and irritable bowel syndrome). With logistic regression, we analysed associations with symptom load, burden of life stressors with negative impact on present health and socio-demographic variables.

RESULTS

Out of the 909 respondents (response rate = 88.8%), 863 had complete data. In total, 39.6% of patients had considered that they may suffer from one or more unexplained conditions (UCs). These concerns were strongly and positively associated with recent symptom load and number of life stressors. If we excluded burnout and food intolerance, corresponding associations were found.

CONCLUSION

Patients frequently considered that they may suffer from UCs. The likelihood of such concerns strongly increased with an increasing symptom load and with the number of life stressors with negative impact on present health. Hence, the number of symptoms may be a strong indicator of whether patients consider their symptoms part of such often controversial multisymptom conditions.

Is it all about a pain in the back?

Multisite musculoskeletal pain is common among people suffering from low back pain. Although the mechanisms behind co-occurrence of multiple somatic symptoms and musculoskeletal pain are still unknown, patients with co-morbidities and co-occurring musculoskeletal symptoms tend to have worse functional status, a poorer prognosis and respond less favourably to treatment. Evidence also suggests that the more pain sites a patient reports, the more reduced their physical and mental function will be regardless of location of pain. At the same time, evidence suggests that strategies for diagnosis and treatment of low back pain and other musculoskeletal disorders such as neck pain and lower limb osteoarthritis are very similar. In this chapter, we discuss the prevalence, consequences, and implications of commonalities between low back pain, pain in other sites and co-occurring pain. In addition, we propose a conceptual framework for a common stepwise approach to the diagnosis and management of back and musculoskeletal pain.

Multiple symptoms and medically unexplained symptoms--closely related concepts in general practitioners' evaluations. A linked doctor-patient study

OBJECTIVES

Symptoms for which doctors cannot find a clear medical explanation, medically unexplained symptoms (MUS), represent a challenge in medical practice. Recent proposals to define this phenomenon are based on patients' symptom count, without distinguishing between medically explained and unexplained symptoms. We describe how general practitioners (GPs) evaluate multiple and medically unexplained symptoms, and how these dimensions are interconnected. Furthermore, we explore how the number of patient-reported symptoms is associated with the two axes.

METHODS

A multi-centre, doctor-patient-linked cross-sectional study in general practice. GPs rated consecutive patients along two 11 point ordinal scales assessing multiple (Multi-scale) and medically unexplained symptoms (MUS-scale). Patients completed a questionnaire addressing 38 symptoms experienced during the previous week and 866 linked questionnaires were available for analysis.

RESULTS

GPs used the whole range of the scales, rating only a minority of the patients as "0 (not at all)". The two scales were highly correlated (r=0.80), with a quadratically weighted kappa of 0.73, reflecting substantial agreement between the scales. MUS-scores were highest in middle age. There was a tendency that Multi-scores increased with age and that correlations between the scales decreased with age, in both sexes, although partly non-significant. The number of patient-reported symptoms was moderately correlated with the two scales.

CONCLUSION

Multisymptomatology captures MUS as a continuous construct to a great degree in GPs' clinical evaluations, although the two cannot be regarded as the same phenomenon. Patient-reported symptoms seem to be a less valid proxy for MUS.

Symptom reporting in a general population in Norway: results from the Ullensaker study

OBJECTIVE

To determine the number of symptoms experienced in an adult population and their relationship with self- reported health, demographic, and lifestyle factors.

DESIGN

A postal questionnaire addressing 23 different symptoms, health, demographic, and lifestyle factors.

SETTING

The community of Ullensaker, Norway, in 2004. Subjects. 3325 subjects (participation rate = 54.4%).

MAIN OUTCOME MEASURE

Number of self-reported symptoms.

RESULTS

At least one symptom was reported by 91.9% of the participants, 46.7% reported six or more, and 17.3% reported 10 or more symptoms. Symptom reporting was frequent in all age groups, also among young people. Women reported a greater mean number of symptoms than men (6.7 vs. 5.1). Those reporting poor health, receipt of social security benefit, unemployment, low education, or obesity had most symptoms. The proportion of respondents with these characteristics increased almost linearly with increasing number of symptoms. According to an adjusted multivariate model, self-reported overall health explained 28.2 % of the variance in the number of symptoms.

CONCLUSION

A large proportion of the responders reported a high number of symptoms. A simple method of counting symptoms may be useful in approaching patients in general and multi-symptom patients in particular, because the total burden of symptoms is strongly associated with the patient's self-reported health and may even be a predictor of future disability.

Symptom load and functional status: results from the Ullensaker population study

Background

There is evidence to support that the number of self-reported symptoms is a strong predictor of health outcomes. In studies examining the link between symptoms and functional status, focus has traditionally been on individual symptoms or specific groups of symptoms. We aim to identify associations between the number of self-reported symptoms and functional status.

Methods

A questionnaire was sent to people in seven age groups (N = 3227) in Ullensaker municipality in Southern Norway. The Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record 10 musculoskeletal symptoms and 13 non-musculoskeletal symptoms, respectively. Four COOP-WONCA charts were used to measure functional status.

Results

We found a strong linear association between the number of self-reported symptoms and functional status. The number of symptoms explained 39.2% of the variance in functional status after adjusting for the effects of age and sex. Including individual symptoms instead of only the number of symptoms made little difference to the effect of musculoskeletal pain but affected the influence of non-muscular symptoms. Including even minor problems captured substantially more of the variance in functional status than including only serious problems.

Conclusions

The strong association between the number of symptoms and functional status, irrespective of type of symptom, might indicate that the symptoms share some common characteristics. The simple act of counting symptoms may provide an approach to study the relationships between health and function in population studies and might be valuable in research on medically unexplained conditions.

IFOMPT 2012: a rendez-vous of hands and minds

Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning opportunities through a conference held every 4 years. In 2012, IFOMPT is partnering with The International Private Practitioners Association (IPPA) to host this prestigious event in Quebec City, Canada. As more than 51% of the Canadian Physiotherapy Association membership is working in private practice, this adds even greater value to this quadrennial event. This conference emulates best-evidence practice in the marriage of research and clinical excellence by pulling together some of the best and brightest hands and minds in orthopaedic physiotherapy. Through a call for proposals that equally emphasized research, clinical excellence, and the knowledge translation link between the two, the IFOMPT mandate of clinical and academic excellence has been kept at the forefront of this year's conference. Included in this supplement are the IFOMPT 2012 keynote addresses, schedule, and abstracts.

Prevalence of multisite musculoskeletal symptoms: a French cross-sectional working population-based study

Background

The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.

Methods

This study was performed on surveillance data of the cross-sectional survey (2002–2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire.

Results

The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb).

Conclusions

The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS.