Knee complaints and consequences on work status; a 10-year follow-up survey among floor layers and graphic designers

Acute effects of an exercise based multimodal in-patient rehabilitation protocol in male knee osteoarthritis patients and the two years follow-up sustainability

BACKGROUND

Working with lifting and carrying heavy loads and kneeling postures with crawling, squats or heel seat position lead to progressive cartilage wear with premature degenerative changes.

OBJECTIVE

To investigate the effects of the exercise based multimodal 'knee college' and its sustainability in patients with knee osteoarthritis with data assessments before and after a starter course, before a 1-year and a 2-year follow-up refresher course in a retrospective observational study.

METHODS

A sample of 401 male patients (ICD10: M17 [arthrosis of knee]/ICF: s75011 [knee joint]) from the construction industries were assessed with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol (EQ-5D), Performance Assessment Capacity Testing (PACT), Isokinetic torque H/Q ratio and Physical Work Capacity Test (PWC). Retrospectively, after two years they were divided into three groups based on their intermediate sporting activity: gym (n = 194, age: 50.8±7.0, BMI: 28.8±4,3), home training (n = 110, age: 50.2±7.0, BMI: 28.4±4,2), no exercising (n = 97, age: 48.2±7.0, BMI: 29.2±4,6).

RESULTS

Patients did not differ significantly in their demographic and anthropometric data prior to the rehab program. Significant interaction effects indicated group-dependent differing sustainability effects for the 2-year follow-up (all outcomes: p < 0.001, except for H/Q ratio: p = 0.03). Group-wise analyses revealed significant acute improvements (after 3-week in-patient starter rehab program: p < 0.05) for all groups in almost all outcomes (except the 'no sport' group, H/Q ratio p = 0.08). These effects remained significant (p < 0.001) only for the 'gym' group during the 1-year and 2-year follow-up.

CONCLUSION

Our data indicate that 2-year sustainability of acute rehabilitation starter effects was demonstrated especially for patients with adherence and compliance to long-term gym based exercises.

[Effects and sustainability of knee school : 2-year results of a secondary prevention program for gonarthrosis]

BACKGROUND

Craftsmen and workers in the construction industry are at an increased risk of developing gonarthrosis due to their work-related burdens. In order to maintain the ability to work, occupational co-operative measures for secondary prevention can be carried out (BG Bau/Kniekolleg). The aim was to evaluate the efficacy after 2 years, depending on the degree of exercise adherence.

MATERIAL AND METHODS

In a repeated measurement design (T1 before, T2 after knee school, T3 after 1 year, T4 after 2 years), 140 construction patients were assessed for their dynamic muscular strength (knee extension, 60°/s,); their quality of life (SF-36) and characteristics for gonarthrosis (WOMAC) were evaluated using analyses of variances, whereby one group trained after the knee training in the gym with instruction (Gr. 1 n = 63), one group completed a home-training program (Gr. 2 n = 38), and one group completed exercises outside of knee school (Gr.3 n = 39).

RESULTS

For all parameters, significant acute efficacy and 2‑year sustainability effects were observed (p ≤ 0.05, d: 0.2-0.8). There was no interaction with adherence during training after knee school (p > 0.05).

CONCLUSION

Knee school has proved to be effective in the long term, leading to a critical questioning of future research, why there are no differences between guided, reduced or even missing long-term maintenance training.

MR Imaging of Intra- and Periarticular Cyst-Like Lesions of the Knee Joint in Workers with Occupational Kneeling

Objective. To determine the risk of intra- and periarticular cyst-like lesions of the knee joint in occupational kneeling. Methods. Magnetic resonance imaging of both knees (n = 282) was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42–70 years). The prevalence of cyst-like lesions was computed among floor layers and graphic designers, respectively, and associations with occupation summarized by odds ratio (OR) with 95% confidence intervals (CIs). Using logistic regression, models were adjusted for age, body mass index, knee injuries, and knee-straining sports. Results. Floor layers had a significantly higher prevalence of cyst-like lesions in the posterior part of the knee joint compared to graphic designers (OR 2.70, 95% CI 1.50–4.84). Floor layers also had a higher prevalence of fluid collections in the popliteus tendon recess (OR 2.17, 95% CI 0.99–4.77) and large cystic lesions of the popliteus muscle (OR 3.83, 95% CI 0.78–18.89). The prevalence of cystic lesions in the anterior part of the knee joint was low among floor layers (8.7%) and there was no significant difference between the two trade groups (P = 0.34). Conclusions. Occupational kneeling increases the risk of cyst-like lesions in the posterior part of the knee joint.

Burden of work-related knee disorders in Washington State, 1999 to 2007

OBJECTIVE

To describe the burden of knee work-related musculoskeletal disorders (WMSDs).

METHODS

Knee WMSDs were identified using Washington State Fund workers' compensation data from 1999 to 2007 and analyzed by cost, industry, occupation, and claims incidence rates.

RESULTS

Knee WMSDs accounted for 7% of WMSD claims and 10% of WMSD costs. The rate of decline in claims incidence rates for knee WMSDs was similar to the rate of decline for all other WMSDs. Industries at highest risk for knee WMSDs included construction and building contractors. Occupations of concern included carpenters and truck drivers in men and nursing aides and housekeepers in women.

CONCLUSIONS

Between 1999 and 2007, Washington State Fund knee WMSDs were widespread and associated with a large cost. Identification of specific occupational knee WMSD risk factors in high-risk industries is needed to guide prevention efforts.

Occupational risk factors for osteoarthritis of the knee: a meta-analysis

INTRODUCTION

Systematic reviews agree that knee osteoarthritis (OA) is related to occupational activities, but have not quantified the overall risks.

METHODS

Systematic review of observational studies of knee OA and occupation. Job titles, elite sport, heavy work, kneeling, and other activities were included. Relative risk estimate and 95% confidence interval (CI) compared to sedentary work were retrieved or calculated for meta-analysis. Publication bias was examined with Egger tests and heterogeneity was determined with I(2) values and Q tests. Subgroup analysis was performed to examine causes of heterogeneity. A random effects model was performed to combine the data.

RESULTS

Studies of knee OA (n=51), persistent knee pain (n=12) and knee OA progression (n=3) were retrieved. Occupational risks for knee OA were examined in a total of 526,343 subjects in 8 cohort/prospective/longitudinal studies, 25 cross-sectional studies and 18 case control studies. The overall odds ratio (OR) was 1.61 (95% CI 1.45-1.78) with significant heterogeneity (I(2)=83.6%). Study designs showed a positive association between knee OA and occupational activities; cohort (OR 1.38, 95% CI 1.10-1.74), cross-sectional (OR 1.57, 95% CI 1.37-1.81) and case control (OR 1.80, 95% CI 1.48-2.19). Overall there was evidence of publication bias (P<0.0001) which was apparent in the cross-sectional and case control studies (P<0.0001 and P=0.0247 respectively).

CONCLUSIONS

Some occupational activities increase the risk of knee OA, although the influences of publication bias and heterogeneity are important limitations of this study. Prospective studies would greatly improve the evidence base.

The effect of disease site (knee, hip, hand, foot, lower back or neck) on employment reduction due to osteoarthritis

BACKGROUND

Osteoarthritis (OA) has a significant impact on individuals' ability to work. Our goal was to investigate the effects of the site of OA (knee, hip, hand, foot, lower back or neck) on employment reduction due to OA (EROA).

METHODS AND FINDINGS

This study involved a random sample of 6,000 patients with OA selected from the Medical Service Plan database in British Columbia, Canada. A total of 5,491 were alive and had valid addresses, and of these, 2,259 responded (response rate = 41%), from which 2,134 provided usable data. Eligible participants were 19 or older with physician diagnosed OA based on administrative data between 1992 and 2006. Data of 688 residents were used (mean age 62.1 years (27 to 86); 60% women). EROA had three levels: no reduction; reduced hours; and total cessation due to OA. The (log) odds of EROA was regressed on OA sites, adjusting for age, sex, education and comorbidity. Odds ratios (ORs) represented the effect predicting total cessation and reduced hours/total cessation. The strongest effect was found in lower back OA, with OR = 2.08 (95% CI: 1.47, 2.94), followed by neck (OR = 1.59; 95% CI: 1.11, 2.27) and knee (OR = 1.43; 95% CI: 1.02, 2.01). We found an interaction between sex and foot OA (men: OR = 1.94; 95% CI: 1.05, 3.59; women: OR = 0.89; 95% CI = 0.57, 1.39). No significant effect was found for hip OA (OR = 1.33) or hand OA (OR = 1.11). Limitations of this study included a modest response rate, the lack of an OA negative group, the use of administrative databases to identify eligible participants, and the use of patient self-reported data.

CONCLUSIONS

After adjusting for socio-demographic variables, comorbidity, and other OA disease sites, we find that OA of the lower back, neck and knee are significant predictors for EROA. Foot OA is only significantly associated with EROA in males. For multi-site combinations, ORs are multiplicative. These findings may be used to guide resource allocation for future development/improvement of vocational rehabilitation programs for site-specific OA.

Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers

OBJECTIVE

To evaluate the association between occupational kneeling and degenerative meniscal tears.

METHODS

Magnetic resonance imaging (MRI) of both knees was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42-70 yrs). The presence of grade 3 MRI signal intensities indicating degenerative tears of the anterior, middle, and posterior one-third of the lateral and medial menisci was assessed on 1.5-Tesla MRI scans. The odds ratio (OR) of meniscal tears was determined among floor layers compared to graphic designers. Using logistic regression, models were adjusted for age, body mass index, and knee-straining sports.

RESULTS

Degenerative tears were significantly more prevalent in the medial meniscus among floor layers than among graphic designers [OR 2.28, 95% confidence interval (CI) 1.10-4.98] and significantly more floor layers had medial tears in both knees (OR 3.46, 95% CI 1.41-8.48). Tears extending to the tibial aspect and localized in the middle and posterior one-third of the medial meniscus were most prevalent. Lateral meniscal tears were predominantly unilateral and the prevalence of lateral tears did not differ between the 2 study groups. Knee complaints occurred in about 50% of all floor layers, irrespective of the presence of meniscal tears.

CONCLUSION

Occupational kneeling increases the risk of degenerative tears in the medial but not the lateral menisci in both knees.