Musculoskeletal pain intensity in different body regions and risk of disability pension among female eldercare workers: prospective cohort study with 11-year register follow-up

The effect of lower limb osteoarthritis on work-related outcomes: a systematic review and meta-analysis

PURPOSE

Lower limb osteoarthritis (OA) is a prevalent condition that has a profound impact on an individual's life in several domains, including occupational activities. The objective of this study was to systematically describe and compare work-related outcomes (e.g., employment status, absenteeism, and productivity loss) in individuals with and without lower limb OA.

MATERIALS AND METHODS

Five databases were searched until 17 June 2023. Studies were eligible for inclusion if they compared work-related outcomes between individuals with lower limb OA and healthy controls (e.g., people without OA or the general population).

RESULTS

Seven studies met the inclusion criteria of which two were included in a meta-analysis. Meta-analysis revealed that individuals with OA were less frequently in paid employment than control individuals (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies indicated greater absenteeism and presenteeism and poorer functional capacity in people with lower limb OA compared to controls.

CONCLUSIONS

This systematic review suggests that individuals with lower limb OA have poorer work-related outcomes than those without OA. Low study numbers and lack of consistency in the way work outcomes are defined and measured make accurate quantification of the impact of OA on work challenging.Prospero: registration number: CRD42020178820.

Occupation-based demographic, clinical, and psychological presentation of spine pain: A retrospective analysis of 71,727 patients from urban India

BACKGROUND

Although many studies have investigated the physical and ergonomic risks of spine pain in specific occupation groups, the literature is lacking on occupation-based clinical and psychological presentation in patients with spine pain.

OBJECTIVE

To analyze occupation-based variation in demographic, clinical, and psychological presentation in patients with spine pain.

METHODS

This retrospective study analyzed the clinical data of 71727 patients with spine pain visiting a chain of spine rehabilitation clinics. Demographic and clinical variables such as gender, age, affected site, symptom duration, clinical symptoms and presentation, pain intensity, disability, and STarT Back Screening Tool (SBT) risk were compared between 9 occupational groups.

RESULTS

The service and sales workers (44%) and students (43.5%) groups had the highest percentage of patients who presented with central spine pain; military personnel had the highest percentage of patients who presented with unilateral radicular pain (51.5%); and the retired or unemployed group had the highest percentage of patients who presented with severe myotomal loss (grade≤3) (6%). Homemakers had significantly higher pain intensity and disability (p < 0.001) and had the highest percentage of patients who presented with severe pain (47%), severe and crippled disability (59.5%), and medium to high risk (59%) with SBT when compared to other occupational groups.

CONCLUSION

Patients with spine pain showed variation in demographic, clinical, and psychological presentation based on their occupation. The findings of this study can be the basis for identifying risk factors for spine pain and helping plan preventive and treatment measures based on their occupation.

The relationships between pain-associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study

INTRODUCTION

The presence of pain-associated psychological distress (PAPD) in musculoskeletal disorders, including negative mood, fear-avoidance, and lack of positive affect/coping, is associated with prolonged disability. The importance of considering psychological influence on pain is well known, but practical ways of addressing it are not as straightforward. Identifying relationships between PAPD and pain intensity, patient expectations, and physical function may guide the development of future studies that assess causality and inform clinical practice.

OBJECTIVE

To assess the relationship between PAPD measured by the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag tool, and baseline pain intensity, expectations of treatment effectiveness, and self-reported physical function at discharge.

DESIGN

Retrospective cohort study.

SETTING

Hospital-based outpatient physical therapy.

PARTICIPANTS

Patients 18 to 90 years old with spinal pain or lower extremity osteoarthritis.

MAIN OUTCOME MEASURES

Pain intensity and patient expectations of treatment effectiveness at intake, and self-reported physical function at discharge.

RESULTS

A total of 534 patients, 56.2% female, median (interquartile range [IQR]) age 61 (21) years with an episode of care between November 2019 and January 2021 were included. A multiple linear regression showed a significant association between PAPD and pain intensity with 6.4% (p < .001) of the variance explained. PAPD explained 3.3% (p < .001) of the variance in patient expectations. One additional yellow flag present resulted in a 0.17-point increase in pain intensity and 1.3% decrease in patient expectations. PAPD was also associated with physical function with 3.2% (p < .001) of the variance explained. PAPD explained 9.1% (p < .001) of the variance in physical function at discharge in the low back pain cohort only when assessed independently by body region.

CONCLUSION

These findings support the theory that the pain experience is complex and multiple factors should be considered when evaluating a patient with musculoskeletal pain. Clinicians who have identified PAPD may consider these relationships when planning or modifying interventions and pursuing multidisciplinary collaboration.

Effects of consecutive workdays and days off on low back pain, fatigue and stress: prospective cohort study among warehouse and construction workers

OBJECTIVES

Limited knowledge exists about day-to-day changes in physical and mental symptoms in warehouse and construction workers. This study investigated the associations between consecutive workdays and days off with low back pain (LBP) intensity, bodily fatigue and mental stress.

METHODS

Participants (n=224) received daily questions for 21 days about LBP, fatigue, stress (outcome, 0-10 scales), and workdays and days off (exposure). We tested associations between 1-3 workdays (n=148) and 1-2 days off (n=158) with LBP intensity, bodily fatigue and mental stress after work and the following morning using linear mixed models with repeated measures controlling for relevant confounders.

RESULTS

Consecutive workdays led to progressively increased LBP intensity, with three workdays increasing LBP intensity by 1.76 (95% CI 1.48 to 2.03) points. Bodily fatigue and mental stress increased after one workday (2.06 (95% CI 1.80 to 2.32) and 0.97 (95% CI 0.77 to 1.17) points, respectively) and remained stable for three workdays. After 1 day off, bodily fatigue and mental stress decreased -1.82 (95% CI -2.03 to -1.61) and -0.88 (95% CI -1.05 to -0.71) points, respectively, without decreasing further. In contrast, LBP intensity decreased progressively -1.09 (95% CI -1.27 to -0.91) and -1.45 (95% CI -1.67 to -1.24) points after 1 and 2 days off, respectively.

CONCLUSIONS

Workdays and days off affected the outcome variables differently. LBP intensity progressively increased with consecutive workdays, while workers needed 2 days off to recover. This study provides valuable knowledge about how to organise the workweek to prevent LBP, fatigue and stress, potentially reducing labour market withdrawal.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Musculoskeletal pain intensity and risk of long-term sickness absence in the general working population: A prospective cohort study with register follow-up

Determining predictors of sickness absence could allow for better screening, guidance, and development of preventive efforts aimed at those in increased risk. This study aimed to determine the prospective association between musculoskeletal pain intensity and risk of incident register-based long-term sickness absence in the general working population, as well as to determine the population attributable fraction. Drawing on data from a nation-wide questionnaire survey, this prospective cohort study followed a representative sample of the Danish general working population without recent long-term sickness absence (≥6 consecutive weeks) (n = 69,273) for long-term sickness absence up to two years (mean follow-up: 93 weeks) in a national register. The predictor was musculoskeletal pain intensity in the neck/shoulder and low-back during the preceding three months rated on an 11-point numerical rating scale from 0 to 10. The weighted incidence of long-term sickness-absence was 8.9% during two-year follow-up (n = 6165). We observed a clear dose-response association between musculoskeletal pain intensity of the neck/shoulder or low-back and the risk of incident long-term sickness absence, with a lower threshold of increased risk of 4 and 3 (scale 0-10) for neck/shoulder (HR (95% CI): 1.25 (1.09-1.42)) and low-back pain (HR (95% CI): 1.13 (1.00-1.29)), respectively. Prevention of pain intensities at or above 4 out of 10 could potentially prevent 17% (population attributable fraction, PAF (95% CI): 16.8 (13.6-20.1)) of the total long-term sickness absence in the general working population. Large-scale interventions to prevent and manage musculoskeletal pain need to be documented and implemented.

Work-limiting musculoskeletal pain and its association with loss of paid employment among senior workers: prospective cohort study with register follow-up

BACKGROUND

A growing population of elderly necessitates a sharpened focus on sustainable employment through aging. Physically demanding work can be challenging, especially for senior workers. Establishing determinants of labor market participation could guide policy development and preventive efforts at the workplaces aiming at keeping senior workers longer in the labor market.

METHODS

We used data from SeniorWorkingLife, a comprehensive questionnaire survey among a representative sample of Danish +50-year workers, and investigated the prospective association between self-reported work limitations due to musculoskeletal pain ('work-limiting pain') in 2018 and register-based loss of paid employment before state pension age at 2-year follow-up among +50-year Danish workers with physically demanding work (n = 3050).

RESULTS

Results showed that work-limiting pain increased the risk of loss of paid employment before the state pension age in a progressive manner, i.e. the higher degree of work-limiting pain, the higher risk of loss of paid employment (P < 0.001). Experiencing a low degree of work-limiting pain was associated with an 18% increased risk of loss of paid employment [risk ratio (RR): 1.18, 95% confidence interval (CI): 1.14-1.21], whereas experiencing a very high degree of work-limiting pain increased the risk of loss of paid employment by 155% (RR: 2.55, 95% CI: 2.43-2.69) compared to no work-limiting pain.

CONCLUSION

In conclusion, work-limiting pain constitutes an important risk factor for loss of paid employment among senior workers with physically demanding work, and effective preventive efforts at both policy and workplace levels should be documented and implemented.

Localized Pain and Fatigue During Recovery From Submaximal Resistance Exercise in People With Fibromyalgia

OBJECTIVE

Exercise is recommended as a main treatment in fibromyalgia. However, many people have limited exercise tolerance and report exacerbated pain and fatigue during and following a bout of exercise. This study examined the local and systemic changes in perceived pain and fatigue during exercise and through the 3-day recovery following isometric and concentric exercises in people with and without fibromyalgia.

METHODS

Forty-seven participants with a physician diagnosis of fibromyalgia (44 women; mean age [SD] = 51.3 [12.3] years; mean body mass index [SD] = 30.2 [6.9]) and 47 controls (44 women; mean age [SD] = 52.5 [14.7] years; mean body mass index [SD] = 27.7 [5.6]) completed this prospective, observational cohort study. A bout of submaximal resistance exercise (isometric and concentric) was performed localized to the right elbow flexors on 2 separate days. Baseline attributes (pain, fatigue, physical function, physical activity, and body composition) were assessed prior to exercise. Primary outcomes were: change in perceived pain and fatigue (0 to 10 on the visual analog scale) in the exercising limb and whole body during recovery with movement (immediately, 1 day following exercise, and 3 days following exercise). Secondary outcomes were perceived pain and exertion during exercise performance and pain and fatigue at rest during recovery.

RESULTS

Following a single bout of isometric or concentric exercise, there was increased perceived pain (ηp2 = 0.315) and fatigue (ηp2 = 0.426) in the exercising limb, which was greater in people with fibromyalgia (pain: ηp2 = 0.198; fatigue: ηp2 = 0.211). Clinically, relevant increases in pain and fatigue during exercise and through the 3-day recovery occurred in individuals with fibromyalgia only. Concentric contractions led to greater perceived pain, exertion, and fatigue during exercise compared with isometric exercise for both groups.

CONCLUSIONS

People with fibromyalgia experienced significant pain and fatigue in the exercising muscle during recovery from low-intensity and short-duration resistance exercise, with greater pain during concentric contractions.

IMPACT

These findings highlight a critical need to assess and manage pain and fatigue in the exercising muscles of people with fibromyalgia up to 3 days following a single bout of submaximal resistance exercise.

LAY SUMMARY

If you have fibromyalgia, you might have significant pain and fatigue up to 3 days following an exercise bout, with the pain and fatigue localized to the exercising muscles and no changes in whole-body pain.

Physical work demands and expected labor market affiliation (ELMA): Prospective cohort with register-follow-up among 46 169 employees

OBJECTIVE

This study aimed to estimate the impact of high physical work demands on expected labor market affiliation (ELMA) among men and women of different ages in the general working population.

METHODS

After participating in the Danish Work Environment and Health study (2012, 2014, and/or 2016), 46 169 employees were followed for two years in national registers. Using multi-state modeling, taking all day-to-day transition probabilities of labor market affiliation into account (work, unemployment, sickness absence, temporary out, and permanently out), and performing multilevel adjustment, we estimated the prospective association between physical work demands (ergonomic index including 7 factors) and ELMA.

RESULTS

During 104 896 person-years of follow-up, we identified of 439 045 transitions. Using low physical work demands as reference, higher physical work demands were associated with fewer days of active work (2-35 days) during 730 days of follow-up, and more days of sickness absence (4-26 days) and unemployment (ranging 1-9 days) among men and women of aged 40-49 and 50-64 years. Among men and women aged 18-39 years, high physical work demands only had minor and inconsistent impact on ELMA.

CONCLUSIONS

Analyzing multiple and highly detailed patterns of transition probabilities concerning labor market affiliation we showed that reducing physical work demands is likely to increase the active working time and prevent high societal cost of sickness absence and unemployment, especially among middle-aged and older workers.

A Simple Resident Need-for-Physical-Assistance Scale in Eldercare: Validation Using 4716 Observation Sequences of Caring Activities

Accurate and simple measures for classifying nursing home residents according to their care needs would be valuable for planning eldercare work. Our aim was to validate a developed classification scale of residents' need for physical assistance. Eldercare workers and managers in 20 Danish nursing homes classified 1456 residents into four categories (from light to complete need for physical assistance). We validated the resident need-for-assistance scale against 4716 workplace observation sequences of caring activities performed by eldercare workers. We found a strong correlation between the resident need-for-assistance scale and observed number of resident handlings (r = 0.71) and a moderate correlation for observed duration of care (r = 0.57). The discriminative ability of the scale was good for both number of resident handlings (ROC-AUC = 0.81) and for duration of care (ROC-AUC = 0.76). Our findings indicate that this simple scale is valid and feasible for classifying residents according to their physical assistance needs.

Pain Among Latvian Workers: General Prevalence vs. Registered Occupational Diseases

The problem of painful and disabling work-related musculoskeletal disorders (MSDs) is increasing in many employment sectors of Latvia. Official statistics may underestimate the proportion of affected employees, causing delays in preventive interventions, ineffective rehabilitation, and a reduction of the workforce. This study investigated the prevalence of painful health conditions among Latvian workers by analyzing survey data and comparing these to official statistics on registered occupational diseases (ODs). A total of 2,446 workers participated in the state-level “Work conditions and risks in Latvia, 2017–2018” survey that included questions about pain lasting longer than 3 days during the previous year. The frequency of subjective reports on the presence, severity, and location of pain and related behaviors was assessed in relation to sex, age, education, and job position. Descriptive statistics and cross tabulation with the chi-squared test as well as multinomial logistic regression were applied to the data. Overall, 27.7% of respondents (n = 678) reported experiencing pain, predominantly in the lower back (14.3%) and mostly moderate (47.1%) or severe (45.1%). Only one-fifth of respondents (20.5%) took sick leave from work and one-third (29.0%) did not take action to alleviate their pain. Participants aged 55–74 years had a significantly higher odds ratio (OR) for pain in at least one body region—including hands and legs—than those aged 18–24 years. Women had significantly higher odds of headache (OR = 2.55) and neck pain (OR = 1.85) than men. Respondents with a primary or elementary education level had higher odds of pain in at least one body region (OR = 1.60) and in the lower back (OR = 1.86), while those with secondary education had higher odds of pain in hands (OR = 1.51) than employees with higher education. Unskilled workers had significantly higher odds of pain in hands (OR = 2.42) and legs (OR = 2.12) than directors. Official data revealed a dramatic increase in the proportion of MSDs and related disabilities in the last decade, reaching 75.5% of all first registered ODs in 2019. These results demonstrate a high prevalence of painful conditions among Latvian employees; urgent attention to diagnostics, treatment, and prevention is needed to ensure the musculoskeletal health and productivity of this population.