The association between psychological distress and musculoskeletal symptoms experienced by Chinese high school students

Relationship between workplace violence and mental/physical health of security guards during the COVID-19 pandemic in Taiwan

Objectives

To investigate the relationship between workplace violence (WPV) and mental and physical health (MPH) of security guards during the COVID-19 pandemic in Taiwan.

Methods

A cross-sectional survey was conducted in 15 representative security companies across northern, central, and southern Taiwan, and outlying islands from July 2021 to June 2022 during the COVID-19 pandemic. 1,200 questionnaires were distributed. A total of 1,032 valid questionnaires were collected.

Results

13.18% of the participants reported that they had experienced WPV during the COVID-19 pandemic, including physical violence (PhV), psychological violence (PsV), verbal violence (VV), and sexual harassment (SH). The most common violence was VV (54.19%), followed by PsV (20.69%). Community residents and property owners were the primary perpetrators, followed by strangers. The study showed that the security guards who had experienced WPV had higher scores on the 12-item Chinese Health Questionnaire (Taiwan version) (CHQ-12), indicating poorer MPH than those who had never experienced WPV. The result showed that VV had strong correlations with the lack of effective communication, dissatisfaction with treatment and service attitude, and work stress. PsV was strongly associated with excessive waiting times.

Conclusion

There were correlations among PhV, VV, and PsV and they had adverse impacts on MPH, except for SH. The study found that the primary perpetrators of WPV against security guards were community residents and property owners. The causes were the lack of effective communication, dissatisfaction with treatment and service attitude, excessive waiting times, and work stress, which further led to turnover intention and poor MPH. The findings of this study have useful implications and it is recommended to enhance the understanding of workplace violence against security guards and to formulate appropriate local and international strategies to address it.

The Association Between Neck Pain and Psychological Distress Experienced by King Abdulaziz University Students: A Cross-Sectional Study

Background Musculoskeletal discomfort resulting from soft tissue injuries to muscles, bones, nerves, tendons, joints, or cartilage is referred to as musculoskeletal disorders. Neck pain is a common musculoskeletal condition with a significant socioeconomic impact on patients. Previous literature has linked the onset of neck pain to various factors, including psychological factors that may affect musculoskeletal disorders (MSDs), similarly to physical factors. Psychological conditions, including anxiety and depression, may result in MSDs. Limited studies on the relationship between neck pain and psychological distress have been conducted among undergraduate students in Jeddah. The study aimed to investigate the relationship between neck pain and psychological distress. Additionally, the study examined the risk factors for developing neck pain, depression, and anxiety in King Abdulaziz University (KAU) undergraduate students. Method This cross-sectional study was conducted in November 2022 at KAU in Jeddah, Saudi Arabia, by distributing a google forms survey among undergraduate university students in KAU, excluding graduate students and students who did not agree to participate. We received 509 responses; each respondent gave written consent and participated in the study. Result Neck pain prevalence was 50.7% of all students (95% CI, 46.3-55.1). Significantly higher neck pain scores were observed in women (p<0.001), in students who did little or no exercise, and in those who drank coffee more frequently >3 cups daily. Anxiety (p<0.001) and depression (p<0.001) scores were also positively and significantly correlated with neck pain scores. The results of the association analysis revealed that women had significant scores for anxiety (p<0.001) and depression (p<0.001). Female sex (p<0.001) and increased neck pain score (p<0.001) were independent risk factors for anxiety. Higher neck pain scores were also associated with depression (p<0.001). Conclusion Our study showed that anxiety and depression significantly impact neck pain. Furthermore, the increased score of depression and anxiety indicates worsening neck pain.

Musculoskeletal pain among medical students at two Jordanian universities

BACKGROUND

Musculoskeletal (MSK) pain is a debilitating multi-perceptual condition afflicting many individuals, especially individuals in the medical profession.

OBJECTIVE

To analyze and evaluate the prevalence of musculoskeletal pain among medical students at Jordanian universities during the complete virtual learning process.

METHODS

A cross-sectional study of 593 medical students at two Jordanian universities was conducted. A modified Nordic questionnaire was used to assess musculoskeletal pain in three body regions.

RESULTS

Five hundred ninety-three students at the two Jordanian universities participated in this study. The prevalence of having MSK pain during the past week in the neck, shoulder, and lower back was 34.6%, 27%, and 41%, respectively; during the past 12 months, it was 61.2%, 45.5%, and 63.1%, respectively. Overall prevalence of having MSK pain was 58.9% in the last week and 78.1% in the past 12 months. 66.8% of students who had psychosomatic symptoms and 62.3% of those with depressive symptoms in the past week had MSK pain. Students who studied 8 hours per day had higher percentages of MSK pain (68.4%) (OR 1.12, 95% CI 0.965-1.312). The average number of hours using a computer per day was significantly associated with MSK pain (p= 0.032). MSK pain during the last week was significantly associated with psychosomatic symptoms (OR 1.842, 95% CI 1.272-2.668, p= 0.001). Family history of MSK pain was significantly related to the presence of the problem in participants (OR 1.732, 95% CI 1.182-2.538, p= 0.005). Gender, depressive symptoms, average hours of computer use per day, and average hours of study at home per day did not show significant relationships with MSK pain over the year.

CONCLUSIONS

High prevalence of MSK pain was observed among medical students. Measures to balance in-person and virtual learning should be considered in medical schools to minimize the risk of MSK pain.

Sex differences in factors associated with neck pain among undergraduate healthcare students: a cross-sectional survey

Background

Neck pain is widespread among students in healthcare-related fields. Although neck pain is more prevalent in females, since most research involves mixed-sex samples we know very little about sex differences in contributors to neck pain. Thus, this study sought to explore sex differences in the risk factors for neck pain in this high-risk population.

Methods

This cross-sectional study was conducted in China in 2021 and included a sample of 1921 undergraduate healthcare students (693 males, 1228 females) from 7 health professional schools at Fujian Medical University. We collected data on neck pain symptoms, demographics, behavioral and psychological factors. Multiple regression analysis was conducted to examine sex differences in the risk factors of neck pain.

Results

The overall prevalence of neck pain was 41.6% with female students having a higher prevalence than male students (44.4% vs. 36.7%, respectively). The adjusted analyses showed that self-study time ≥ 6 h/day (OR = 1.44, 95% CI:1.13-1.83), flexed neck posture >20 degrees (OR = 2.19, 95% CI: 1.28-3.74), static duration posture >2 h (OR = 1.42, 95% CI: 1.02-1.97), and psychological distress (high: OR = 2.04, 95% CI:1.42-2.94; very high: OR = 2.50, 95% CI:1.57-3.74; respectively) were independent factors for neck pain in females. Among males, self-study time ≥ 6 h/day (OR = 1.43, 95% CI: 1.02-2.01) and psychological distress (moderate: OR = 2.04, 95% CI:1.28-3.25; high: OR = 2.37, 95% CI:1.49-3.79; very high: OR = 2.97, 95% CI:1.75-5.02; respectively) were significant risk factors for neck pain.

Conclusions

These findings suggest that the risk profiles of neck pain differ between females and males. The modifiable risk factors for neck pain, such as prolonged self-study time and elevated psychological distress, as well as poor posture among females, could be targeted through health promotion interventions in university settings.

Increased Computer Use is Associated with Trunk Asymmetry That Negatively Impacts Health-Related Quality of Life in Early Adolescents

PURPOSE

This study aimed to investigate the effects of trunk asymmetry on the health-related quality of life of early adolescents and to identify daily activities that were associated with trunk asymmetry in this cohort.

METHODS

This study included 200 early adolescents (52 male and 148 female) aged 10 to 14 years in Hong Kong. Among them, 100 adolescents were considered to have trunk asymmetry with angle of trunk rotation ≥5° and one or more physical signs on visual inspection. The 36-Item Short Form Health Survey was used to measure the eight scales under the physical and mental domains of the health-related quality of life. The adolescents reported their average daily durations spent (1) using a computer; (2) using a smartphone; (3) watching television, videos or DVDs; (4) doing homework; and (5) doing physical exercise. Independent samples t-tests, chi-square (χ 2) tests or Mann-Whitney U-tests were performed to compare the health-related quality of life and the average daily duration of daily activities between early adolescents with and without trunk asymmetry. Logistic regression was performed to investigate the odds ratios of daily activities for trunk asymmetry.

RESULTS

Compared with early adolescents without trunk asymmetry, those with trunk asymmetry had a lower health-related quality of life in some of the physical domains, namely, bodily pain and general health, and all mental domains, namely, vitality (energy/fatigue), social functioning, role limitation due to emotional problems and mental health (p < 0.05). Use of computer was found to be significantly associated with trunk asymmetry in early adolescents (OR = 1.63, 95% CI [1.23, 2.14]).

CONCLUSION

Our results indicate that increased computer use is associated with trunk asymmetry, which negatively impacts the health-related quality of life in early adolescents.

Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study

OBJECTIVE

The purpose of this study was to determine whether sagittal neck sitting posture subgroup membership in late adolescence was a risk factor for persistent neck pain (PNP) in young adults.

METHODS

There were 686 participants enrolled in the Raine Study at the 17- and 22-year follow-ups. At 17 years of age, posture was measured by photographs, and 4 subgroups of sitting neck posture were determined by cluster analysis. Height and weight were measured, and exercise frequency, depression, and PNP were assessed by questionnaire. At 22 years of age, participants answered questions about neck pain and occupation type. Logistic regression examined if neck posture subgroups at 17 years of age were a risk factor for PNP at 22 years of age, taking into account other factors.

RESULTS

Female sex (odds ratio [OR] = 1.75, 95% CI = 1.16-2.65) and PNP at 17 years of age (OR = 3.78, 95% CI = 2.57-5.57) were associated with PNP at 22 years of age. In females, neck posture subgroup at 17 years of age was a risk factor for PNP at 22 years of age. Compared with the upright subgroup, both the slumped thorax/forward head subgroup groups and the intermediate subgroup had decreased odds for PNP at 22 years of age (OR = 0.24, 95% CI = 0.08-0.76; OR = 0.38, 95% CI = 0.15-0.99, respectively). No association was found in males.

CONCLUSION

After taking into account PNP at 17 years, sitting neck posture at 17 was not a risk factor for PNP at 22 years of age in males, whereas in females, more relaxed postures (slumped thorax/forward head and Intermediate postures) were protective of neck pain compared with upright posture.

IMPACT

Females in late adolescence who sat in slumped thorax/forward head or intermediate posture rather than upright sitting posture had a lower risk of PNP as a young adult. The practice of generic public health messages to sit up straight to prevent neck pain needs rethinking.

Nonspecific wrist pain in pediatric patients: A systematic review

Determining the cause of wrist pain is a challenge for clinicians due to the complex biomechanical characteristics of the multiple articulations which comprise the wrist, and the intricacies of the soft tissue supporting them. Patients presenting with wrist pain can be diagnosed by obtaining a detailed history, physical examination and radiographic images. For some patients, a diagnosis remains elusive even after a complete appropriate work up, and the pain may persist following conservative management. The aim of this systematic review was to analyze the effect that psychosocial factors have on the development chronic idiopathic wrist pain in children and adolescents.

Prevalence and associated factors of neck, shoulder, and low-back pains among medical students at Jazan University, Saudi Arabia: A cross-sectional study

Background

Musculoskeletal pain (MSP) in the neck, shoulder, and lower back is common widespread among medical students. The objective of this research is to estimate the prevalence of neck, shoulder, and low-back pains and to explore factors associated with MSP among medical students at Jizan University in southwest of Saudi Arabia.

Methods

A cross-sectional, self-administered questionnaire-based study was conducted among undergraduate medical students of Jazan University. A total of 440 students were selected by random sampling. Descriptive statistics, a Chi-squared test, and logistic regression were performed to examine the prevalence, associations, and predictors of MSP.

Results

The overall prevalence of MSP was (53.5%; 95% CI: 49.2-58.4). Neck pain was reported by 197 (44.8%) in the week prior to the study and by 268 (60.9%) in the year prior to the survey. Regarding shoulder pain, it was reported by 231 (52.5%) in the week prior to the study and 175 (39.8%) in the year prior to the study. Regarding low-back pain, it was reported by 147 (33.4%) in the week prior to the study and 270 (61.4%) in the year prior to the study. Factors associated with the risk of MSP include history of trauma (OR = 2.70; 95% CI: 1.36-5.36 depressive symptoms (OR = 1.94; 95% CI: 1.03-3.66) and report of psychosomatic symptoms (OR = 2.98; 95% CI: 1.71-5.18).

Conclusion

In conclusion, the proportion of medical students with MSP was very high. Factors associated with the increased risk of MSP include history of trauma, depressive, and psychosomatic symptoms. Intervention program may help improving the musculoskeletal health of the medical students and to hence their quality of life.

Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents

BACKGROUND

There is conflicting evidence on the association between sagittal neck posture and neck pain.

OBJECTIVE

The purposes of this study were: (1) to determine the existence of clusters of neck posture in a cohort of 17-year-olds and (2) to establish whether identified subgroups were associated with biopsychosocial factors and neck pain.

DESIGN

This was a cross-sectional study.

METHODS

The adolescents (N=1,108) underwent 2-dimensional photographic postural assessment in a sitting position. One distance and 4 angular measurements of the head, neck, and thorax were calculated from photo-reflective markers placed on bony landmarks. Subgroups of sagittal sitting neck posture were determined by cluster analysis. Height and weight were measured, and lifestyle and psychological factors, neck pain, and headache were assessed by questionnaire. The associations among posture subgroups, neck pain, and other factors were evaluated using logistic regression.

RESULTS

Four distinct clusters of sitting neck posture were identified: upright, intermediate, slumped thorax/forward head, and erect thorax/forward head. Significant associations between cluster and sex, weight, and height were found. Participants classified as having slumped thorax/forward head posture were at higher odds of mild, moderate, or severe depression. Participants classified as having upright posture exercised more frequently. There was no significant difference in the odds of neck pain or headache across the clusters.

LIMITATIONS

The results are specific to 17-year-olds and may not be applicable to adults.

CONCLUSION

Meaningful sagittal sitting neck posture clusters were identified in 17-year-olds who demonstrated some differences with biopsychosocial profiling. The finding of no association between cluster membership and neck pain and headaches challenges widely held beliefs about the role of posture in adolescent neck pain.

Electromyography comparison of normal chair-desk system and assistant chair-desk system on fatigue

[Purpose] This study was designed to test the effects of the Assistant Chair-Desk System (ACDS), which can reduce the forward tilt of the neck and trunk and the level of fatigue during long lasting study in the sitting position. [Subjects] Fourteen middle school students and 14 college students of mixed gender participated in this study. [Methods] Fatigue level, the trapezius muscle, and the forward tilt angle of the head and trunk as well as distance factors were assessed before after using a normal chair-desk system (NCDS) and the ACDS for 120 minutes. [Results] There was an interaction effect in the angle and length of the neck from the sitting posture changes after 2 hours of studying using the NCDS and ACDS. There were also significant differences in the fatigue levels, hip joint angles and the lengths from the head according to the main effects of the chair-systems. [Conclusion] The studying position while using the ACDS was determined to prevent significant fatigue levels of the muscle and body, provide support to the head, by limiting the forward movement of the neck, and prevent forward tilt of the neck and trunk, by enabling the target point and gaze to be closer to the horizontal direction.

Are students' symptoms and health complaints associated with perceived stress at university? Perspectives from the United Kingdom and Egypt

This cross-sectional survey assessed and compared by country, the levels and correlates of 21 self-reported symptoms/health complaints. We examined the associations between self-reported symptoms and perceived stress. Data was collected from universities in the United Kingdom and Egypt (N = 3706 and 3271 undergraduates, respectively). A self-administered questionnaire assessed a range of self-reported symptoms, perceived stress, sociodemographic (gender, age, marital status, year of study, living arrangements during semester, income sufficiency), lifestyle (tobacco smoking, illicit drug/s use, alcohol consumption frequency), and health variables (subjective health status, health awareness, BMI), along with religiosity, and quality of life. Factor analysis categorized the 21 self-reported symptoms into four components. Correlation analysis and linear regression tested the associations between the self-reported symptoms and stress. Factor analysis of the health symptoms generated four symptom groups for each of the UK and Egypt (psychological; circulatory/breathing; gastrointestinal; and, pains/aches), and factor loadings were quite similar for both countries. Whilst the two samples showed similarities as to the kind of symptoms most frequently reported by students, the Egyptian sample had significantly higher frequency than the UK for every symptom. Frequent complaints (both countries) included difficulties to concentrate, fatigue, headaches, nervousness/anxiety, and back pain (UK) and mood swings (Egypt). Significantly more Egyptian students reported ≥4 symptoms over the past year than the UK. For each of the UK and Egypt, across each of the four symptom groups, there was a stepladder appearance whereby the frequency of symptoms increased with increasing quartiles of perceived stress. Not controlling for other variables, for both countries, there were significant positive correlations between each of the four symptom groups and stress; the highest correlation was for psychological symptoms. After controlling for sex, age country, and other symptom groups, stress was highly and significantly associated with psychological symptoms and also with pain & aches symptoms in both countries. UK students were generally less stressed than their counterparts in Egypt. Age and female gender were also associated with stress; the younger the student was the more likely to suffer from stress. Interactions were not significant. Across both countries, the levels of stress among students and the associations between perceived stress and health complaints suggest the need for a multiple approaches in order to understand the sources of stress; how college students experience stress; and, the coping mechanisms that different students employ to mitigate stress. Interventions aimed at both preventing, treating and caring for students’ distress, and also preventive strategies to help minimize the impact of stressful situations are required. Strategies that address both physical and psychological complaints may be beneficial for this population.

The spinal posture of computing adolescents in a real-life setting

Background

It is assumed that good postural alignment is associated with the less likelihood of musculoskeletal pain symptoms. Encouraging good sitting postures have not reported consequent musculoskeletal pain reduction in school-based populations, possibly due to a lack of clear understanding of good posture. Therefore this paper describes the variability of postural angles in a cohort of asymptomatic high-school students whilst working on desk-top computers in a school computer classroom and to report on the relationship between the postural angles and age, gender, height, weight and computer use.

Methods

The baseline data from a 12 month longitudinal study is reported. The study was conducted in South African school computer classrooms. 194 Grade 10 high-school students, from randomly selected high-schools, aged 15–17 years, enrolled in Computer Application Technology for the first time, asymptomatic during the preceding month, and from whom written informed consent were obtained, participated in the study. The 3D Posture Analysis Tool captured five postural angles (head flexion, neck flexion, cranio-cervical angle, trunk flexion and head lateral bend) while the students were working on desk-top computers. Height, weight and computer use were also measured. Individual and combinations of postural angles were analysed.

Results

944 Students were screened for eligibility of which the data of 194 students are reported. Trunk flexion was the most variable angle. Increased neck flexion and the combination of increased head flexion, neck flexion and trunk flexion were significantly associated with increased weight and BMI (p = 0.0001).

Conclusions

High-school students sit with greater ranges of trunk flexion (leaning forward or reclining) when using the classroom computer. Increased weight is significantly associated with increased sagittal plane postural angles.

Primary prevention of disc degeneration-related symptoms

INTRODUCTION

It has been shown previously that a history of low back pain often begins in childhood or adulthood. Indeed, the prevalence of severe back symptoms among schoolchildren is not insignificant. Possibilities for the primary prevention of intervertebral disc degeneration-related conditions are poorly reported in the literature despite the assumed socio-economical impact of the prevention of these conditions.

METHODS

In this review, the authors have collated published data on the prevalence and risk factors of childhood low back pain as well as the structure and results of published primary prevention programs.

RESULTS

The prevalence of self-reported low back pain is 7-65% among children and it increases with age. Several lifestyle factors have been reported as significant risk factors for back pain, many of which are related to the schools. Current educational primary prevention programs in schools show no clear or long-term stable effect.

CONCLUSION

Considering the growing evidence about the importance of normal and bad posture, an exercise-based posture correction program is suggested as a school-based primary prevention of disc degeneration-related symptoms. Further, prospective randomized studies with more than 20 years follow-up, however, are strongly required to confirm it.

The effect of aging on muscle activation and postural control pattern for young and older computer users

A lot of older adults try to learn to use computers and might use different ways to perform a computer task compared to younger people. Fifteen healthy young and 15 healthy older adults participated in this study and all performed a series of mouse tasks. A three dimensional motion capture system and electromyographic analysis were used to obtain kinematic and kinetic data during performing the computer tasks. Three-way analysis of variance with repeated measures on task and time factors was used to analyze all dependent measurements. Older adults had higher RMS of forearm muscles compared to the young adults. The RMS of the finger extensor was highest when performing a dragging task. Compared with young adults, the older adults had greater cranial-cervical angle and neck flexion, but smaller head flexion, shoulder angle, elbow angle and ulnar deviation. Consequently, the older adults might have a greater risk of developing musculoskeletal disorder.

The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review

BACKGROUND

Prolonged sitting has been associated with musculoskeletal dysfunction. For desk workers, workstation modifications frequently address the work surface and chair. Chairs which can prevent abnormal strain of the neuromuscular system may aid in preventing musculo-skeletal pain and discomfort. Anecdotally, adjustability of the seat height and the seat pan depth to match the anthropometrics of the user is the most commonly recommended intervention. Within the constraints of the current economic climate, employers demand evidence for the benefits attributed to an investment in altering workstations, however this evidence-base is currently unclear both in terms of the strength of the evidence and the nature of the chair features. The purpose of this study was to evaluate the evidence for the effectiveness of chair interventions in reducing workplace musculoskeletal symptoms.

METHODS

Pubmed, Cinahl, Pedro, ProQuest, SCOPUS and PhysioFocus were searched. 'Ergonomic intervention', 'chair', 'musculoskeletal symptoms', 'ergonomics', 'seated work' were used in all the databases. Articles were included if they investigated the influence of chair modifications as an intervention; participants were in predominantly seated occupations; employed a pre/post design (with or without control or randomising) and if the outcome measure included neuro-musculoskeletal comfort and/or postural alignment. The risk of bias was assessed using a tool based on The Cochrane Handbook.

RESULTS

Five studies were included in the review. The number of participants varied from 4 to 293 participants. Three of the five studies were Randomised Controlled Trials, one pre and post-test study was conducted and one single case, multiple baselines (ABAB) study was done. Three studies were conducted in a garment factory, one in an office environment and one with university students. All five studies found a reduction in self-reported musculoskeletal pain immediately after the intervention. Bias was introduced due to poor randomization procedures and lack of concealed allocation. Meta-analysis was not possible due to the heterogeneity of the data (differing population, intervention and outcomes across studies).

CONCLUSION

The findings of this review indicate a consistent trend that supports the role of a chair intervention to reduce musculoskeletal symptoms among workers who are required to sit for prolonged periods. However the amount, level and quality of the evidence are only moderate therefore we cannot make strong recommendations until further trials are conducted. The review also highlights gaps: for example in showing whether the effectiveness of a chair intervention has long-term impact, particularly with respect to musculoskeletal symptoms, as well as the recurrence of symptoms and the consequent cost of care.

Comparison of posture and muscle control pattern between male and female computer users with musculoskeletal symptoms

The primary purpose of this study was to compare the posture and muscle control patterns between male and female computer users with musculoskeletal symptoms. Forty computer users were recruited. Each subject performed a preferred speed typing, a fast speed typing, and a repetitive mouse task. The independent variables were gender, typing speed, and time. There were significant differences between genders for head and neck flexion angles when they were performing the preferred speed typing task. Significant differences between genders were also found for upper extremity angles when they were performing the repetitive mouse task. Male computer users had a smaller root mean square of the right extensor digitorium than females. In general, postural differences were significant between genders, even when the subjects' table and chair were adjusted to meet their anthropometry. Our results suggest that modifications of the computer working environment may be different between genders.

Prevalence and risk factors associated with spinal pain in adolescent computer users: a systematic review

BACKGROUND

Increased computer use has been suggested as a contributing factor for a rapid increase in the prevalence of neck and back pain in adolescents in the late 1990s and the beginning of 2000.

OBJECTIVE

The overall objective of this review was to synthesise the best available evidence on the estimates of prevalence of, and risk factors associated with, spinal discomfort in adolescent computer users.

INCLUSION CRITERIA

This review considered cross-sectional, case-control, or cohort studies. Studies were considered for inclusion if they reported either prevalence or risk factors associated with spinal pain in adolescents aged between 13 and 18 years using computer in school or at home.

SEARCH STRATEGY

The search included The Cochrane Library, JBI Library of Systematic Reviews, PEDro, MEDLINE, CINAHL, Web of Science, ERIC, PsycINFO, EMBASE, and CEPS. The grey literature was also searched. The search was limited to English and Chinese language papers, and spanned from the inception of each database to May 2011.

METHODOLOGICAL QUALITY

Two review authors independently evaluated the methodological quality of the included studies using the standardised Joanna Briggs Institute instruments.

DATA EXTRACTION

Data was extracted using the standardised Joanna Briggs Institute data extraction form.

DATA SYNTHESIS

Meta-analysis was not appropriate because there was considerable heterogeneity between studies. The findings were summarised in tables and in narrative form.

RESULTS

Seven studies were included in this review: three studies were carried out in Finland, two in the USA, one in Sweden, and one in South Africa. There was marked variability in the period prevalence data across different studies: 15-60% for cervical pain and 12-53% for lumbar pain. None of the reviewed studies reported the confidence intervals for prevalence estimate. Four studies investigated the association between the duration of computer use and cervical pain, two studies for lumbar pain and none for thoracic pain. Positive associations between the duration of computer use and cervical pain were found in three out of four studies, with the odds ratio ranged from 1.3 (95% CI 1.1 to 1.6) to 2.3 (95% CI 1.5 to 3.6). One study found that weekly internet use greater than 42 hours predicted the occurrence of lumbar pain, and the odds ratio was 1.9 with 95% CI of 1.1 to 3.4. The other study reported non-significant association without providing statistical evidence.

CONCLUSION

This systematic review suggests a relatively high prevalence of spinal pain in adolescents. The cervical spine region appears to be more prone to musculoskeletal pain than the lumbar or thoracic regions. Cervical spine pain was statistically significantly associated with duration of computer use, however the odds ratio may be too small to be considered clinical significant. There is conflicting evidence on the association with duration of computer use and lumbar pain and no evidence for thoracic spine.

IMPLICATIONS FOR PRACTICE

The relatively high prevalence of spinal pain in adolescents highlights the need for preventative and treatment strategies.

IMPLICATIONS FOR RESEARCH

Further research, preferably prospective cohort studies utilising physical examination, is required to more rigorously investigate the issue of computer use and spinal pain among adolescents. There is a need to conduct more research in Asian or developing countries to reflect any cultural or socioeconomic differences that may influence the amount of computer exposure and its potential impact on musculoskeletal health in adolescent computer users.

Characteristics of chronic non-specific musculoskeletal pain in children and adolescents attending a rheumatology outpatients clinic: a cross-sectional study

BACKGROUND

Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, leading to disability and reduced quality of life that continues into adulthood. The purpose of the study was to build a biopsychosocial profile of children and adolescents with CNSMSP.

METHODS

CNSMSP subjects (n = 30, 18 females, age 7-18) were compared with age matched pain free controls across a number of biopsychosocial domains.

RESULTS

In the psychosocial domain CNSMSP subjects had increased levels of anxiety and depression, and had more somatic pain complaints. In the lifestyle domain CNSMSP subjects had lower physical activity levels, but no difference in television or computer use compared to pain free subjects. Physically, CNSMSP subjects tended to sit with a more slumped spinal posture, had reduced back muscle endurance, increased presence of joint hypermobility and poorer gross motor skills.

CONCLUSION

These findings support the notion that CNSMSP is a multidimensional biopsychosocial disorder. Further research is needed to increase understanding of how the psychosocial, lifestyle and physical factors develop and interact in CNSMSP.

Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire in patients with hand injury

PURPOSE

To compare responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) with that of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in patients with hand injuries. We postulated that the MHQ may be more sensitive to functional changes in the hands, whereas the DASH questionnaire would have a closer association with days of disability.

METHODS

Patients with hand injuries were consecutively recruited from 2 community hospitals. Each patient was asked to complete out the MHQ, the DASH questionnaire, the satisfaction with their health-related quality of life (Sat-HRQOL) measure, and Chinese Health Questionnaire (CHQ), which is a measure of psychological stressors. Disability days were defined as the duration of restricted activities of daily living during the previous 4 weeks. Patients repeated the same questionnaires between 2 and 9 months after enrollment (average: 4 mo).

RESULTS

A total of 105 patients with hand injuries were recruited, and 50 of the 105 patients returned for the second evaluation. There were no statistical differences between responders and nonresponders for age, gender, disability days, the MHQ, the DASH questionnaire, the CHQ, or the Sat-HRQOL. Responsiveness was evaluated by effect sizes and standardized response means: Those for the MHQ were 0.84 and 1.05, and those for the DASH were 0.67 and 0.86, respectively. A mixed model analysis for repeated measurements of the 50 participants showed a significant influence of psychological factors (CHQ) for both the Sat-HRQOL and disability days. After adjustment for the effects of age, gender, and the CHQ, there was an increment of one Sat-HRQOL unit for an MHQ score increment of 3.2, whereas the score decrement for the DASH questionnaire was 3.3 units.

CONCLUSIONS

The MHQ might be slightly more sensitive to functional changes, but the DASH questionnaire seemed more correlated with disability days. Psychological factors are the strongest determinants of the HRQOL and disability.

A systematic review of posture and psychosocial factors as contributors to upper quadrant musculoskeletal pain in children and adolescents

Musculoskeletal pain has become a major symptomatic complaint among children and adolescents and is increasingly occurring at a younger age. This systematic review was done to evaluate the evidence for the contribution of posture and psychosocial factors to the development of upper quadrant musculoskeletal pain in children and adolescents. The review describes the measurement tools used to assess musculoskeletal pain, sitting posture, and psychosocial factors. Two independent reviewers searched seven databases for observational studies that included prospective and cross-sectional study designs. Ten studies were extracted and assessed by two reviewers using the Critical Appraisal Form-Quantitative Studies (Law et al, 1998). The studies measured upper quadrant musculoskeletal pain as an outcome measure. Five studies evaluated sitting posture and found an association between the duration of static sitting and upper quadrant musculoskeletal pain. Six studies measured psychosocial factors of which depression, stress, and psychosomatic symptoms were the factors most commonly found to influence the development of upper quadrant musculoskeletal pain. The eligible studies used different pain measurement tools and different measurement tools to assess sitting posture and psychosocial factors. This review concludes that the duration of sitting posture and psychosocial factors may influence the experience of musculoskeletal pain among children and adolescents.

Survey of faulty postures and associated factors among Chinese adolescents

OBJECTIVE

This study investigates the prevalence of common faulty postures among adolescents and identify if significant relationships existed among the number of faulty postures, psychologic distress, and musculoskeletal symptoms.

METHODS

The Musculoskeletal Questionnaire and Chinese Health Questionnaire were randomly distributed to 300 high school students in the Tainan area. On-campus postural screening, which included digital photography, manual muscle tests, and flexibility tests, was also performed.

RESULTS

Two hundred eighty-seven participants completed all of the evaluations. The most common faulty posture was uneven shoulder level (36%), followed by forward head posture (25%). There was a sex difference between groups. The incidence of forward head posture for the male students was higher than that of the female students (P < .0001). In addition, the high psychologic distress group tended to have a higher prevalence of uneven shoulder height than that of the low psychologic distress group (P < .0001). As for the correlation analysis, the researchers did not find a high correlation among the scores of the faulty posture, psychologic distress, and musculoskeletal symptoms.

CONCLUSION

The results of this study show that the incidence of faulty posture was high for the adolescent group, especially for the uneven shoulder level. Subjects' awareness about being assessed might decrease the incidence for some faulty posture. However, the relationships among the number of faulty postures, psychologic distress, and musculoskeletal symptoms were low. We suggest that there are multiple factors that might contribute to musculoskeletal symptoms; faulty posture could be one important factor that causes symptoms.

Emotion-Oriented Coping, Avoidance Coping, and Fear of Pain as Mediators of the Relationship Between Positive Affect, Negative Affect, and Pain-Related Distress Among African American and Caucasian College Women

The authors tested whether coping styles and fear of pain mediate the relationship between positive affect and negative affect on one hand and pain-related distress (PD) on the other. Among African American and Caucasian female college students, negative affect, fear of pan, and emotion-oriented coping together accounted for 34% of the variance in PD among African American woman and 40% of the variance in PD among Caucasion women. Emotion-oriented coping and fear of pain fully mediated the relationship between negative affect and PD among Caucasian women and partly mediated the relationship between negative affect and PD among African American women. Results suggest that reducing college women's reliance on emotion-oriented coping and their fears of pain may help reduce PD.

Neck and shoulder pain related to computer use

The neck and shoulder pain (NSP) symptoms are very common among intensive computer users. This paper reviews recent 20 years' research publications, which have focused on pathophysiology and other aspects of the neck and shoulder pain related to computer use (NSPRCU). The disorder is usually multidimensional, occupational, personal and social factors are among these evolved. Suggestions concerning the diagnostics, procedures of prevention, and treatment options have been discussed. As the details of pathophysiology of these disorders are not yet clear, further studies on NSPRCU are necessary.

Stress Perception and Social Indicators for Low Back, Shoulder and Joint Pains in Japan: National Surveys in 1995 and 2001

This study aims to clarify the effects of stress perception and related social indicators on three major musculoskeletal symptoms: low back, shoulder, and joint pains in a Japanese population. Twenty health-related variables (stress perception and 19 social indicators) and the three symptoms were obtained from the following Japanese national surveys: the Comprehensive Survey of Living Condition of the People on Health and Welfare, the System of Social and Demographic Statistics of Japan, and the Statistical Report on Health Administration Services. The results were compared among 46 Japanese prefectures in 1995 and 2001. By factor analysis, the 19 indicators were classified into three factors of urbanization, aging and life-regularity, and individualization. The prevalence of stress perception was significantly correlated to the 8 indicators of urbanization factor. Although simple correlation analysis revealed a significant relationship of stress perception only to shoulder pain (in both years) and low back pain (in 2001), the results of multiple regression analysis showed that stress perception and some urbanization factors were significantly associated with all the three symptoms in both years exclusive of joint pain in 1995. Taking the effects of urbanization into consideration, stress perception seems to be closely related to the complaints of musculoskeletal symptoms in Japan.