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Rossetto G, Sala E, Albertelli IF, Donatoni C, Mazzali M, Merlino V, Paraggio E, De Palma G, Lopomo NF. Musculoskeletal disorders and diseases in healthcare workers. A scoping review. Work 2024:WOR230577. [PMID: 38995751 DOI: 10.3233/wor-230577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The impact of work-related tasks with potential biomechanical overload on the musculoskeletal system represents an essential socio-economical challenge. OBJECTIVE This scoping review aimed to map the current literature to identify musculoskeletal disorders and diseases among healthcare professionals and define the approaches used to assess these problems. METHODS The analysis was developed according to the JBI methodologies for scoping reviews and reported following the PRISMA-ScR framework. RESULTS We conducted specific searches on online databases; of the 357 articles initially identified, only 118 met the inclusion criteria. CONCLUSIONS Despite some discrepancies in their unambiguous identification, the presence of work-related musculoskeletal disorders in healthcare professionals is unequivocal. On the other hand, using technology as a supporting evaluation tool still needs to be explored. Furthermore, several improvements are required to enhance the quality of work and simplify the analysis across studies.
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Affiliation(s)
- Gianluca Rossetto
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Emma Sala
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ivan Ferdinando Albertelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy
| | - Claudio Donatoni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy
| | - Marco Mazzali
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy
| | - Valeria Merlino
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy
| | - Emilio Paraggio
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy
| | - Giuseppe De Palma
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy
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Lo GH, Patarini JC, Richard MJ, McAlindon TE, Kriska AM, Rockette-Wagner B, Eaton CB, Hochberg MC, Kwoh CK, Nevitt MC, Driban JB. Gardening/yardwork in people with knee osteoarthritis is not associated with symptom or structural progression over 48 months: data from the Osteoarthritis Initiative. Clin Rheumatol 2024; 43:1755-1762. [PMID: 38561590 DOI: 10.1007/s10067-024-06912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To evaluate the relationship of gardening/yardwork with symptomatic and structural progression in those with pre-existing radiographic knee osteoarthritis (OA) in the Osteoarthritis Initiative (OAI), an observational study designed to evaluate potential and known biomarkers and risk factors of knee OA. METHODS We conducted a cohort study nested within the OAI, including participants ≥ 50 years old with radiographic OA in at least one knee at the time of OAI enrollment. A participant reported the level of gardening/yardwork activity in a self-administered survey. Logistic regression analyses were used to evaluate the association of gardening/yardwork on new frequent knee pain, Kellgren-Lawrence (KL) worsening, medial joint space narrowing (JSN) worsening, and improved frequent knee pain. RESULTS Of 1808 knees (1203 participants), over 60% of knees had KL grade = 2, 65% had medial JSN, and slightly more than a third had frequent knee symptoms. Gardeners/yardworkers and non-gardners/yardworkers had similar "worsening" outcomes for new knee pain (29% vs. 29%), KL worsening (19% vs. 18%), and medial JSN (23% vs. 24%). The adjusted odds ratio (OR) for the "worsening" outcomes of new knee pain, KL worsening, and medial JSN worsening were 1.0 (0.7-1.3), 1.0 (0.8-1.3), and 1.1 (0.9-1.4), respectively. The gardeners/yardworkers had an adjusted OR of 1.2 (0.9-1.7) for improved knee pain compared with non-gardners/yardworkers. CONCLUSION Gardening/yardwork is not associated with knee OA progression and should not be discouraged in those with knee OA. Key Points • Gardening/yardwork is not associated with knee OA symptomatic or structural progression. • Gardening/yardwork should not be discouraged in people with knee OA.
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Affiliation(s)
- Grace H Lo
- Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, BCM-285, Houston, TX, USA.
- Medical Care Line and Research Care Line, Michael E. DeBakey Medical Center, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
| | - Julieann C Patarini
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, MA, USA
| | - Michael J Richard
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, MA, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, MA, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Marc C Hochberg
- Department of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Kent Kwoh
- University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey B Driban
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Higuchi T, Koseki H, Yonekura A, Imai C, Tomonaga I, Sunagawa S, Matsumura U, Osaki M. Comparison of short-term clinical outcomes between open-wedge high tibial osteotomy and tibial condylar valgus osteotomy. BMC Musculoskelet Disord 2024; 25:98. [PMID: 38281004 PMCID: PMC10821256 DOI: 10.1186/s12891-024-07205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND This study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures. METHODS Twenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively. RESULTS Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0). CONCLUSIONS Both osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.
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Affiliation(s)
- Takashi Higuchi
- Department of Physical Therapy, Osaka University of Human Sciences, Settsu, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chieko Imai
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Iku Tomonaga
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Umi Matsumura
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Liu S, Amiri P, McGregor AH, Bull AMJ. Bilateral Asymmetry in Knee and Hip Musculoskeletal Loading During Stair Ascending/Descending in Individuals with Unilateral Mild-to-Moderate Medial Knee Osteoarthritis. Ann Biomed Eng 2023; 51:2490-2503. [PMID: 37482575 PMCID: PMC10598163 DOI: 10.1007/s10439-023-03289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
Most cases of unilateral knee osteoarthritis (OA) progress to bilateral OA within 10 years. Biomechanical asymmetries have been implicated in contralateral OA development; however, gait analysis alone does not consistently detect asymmetries in OA patient gait. Stair ambulation is a more demanding activity that may be more suited to reveal between-leg asymmetries in OA patients. The objective of this study was to investigate the between-leg biomechanical differences in patients with unilateral mild-to-moderate knee OA. Sixteen unilateral mild-to-moderate medial knee OA patients and 16 healthy individuals underwent kinematic and kinetic analysis of stair ascent and descent. Stair ascent produced higher loading and muscle forces in the unaffected limb compared to the OA limb, and stair descent produced lower loading on the OA limb compared to healthy subjects. These biomechanical differences were apparent in the ankle, knee, and hip joints. The implications of these findings are that OA patients rely more heavily on their unaffected sides than the affected side in stair ascent, a strategy that may be detrimental to the unaffected joint health. The reduction in affected limb loading in stair descent is thought to be related to minimizing pain.
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Affiliation(s)
- Sirui Liu
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK.
| | - Pouya Amiri
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
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Lee W, Miller EY, Zhu H, Schneider SE, Reiter DA, Neu CP. Multi-frame biomechanical and relaxometry analysis during in vivo loading of the human knee by spiral dualMRI and compressed sensing. Magn Reson Med 2023; 90:995-1009. [PMID: 37213087 PMCID: PMC10330244 DOI: 10.1002/mrm.29690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Knee cartilage experiences repetitive loading during physical activities, which is altered during the pathogenesis of diseases like osteoarthritis. Analyzing the biomechanics during motion provides a clear understanding of the dynamics of cartilage deformation and may establish essential imaging biomarkers of early-stage disease. However, in vivo biomechanical analysis of cartilage during rapid motion is not well established. METHODS We used spiral displacement encoding with stimulated echoes (DENSE) MRI on in vivo human tibiofemoral cartilage during cyclic varus loading (0.5 Hz) and used compressed sensing on the k-space data. The applied compressive load was set for each participant at 0.5 times body weight on the medial condyle. Relaxometry methods were measured on the cartilage before (T1ρ , T2 ) and after (T1ρ ) varus load. RESULTS Displacement and strain maps showed a gradual shift of displacement and strain in time. Compressive strain was observed in the medial condyle cartilage and shear strain was roughly half of the compressive strain. Male participants had more displacement in the loading direction compared to females, and T1ρ values did not change after cyclic varus load. Compressed sensing reduced the scanning time up to 25% to 40% when comparing the displacement maps and substantially lowered the noise levels. CONCLUSION These results demonstrated the ease of which spiral DENSE MRI could be applied to clinical studies because of the shortened imaging time, while quantifying realistic cartilage deformations that occur through daily activities and that could serve as biomarkers of early osteoarthritis.
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Affiliation(s)
- Woowon Lee
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Emily Y. Miller
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
| | - Hongtian Zhu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Stephanie E. Schneider
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - David A. Reiter
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Corey P. Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
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White DK, Jakiela J, Bye T, Aily J, Voinier D. Stepping Forward: A Scoping Review of Physical Activity in Osteoarthritis. J Rheumatol 2023; 50:611-616. [PMID: 36455947 PMCID: PMC10159874 DOI: 10.3899/jrheum.220728] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 05/03/2023]
Abstract
Physical activity (PA) is recommended to mitigate the symptoms of osteoarthritis (OA); however, this modality remains an unfamiliar construct for many patients and clinicians. Moreover, there can be confusion over the nuanced differences in terminology, such as exercise, sedentary behavior, and moderate intensity. The purpose of this scoping review is to provide a basic overview of PA including terminology, summarize the importance of PA for adults with OA, and discuss current gaps in the literature. Broadly, PA is defined as any energy expenditure from skeletal muscle above a resting level, and exercise is considered a type of PA that is planned, structured, and repetitive. Robust literature shows that PA has a modest protective effect on pain, functional limitation, and disability for OA, in addition to positive effects on a broad range of outcomes from mood and affect to mortality and morbidity in the general population. We provide recommendations for which measurement instruments can be used to record PA, both from a clinical and research perspective, as well as which metrics to employ for summarizing daily activity.
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Affiliation(s)
- Daniel K White
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
| | - Jason Jakiela
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Tom Bye
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Jessica Aily
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Dana Voinier
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Sadura-Sieklucka T, Czerwosz LT, Kądalska E, Kożuchowski M, Księżopolska-Orłowska K, Targowski T. Is Balance Training Using Biofeedback Effective in the Prophylaxis of Falls in Women over the Age of 65? Brain Sci 2023; 13:brainsci13040629. [PMID: 37190594 DOI: 10.3390/brainsci13040629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
The paper aims to investigate the usefulness of training in improving mobility and reducing the risk of falls of patients with osteoarthritis by using a force plate and virtual reality as rehabilitation tools. The study involved 72 women randomly divided into two equal groups: the force plate training group, which underwent virtual balance training with visual motor feedback, and the gym training group, which received conventional balance training only. The functional balance assessment was performed before and after the rehabilitation by computerized posturography in a relaxed upright position with open and closed eyes, with visual motor feedback. In the FPT group in the feedback measurement, the mean radius of sways was 30% smaller after rehabilitation (p < 0.00002); the feedback coordination coefficient was more than 10% bigger after rehabilitation (p < 0.001) and reached 92%, which is excellent for elderly people. Total stagnation and stumbling reported by patients decreased after rehabilitation compared to the first examination. Both tested forms of training can contribute to reducing the risk of falls. However, a more significant improvement was obtained in the force plate training group perhaps because the physical effort on a force plate trains the precise movements needed to reposition the centre of gravity without generating excessive inertia forces responsible for loss of balance and falls. Perhaps the most desirable method of intervention is to train a person's ability to perform slow but definite body movements.
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Affiliation(s)
| | - Leszek Tomasz Czerwosz
- Department of Respiration Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Ewa Kądalska
- National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Marcin Kożuchowski
- National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | | | - Tomasz Targowski
- National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
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Associations between obesity, diabetes mellitus, and cardiovascular disease with progression states of knee osteoarthritis (KOA). Aging Clin Exp Res 2023; 35:333-340. [PMID: 36525243 DOI: 10.1007/s40520-022-02312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data on common comorbidities targeting at different progression states of knee osteoarthritis (KOA) in continuous time are limited. AIMS To examine the associations between obesity, diabetes mellitus (DM), and cardiovascular disease (CVD) with the progression of KOA. METHODS Data were obtained from the Osteoarthritis Initiative for up to 48 months. Progression states of KOA were defined as (1) normal; (2) asymptomatic radiographic KOA (RKOA, Kellgren-Lawrence grade ≥ 2 in at least one knee); (3) only knee symptoms; (4) symptomatic KOA (SxKOA, a combination of RKOA and knee symptoms in the same knee). A multi-state Markov model was used to investigate the associations while accounting for potential confounders. RESULTS Participants with obesity had an increased risk of developing RKOA [normal to asymptomatic RKOA, adjusted hazard ratio (aHR) 1.55, 95% confidence interval (95% CI) (1.07, 2.24); only knee symptoms to SxKOA, aHR 2.25, 95% CI (1.60, 3.18)], and an increased risk of developing knee symptoms [normal to only knee symptoms, aHR 1.45, 95% CI (1.15, 1.83); asymptomatic RKOA to SxKOA, aHR 1.33, 95% CI (1.16, 1.52)]. DM was also significantly associated with development of RKOA or knee symptoms [normal to asymptomatic RKOA, aHR 1.92, 95% CI (1.12, 3.30); normal to only knee symptoms, aHR 1.78, 95% CI (1.12, 2.84)]. Knee symptoms were less likely to be relieved among participants with CVD, compared with those without [only knee symptoms to normal, aHR 0.60, 95% CI (0.38, 0.94)]. CONCLUSIONS Obesity, DM and CVD are associated with an increased risk for SxKOA progression. Common comorbidities should be considered to prevent KOA development.
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Nilsen DH, Furnes O, Kroken G, Robsahm TE, Johnsen MB, Engebretsen L, Nordsletten L, Bahr R, Lie SA. Risk of total hip arthroplasty after elite sport: linking 3304 former world-class athletes with the Norwegian Arthroplasty Register. Br J Sports Med 2022; 57:bjsports-2022-105575. [PMID: 36588424 PMCID: PMC9811096 DOI: 10.1136/bjsports-2022-105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES At present, there is no cure for osteoarthritis (OA), but severe hip joint degeneration can require total hip arthroplasty (THA). The literature on OA after elite sport is limited. We hypothesise that elite athletic activity increases the risk of receiving a THA later in life. METHODS We linked a cohort of former Norwegian world-class athletes (1402 females and 1902 males, active 1936-2006) to the Norwegian Arthroplasty Register (THA performed 1987-2020). We used standardised incidence ratio (SIR), one-minus Kaplan-Meier and relative Cox regression (relative HR, RHR), with 95% CIs, and funnel plots at age 75, to assess THA risk for different sport disciplines, joint impact categories of sport disciplines and sex. The risk of THA for the corresponding general Norwegian population was used as reference. RESULTS We found an overall increased risk for THA for the former elite athletes (SIR 2.11, 95% CI 1.82 to 2.40) at age 75 years, compared with the general population. THA risk at age 75 years was 11.6% for female athletes and 8.3% for male athletes. SIR was 1.90 (95% CI 1.49 to 2.31) for female and 2.28 (95% CI 1.87 to 2.70) for male athletes. Among males, high joint impact sport disciplines were associated with increased risk compared with low-impact sport disciplines (RHR 1.81, 95% CI 1.06 to 3.08, p=0.029). CONCLUSION Having been an elite athlete was associated with a doubling of THA risk compared with the general population for both sexes. High joint impact sport disciplines were associated with subsequent THA for male athletes.
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Affiliation(s)
- Daniel Hoseth Nilsen
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Gard Kroken
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Marianne Bakke Johnsen
- Department of Rehabilitation Science and Health Technology, Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lars Engebretsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Roald Bahr
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Stein Atle Lie
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Osteoarthritis Risks and Sports: An Evidence-based Systematic Review. Sports Med Arthrosc Rev 2022; 30:118-140. [PMID: 35921595 DOI: 10.1097/jsa.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA. METHODS A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 . CONCLUSION Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.
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11
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Lo GH, Richard MJ, McAlindon TE, Park C, Strayhorn MT, Harkey MS, Price LL, Eaton CB, Driban JB. Increased risk of incident knee osteoarthritis in those with greater work-related physical activity. Occup Environ Med 2022; 79:543-549. [PMID: 35618387 PMCID: PMC9337839 DOI: 10.1136/oemed-2022-108212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Occupations involving greater physical activity may increase risk for knee osteoarthritis (OA). Existing studies have not evaluated work-related physical activity before OA onset. Hence, we aimed to evaluate the association between work-related physical activity and knee OA incidence. METHODS We performed a person-based longitudinal study using Osteoarthritis Initiative (OAI) data among people who volunteered or worked for pay without baseline radiographic knee OA or knee pain. Bilateral knee radiographs were obtained at baseline and annual follow-ups. We defined radiographic OA as Kellgren-Lawrence grade ≥2. Questions from the Physical Activity Scale for the Elderly at baseline and annual OAI visits provided information about work-related physical activity level and hours. We performed logistic regression with work-related physical activity level ( mainly sitting , standing and some walking , walking while handling some materials ) and hours as predictors. The outcome was incident person-based radiographic OA within the ensuing 12 months, over 48 months. RESULTS Among 951 participants (2819 observations), higher work-related physical activity levels had greater adjusted ORs for incident radiographic OA (people with jobs with standing and some walking : 1.11 (0.60-2.08), and walking while handling some materials : 1.90 (1.03-3.52), when compared with those with mainly sitting work-related activity ). There was no association between number of hours worked and incident radiographic OA. CONCLUSIONS People performing work that require walking while handling some materials have greater odds of incident knee OA than those with jobs mostly involving sitting. Strategies are needed to mitigate risk factors predisposing them to radiographic OA.
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Affiliation(s)
- Grace H Lo
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA .,Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Michael J Richard
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Chantel Park
- Division of Rheumatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael T Strayhorn
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
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12
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Andersson MLE, Haglund E, Aili K, Bremander A, Bergman S. Cohort profile: the Halland osteoarthritis (HALLOA) cohort-from knee pain to osteoarthritis: a longitudinal observational study in Sweden. BMJ Open 2022; 12:e057086. [PMID: 35835523 PMCID: PMC9289013 DOI: 10.1136/bmjopen-2021-057086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The overall objective in this study is to investigate the early development of radiographic knee osteoarthritis (OA) and its association with hand or/and knee OA, metabolic diseases, biomarkers, chronic pain, physical function and daily physical activity types. PARTICIPANTS The Halland osteoarthritis (HALLOA) cohort is a longitudinal cohort study that includes individuals with knee pain in the southwest of Sweden. Enrolment took place from 2017 to 2019. The inclusion criteria were current knee pain, with no former known radiographic knee OA and no cruciate ligament rupture or rheumatological disorder. The participants were recruited: (1) when seeking care for knee pain in primary healthcare or (2) by advertisements in local newspapers. There are 306 individuals included in the study, mean age (SD) 51.7 (8.7) years and 69% are women. The baseline and follow-ups include clinical tests, radiographical examinations, blood samples, metabolic measures, pain pressure thresholds, tests of physical functions, daily physical activity types and patient-reported outcomes. FINDINGS TO DATE There were associations between metabolic factors and radiographic knee OA, even in those with normal body mass index at baseline. In addition, clinical hand OA was positively associated with fasting plasma glucose. We also found that modifiable factors as increased visceral fat and total body fat were associated with increased pain sensitivity among individuals with knee pain. FUTURE PLANS By studying possible pathophysiological mechanisms of OA over time, we aim to provide new insights on OA progression, identify usable preventive measures helping the clinicians in the management of the disease and improve health for the patients. It is also important to study the development of chronic pain in OA, to get tools to identify individuals at risk and to be able to offer them treatment. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04928170).
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Affiliation(s)
- Maria L E Andersson
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
| | - Emma Haglund
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Enviromental and Biosciences, School of Business, Innovation and Sustainibility, Halmstad University, Halmstad, Sweden
| | - Katarina Aili
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Bremander
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark
| | - S Bergman
- Spenshult Research and Development Centre, Halmstad, Sweden
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions. J Clin Med 2022; 11:jcm11123252. [PMID: 35743322 PMCID: PMC9224572 DOI: 10.3390/jcm11123252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
For patients presenting knee pain coming from osteoarthritis (OA), non-pharmacological conservative treatments (e.g., physical therapy interventions) are among the first methods in orthopedics and rehabilitation to prevent OA progression and avoid knee surgery. However, the best strategy for each patient is difficult to establish, because knee OA's exact causes of progression are not entirely understood. This narrative review presents (i) the most recent update on the pathogenesis of knee OA with the risk factors for developing OA and (ii) the most recent evidence for reducing knee pain with physical therapy intervention such as Diathermy, Exercise therapy, Ultrasounds, Knee Brace, and Electrical stimulation. In addition, we calculated the relative risk reduction in pain perception for each intervention. Our results show that only Brace interventions always reached the minimum for clinical efficiency, making the intervention significant and valuable for the patients regarding their Quality of Life. In addition, more than half of the Exercise and Diathermy interventions reached the minimum for clinical efficiency regarding pain level. This literature review helps clinicians to make evidence-based decisions for reducing knee pain and treating people living with knee OA to prevent knee replacement.
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14
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Frank R, Gilat R, Haunschild ED, Huddleston H, Patel S, Evuarherhe A, Knapik DM, Drager J, Yanke AB, Cole BJ. Do Outcomes of Meniscal Allograft Transplantation Differ Based on Age and Sex? A Comparative Group Analysis. Arthroscopy 2022; 38:452-465.e3. [PMID: 34052385 DOI: 10.1016/j.arthro.2021.05.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the effect of patient age, sex, and associated preoperative factors on patient-reported outcome (PRO) measures and graft survival following primary meniscal allograft transplantation (MAT). METHODS A prospectively collected database was retrospectively reviewed to identify patients who underwent primary MAT with a minimum of 2 years of follow up between 1999 and 2017. Demographic, intraoperative, and postoperative outcome data were collected for each patient. Postoperative outcomes were stratified based on age and sex, and comparative statistical analysis was performed between sexes, both >40 and <40. RESULTS A total of 238 patients underwent primary MAT during the study period, of which 212 patients (mean age, 28.5 ± 9.0 years; range, 15.01-53.67 years) met the inclusion criteria with a mean follow-up of 5.1 ± 3.4 years (range 2.0-15.9 years). At final follow-up, patients ≥40 and <40 years of age demonstrated statistically significant improvements in nearly all PRO scores (P < .05 for both groups). There were no significant differences between either group for achievement of minimal clinically important difference for International Knee Documentation Committee (P = .48) or Knee Injury and Osteoarthritis Outcome Score symptoms (P = .76). Because of insufficient numbers, a statistically significant difference could not be demonstrated in reoperation rate (≥40: 1.49 ± 1.77 years, <40: 1.87 ± 1.98 years, P = .591), failure rate (≥40: 7/32 [21.9%], <40: 19/180 [10.6%], P = .072), or complication rate (≥40: 2/32 [6.3%], <40: 12/180 [6.7%], P = .930) based on age. Both sexes showed a significant improvement in PROs, whereas female patients were more likely to undergo revision surgery (P = .033), with no significant differences based on time to reoperation, failure, or complication rates. CONCLUSIONS PROs similarly improved following MAT in both patients aged ≥40 and those <40 at final follow-up with no significant differences in minimal clinically important difference achievement rate, complication rate, reoperation rate, time to reoperation, or failure rate between groups. Female patients may be more likely to undergo revision surgery after MAT. LEVEL OF EVIDENCE III; therapeutic retrospective comparison study.
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Affiliation(s)
- Rachel Frank
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Hailey Huddleston
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sumit Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Aghogho Evuarherhe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Justin Drager
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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15
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Lessa RS, Fernandes RDCP. Dor nas extremidades inferiores, demandas físicas e psicológicas em trabalhadores da limpeza urbana: estudo transversal. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2022. [DOI: 10.1590/2317-6369000019919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: descrever as características do trabalho e investigar a prevalência e os fatores associados à dor em membros inferiores em trabalhadores da limpeza urbana. Métodos: estudo de corte transversal, realizado na Bahia. Dados coletados entre 2009 e 2010. A dor foi avaliada por meio do Nordic Musculoskeletal Questionnaire, enquanto as demandas psicossociais no trabalho foram medidas pelo Job Content Questionnaire. Também foram avaliadas as demandas físicas, incluindo posturas gerais e manuseio de carga. A análise de regressão logística múltipla foi utilizada para identificar fatores associados à dor em membros inferiores. Resultados: 624 trabalhadores participaram da pesquisa. Constatou-se alta prevalência de dor em membros inferiores nos últimos sete dias (23,7%) e nos últimos doze meses (42,1%), sendo maior entre agentes de limpeza e coletores. A dor em membros inferiores foi associada a: mais de três anos de trabalho na empresa (OR = 1,34); alta exposição ao manuseio de cargas (OR = 1,35); demanda psicológica no trabalho (OR = 1,87); e condicionamento físico insuficiente (OR = 1,67). O trabalho na limpeza urbana envolveu grande sobrecarga física, com pressão de tempo para sua execução. Conclusão: evidenciou-se a necessidade de medidas para redução do manuseio de cargas e de mudanças na organização do trabalho, incluindo pausas durante a jornada e adequação das tarefas ao tempo disponível, a fim de evitar sobrecargas física e psicológica dos trabalhadores.
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Whittaker JL, Runhaar J, Bierma-Zeinstra S, Roos EM. A lifespan approach to osteoarthritis prevention. Osteoarthritis Cartilage 2021; 29:1638-1653. [PMID: 34560260 DOI: 10.1016/j.joca.2021.06.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
Prevention is an attractive solution for the staggering and increasingly unmanageable burden of osteoarthritis. Despite this, the field of osteoarthritis prevention is relatively immature. To date, most of what is known about preventing osteoarthritis and risk factors for osteoarthritis is relative to the disease (underlying biology and pathophysiology) of osteoarthritis, with few studies considering risk factors for osteoarthritis illness, the force driving the personal, financial and societal burden. In this narrative review we will discuss what is known about osteoarthritis prevention, propose actionable prevention strategies related to obesity and joint injury which have emerged as important modifiable risk factors, identify where evidence is lacking, and give insight into what might be possible in terms of prevention by focussing on a lifespan approach to the illness of osteoarthritis, as opposed to a structural disease of the elderly. By targeting a non-specialist audience including scientists, clinicians, students, industry employees and others that are interested in osteoarthritis but who do not necessarily focus on osteoarthritis, the goal is to generate discourse and motivate inquiry which propel the field of osteoarthritis prevention into the mainstream.
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Affiliation(s)
- J L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Arthritis Research Canada, Canada.
| | - J Runhaar
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands.
| | - S Bierma-Zeinstra
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Erasmus MC University Medical Center Rotterdam, Department of General Practice, and Department of Orthopaedics, Rotterdam, the Netherlands.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Denmark.
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17
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Ningrum DNA, Kung WM, Tzeng IS, Yuan SP, Wu CC, Huang CY, Muhtar MS, Nguyen PA, Li JYC, Wang YC. A Deep Learning Model to Predict Knee Osteoarthritis Based on Nonimage Longitudinal Medical Record. J Multidiscip Healthc 2021; 14:2477-2485. [PMID: 34539180 PMCID: PMC8445097 DOI: 10.2147/jmdh.s325179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To develop deep learning model (Deep-KOA) that can predict the risk of knee osteoarthritis (KOA) within the next year by using the previous three years nonimage-based electronic medical record (EMR) data. PATIENTS AND METHODS We randomly selected information of two million patients from the Taiwan National Health Insurance Research Database (NHIRD) from January 1, 1999 to December 31, 2013. During the study period, 132,594 patients were diagnosed with KOA, while 1,068,464 patients without KOA were chosen randomly as control. We constructed a feature matrix by using the three-year history of sequential diagnoses, drug prescriptions, age, and sex. Deep learning methods of convolutional neural network (CNN) and artificial neural network (ANN) were used together to develop a risk prediction model. We used the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and precision to evaluate the performance of Deep-KOA. Then, we explored the important features using stepwise feature selection. RESULTS This study included 132,594 KOA patients, 83,111 females (62.68%), 49,483 males (37.32%), mean age 64.2 years, and 1,068,464 non-KOA patients, 545,902 females (51.09%), 522,562 males (48.91%), mean age 51.00 years. The Deep-KOA achieved an overall AUROC, sensitivity, specificity, and precision of 0.97, 0.89, 0.93, and 0.80 respectively. The discriminative analysis of Deep-KOA showed important features from several diseases such as disorders of the eye and adnexa, acute respiratory infection, other metabolic and immunity disorders, and diseases of the musculoskeletal and connective tissue. Age and sex were not found as the most discriminative features, with AUROC of 0.9593 (-0.76% loss) and 0.9644 (-0.25% loss) respectively. Whereas medications including antacid, cough suppressant, and expectorants were identified as discriminative features. CONCLUSION Deep-KOA was developed to predict the risk of KOA within one year earlier, which may provide clues for clinical decision support systems to target patients with high risk of KOA to get precision prevention program.
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Affiliation(s)
- Dina Nur Anggraini Ningrum
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Public Health Department, Faculty of Sport Science, Universitas Negeri Semarang, Semarang City, Indonesia
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Statistics, National Taipei University, Taipei, Taiwan
| | - Sheng-Po Yuan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Department of Otorhinolaryngology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chieh-Chen Wu
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Chu-Ya Huang
- Taiwan College of Healthcare Executives, Taipei, Taiwan
| | - Muhammad Solihuddin Muhtar
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Phung-Anh Nguyen
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Jack Yu-Chuan Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao-Chin Wang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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18
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Krishnamurthy A, Lang AE, Pangarkar S, Edison J, Cody J, Sall J. Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis. Mayo Clin Proc 2021; 96:2435-2447. [PMID: 34481599 DOI: 10.1016/j.mayocp.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched (ie, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE PreMEDLINE, PubMed, and the Agency for Healthcare Research and Quality website) and evaluated the literature, created a simple 1-page algorithm, and advanced 19 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. This synopsis summarizes key recommendations in all 6 topics covered in the guideline. These topics are diagnosis, self-management, physical therapy, pharmacotherapy, orthobiologics, and complementary and integrative health.
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Affiliation(s)
- Anil Krishnamurthy
- Department of Orthopedics and Plastic Surgery, Dayton Veterans Affairs Medical Center, Dayton, OH; Department of Orthopaedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA.
| | - Sanjog Pangarkar
- Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
| | - Jess Edison
- Department of Rheumatology ,Walter Reed National Military Medical Center, Bethesda, MD
| | - John Cody
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - James Sall
- Office of Evidence-Based Practice, Veterans Affairs Central Office, Washington, DC
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19
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Agarwal BM, Yadav RP, Tambe SD, Kulkarni CC, Mullerpatan RP. Evaluation of Early Knee Osteoarthritis Using Biomechanical and Biochemical Markers. Crit Rev Biomed Eng 2021; 49:29-39. [PMID: 35993949 DOI: 10.1615/critrevbiomedeng.2022043127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Altered cellular mechano-transduction and biochemistry lead to degeneration of articular cartilage in people with knee osteoarthritis. However, the influence of low-moderate exposure to weight-bearing activity such as squatting on cartilage metabolism has not been adequately studied. The current study explored associations between knee adduction moment (KAM) during walking, biochemical markers and daily squat exposure. 3D gait analysis was used to determine external loads acting on the knee as indicators of joint compressive forces whereas biomarkers-Urine type-II-collagen-telopeptide (uCTxII), antioxidant and phospholipase A2 (PLA2) activity reflected on articular cartilage status. Following ethical approval, 66 participants with varying daily squat exposure (non-squatters [n = 21, exposure = 0 min]; activity of daily living [ADL] squatters [n = 16, exposure = 34 min]; occupational squatters [n = 13, exposure = 102 min]) and people with grade 2-3 knee osteoarthritis (n = 16, exposure = 28 min) were evaluated using 3D gait and biomarker analysis. The PLA2 activity was lowest in ADL squatters while occupational squatters demonstrated highest activity (p < 0.05). KAM and urine biomarker were similar among the groups. Moderate-strong positive association was observed between sweat PLA2 activity and age (r = 0.819, p = 0.004), daily squat exposure and biomarker uCTxII (r = 0.604, p = 0.013), antioxidant activity and Right-KAM (r = -0.917, p = 0.001), and Left-KAM (r = -0.767, p = 0.016), in people with knee OA. Healthy people demonstrated weak positive associations between KAM, uCTxII, and BMI. Associations between non-invasive biomechanical and biochemical markers indicate their potential use to identify early knee osteoarthritis. Studies with larger sample size are necessary to support prescription of body weight joint loading activities such as squatting in moderation, to delay functional decline caused by knee OA.
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Affiliation(s)
- Bela M Agarwal
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Sector 1, Plot Number 1&2, Kamothe, Navi Mumbai, Maharashtra, India
| | - Raman P Yadav
- MGMIHS OMICS Research Center, MGM Medical College, MGM Institute of Health Sciences, Sector 1, Plot Number 1&2, Kamothe, Navi Mumbai, India
| | - Sanketa D Tambe
- MGMIHS OMICS Research Center, MGM Medical College, MGM Institute of Health Sciences, Sector 1, Plot Number 1&2, Kamothe, Navi Mumbai, India
| | - Chandana C Kulkarni
- MGMIHS OMICS Research Center, MGM Medical College, MGM Institute of Health Sciences, Sector 1, Plot Number 1&2, Kamothe, Navi Mumbai, India
| | - Rajani P Mullerpatan
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Sector 1, Plot Number 1&2, Kamothe, Navi Mumbai, Maharashtra, India
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20
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Abstract
Osteoarthritis is a prominent cause of disability in older adults, especially with an increasingly obese and aging population. Clinical management of pain secondary to osteoarthritis should focus on education and self-management with exercise and weight management as a priority. Surgical intervention should only be considered once conservative measures have failed. This review provides a clinical update on the pathogenesis, diagnosis, and management of osteoarthritis.
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Primorac D, Molnar V, Rod E, Jeleč Ž, Čukelj F, Matišić V, Vrdoljak T, Hudetz D, Hajsok H, Borić I. Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations. Genes (Basel) 2020; 11:E854. [PMID: 32722615 PMCID: PMC7464436 DOI: 10.3390/genes11080854] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/11/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
Being the most common musculoskeletal progressive condition, osteoarthritis is an interesting target for research. It is estimated that the prevalence of knee osteoarthritis (OA) among adults 60 years of age or older is approximately 10% in men and 13% in women, making knee OA one of the leading causes of disability in elderly population. Today, we know that osteoarthritis is not a disease characterized by loss of cartilage due to mechanical loading only, but a condition that affects all of the tissues in the joint, causing detectable changes in tissue architecture, its metabolism and function. All of these changes are mediated by a complex and not yet fully researched interplay of proinflammatory and anti-inflammatory cytokines, chemokines, growth factors and adipokines, all of which can be measured in the serum, synovium and histological samples, potentially serving as biomarkers of disease stage and progression. Another key aspect of disease progression is the epigenome that regulates all the genetic expression through DNA methylation, histone modifications, and mRNA interference. A lot of work has been put into developing non-surgical treatment options to slow down the natural course of osteoarthritis to postpone, or maybe even replace extensive surgeries such as total knee arthroplasty. At the moment, biological treatments such as platelet-rich plasma, bone marrow mesenchymal stem cells and autologous microfragmented adipose tissue containing stromal vascular fraction are ordinarily used. Furthermore, the latter two mentioned cell-based treatment options seem to be the only methods so far that increase the quality of cartilage in osteoarthritis patients. Yet, in the future, gene therapy could potentially become an option for orthopedic patients. In the following review, we summarized all of the latest and most important research in basic sciences, pathogenesis, and non-operative treatment.
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Affiliation(s)
- Dragan Primorac
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- Eberly College of Science, The Pennsylvania State University, University Park, State College, PA 16802, USA
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT 06516, USA
- Medical School, University of Split, 21000 Split, Croatia
- School of Medicine, Faculty of Dental Medicine and Health, University “Josip Juraj Strossmayer”, 31000 Osijek, Croatia
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Medical School REGIOMED, 96 450 Coburg, Germany
- Medical School, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Vilim Molnar
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Eduard Rod
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Željko Jeleč
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing, University North, 48 000 Varaždin, Croatia
| | - Fabijan Čukelj
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- Medical School, University of Split, 21000 Split, Croatia
| | - Vid Matišić
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
| | - Trpimir Vrdoljak
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- Department of Orthopedics, Clinical Hospital “Sveti Duh”, 10000 Zagreb, Croatia
| | - Damir Hudetz
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Orthopedics, Clinical Hospital “Sveti Duh”, 10000 Zagreb, Croatia
| | - Hana Hajsok
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- Medical School, University of Zagreb, 10000 Zagreb, Croatia
| | - Igor Borić
- St. Catherine Specialty Hospital, 49210 Zabok/10000 Zagreb, Croatia; (V.M.); (E.R.); (Ž.J.); (F.Č.); (V.M.); (T.V.); (D.H.); (H.H.); (I.B.)
- Medical School, University of Split, 21000 Split, Croatia
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Medical School, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
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Abstract
Being the most common musculoskeletal progressive condition, osteoarthritis is an interesting target for research. It is estimated that the prevalence of knee osteoarthritis (OA) among adults 60 years of age or older is approximately 10% in men and 13% in women, making knee OA one of the leading causes of disability in elderly population. Today, we know that osteoarthritis is not a disease characterized by loss of cartilage due to mechanical loading only, but a condition that affects all of the tissues in the joint, causing detectable changes in tissue architecture, its metabolism and function. All of these changes are mediated by a complex and not yet fully researched interplay of proinflammatory and anti-inflammatory cytokines, chemokines, growth factors and adipokines, all of which can be measured in the serum, synovium and histological samples, potentially serving as biomarkers of disease stage and progression. Another key aspect of disease progression is the epigenome that regulates all the genetic expression through DNA methylation, histone modifications, and mRNA interference. A lot of work has been put into developing non-surgical treatment options to slow down the natural course of osteoarthritis to postpone, or maybe even replace extensive surgeries such as total knee arthroplasty. At the moment, biological treatments such as platelet-rich plasma, bone marrow mesenchymal stem cells and autologous microfragmented adipose tissue containing stromal vascular fraction are ordinarily used. Furthermore, the latter two mentioned cell-based treatment options seem to be the only methods so far that increase the quality of cartilage in osteoarthritis patients. Yet, in the future, gene therapy could potentially become an option for orthopedic patients. In the following review, we summarized all of the latest and most important research in basic sciences, pathogenesis, and non-operative treatment.
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Gignac MAM, Irvin E, Cullen K, Van Eerd D, Beaton DE, Mahood Q, McLeod C, Backman CL. Men and Women's Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systematic Review and Recommendations for Future Research. Arthritis Care Res (Hoboken) 2020; 72:378-396. [PMID: 30762317 PMCID: PMC7065017 DOI: 10.1002/acr.23855] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/12/2019] [Indexed: 12/24/2022]
Abstract
Objective To systematically review the evidence for an increased risk of osteoarthritis in the hip, knee, hand, wrist, finger, ankle, foot, shoulder, neck, and spine related to diverse occupational activities of men and women and to examine dose‐response information related to the frequency, intensity, and duration of work exposures and the risk of osteoarthritis (OA). Methods Established guidelines for systematic reviews in occupational health and safety studies were followed. MEDLINE, Embase, CINAHL, and Cochrane Library were searched from inception to December 2017. Studies were reviewed for relevance, quality was appraised, and data were extracted and synthesized. Results Sixty‐nine studies from 23 countries yielded strong and moderate evidence for lifting, cumulative physical loads, full‐body vibration, and kneeling/squatting/bending as increasing the risks of developing OA in men and women. Strong and moderate evidence existed for no increased risk of OA related to sitting, standing, and walking (hip and knee OA), lifting and carrying (knee OA), climbing ladders (knee OA), driving (knee OA), and highly repetitive tasks (hand OA). Variability in dose‐response data resulted in an inability to synthesize these data. Conclusion Evidence points to the potential for OA occupational recommendations and practice considerations to be developed for women and men. However, research attention is needed to overcome deficits in the measurement and recall of specific work activities so that recommendations and practice considerations can provide the specificity needed to be adopted in workplaces.
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Affiliation(s)
- Monique A M Gignac
- Institute for Work and Health and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emma Irvin
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Kim Cullen
- Institute for Work and Health, Toronto, and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Quenby Mahood
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Chris McLeod
- Institute for Work and Health, Toronto, Ontario, and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine L Backman
- University of British Columbia and Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada
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Yang Y, You X, Cohen JD, Zhou H, He W, Li Z, Xiong Y, Yu T. Sex Differences in Osteoarthritis Pathogenesis: A Comprehensive Study Based on Bioinformatics. Med Sci Monit 2020; 26:e923331. [PMID: 32255771 PMCID: PMC7163332 DOI: 10.12659/msm.923331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Osteoarthritis (OA) is a common disorder in the elderly. OA influences the daily life of patients and has become a worldwide health problem. It is still unclear whether the pathogenesis mechanism is different between males and females. This study investigated the differentially expressed genes (DEGs) and explored the different signaling pathways of OA between males and females. Material/Methods Data sets of GSE55457, GSE55584, and GSE12021 were retrieved from Gene Expression Omnibus to conduct DEGs analysis. Enrichment analysis of Kyoto Encyclopedia of Genes and Genomes pathway and Gene Ontology term was performed using the Database for Annotation, Visualization and Integrated Discovery (DAVID) bioinformatics tool. The protein interaction network was constructed in Cytoscape 3.7.2. qRT-PCR was then performed to validate the expression of hub genes in OA patients and healthy people. Results In total, 4 co-upregulated and 10 co-downregulated genes were identified. We found that enriched pathways were different between males and females. BCL2L1, EEF1A1, EEF2, HNRNPD, and PABPN1 were considered as hub genes in OA pathogenesis in males, while EEF2, EEF1A1, RPL37A, FN1 were considered as hub genes in OA pathogenesis in females. Consistent with the bioinformatics analysis, the qRT-PCR analysis also showed that the gene expression of BCL2L1, HNRNPD, and PABPN1 was significantly lower in male OA patients. In contrast, EEF2, EEF1A1, and RPL37A were significantly lower in female OA patients. Conclusions The DEGs identified may be involved in different OA disease progression mechanisms between males and females, and they are considered as treatment targets or prognosis markers for males and females. The pathogenesis mechanism is sex-dependent.
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Affiliation(s)
- Yunfeng Yang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xiaomeng You
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jordan Daniel Cohen
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Haichao Zhou
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Wenbao He
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zihua Li
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Tao Yu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Schram B, Orr R, Pope R, Canetti E, Knapik J. Risk factors for development of lower limb osteoarthritis in physically demanding occupations: A narrative umbrella review. J Occup Health 2019; 62:e12103. [PMID: 31828895 PMCID: PMC6970406 DOI: 10.1002/1348-9585.12103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives Osteoarthritis (OA) is a common disorder which affects the joints. As relationships between occupational factors and lower limb OA have been widely studied in systematic reviews, the aim of this umbrella review was to synthesize their key findings in the risk factors for development of lower limb OA. Methods A systematic search was conducted using the databases PUBMED, Cumulative Index of Nursing and Allied Health Literature, and Elton B Stevens Company to identify reviews examining associations between lower limb OA and occupational tasks. These reviews were rated for their methodological quality before key data were extracted and synthesized. Results Sixteen reviews were found, seven pertained to the knee, four to the hip, two to a variety of joints, and three to both the hip and knee. One was deemed to be of high methodological quality, one of critically low methodological quality, and the others of moderate methodological quality. The reviews found moderate to good evidence for heavy occupational lifting to be associated with an increased risk of OA at the knee and the hip. Kneeling, squatting, and climbing, previous injuries to joints, being overweight and obese were also predictive of lower limb OA. Conclusion Occupations which involve heavy physical workloads increase the risk of developing lower limb OA. Heavy lifting, squatting, knee bending, kneeling, and climbing may all increase the risk of developing OA in both the knees and hips. Efforts to reduce exposure to these tasks, reducing joint injuries, optimizing bodyweight may reduce the risks of lower limb OA for occupations which are physically demanding.
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Affiliation(s)
- Ben Schram
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Rodney Pope
- Tactical Research Unit, Bond University, Robina, QLD, Australia.,School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Elisa Canetti
- Tactical Research Unit, Bond University, Robina, QLD, Australia
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Mikkelsen S, Pedersen EB, Brauer C, Møller KL, Alkjaer T, Koblauch H, Simonsen EB, Thygesen LC. Knee osteoarthritis among airport baggage handlers: A prospective cohort study. Am J Ind Med 2019; 62:951-960. [PMID: 31452223 DOI: 10.1002/ajim.23044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/12/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Knee osteoarthritis is a common and often disabling disorder, which has been related to knee-straining work. However, exposure response relations are uncertain and there are few prospective studies. We studied prospectively if incident knee osteoarthritis is associated with cumulative exposure as an airport baggage handler, lifting on average 5000 kg/d. METHODS The study is based on the Copenhagen Airport Cohort, a historical cohort of male baggage handlers and a reference group of unskilled men from the greater Copenhagen area, followed from 1990 to 2012. Cumulative years of employment as a baggage handler was based on information from company employment and union registers. Outcome was first hospital admission with a discharge diagnosis of knee osteoarthritis and/or knee replacement, ascertained from the Danish National Patient Register. RESULTS The cohort contained 3442 baggage handlers and 65 511 workers in the reference group. The unadjusted incidence rate ratio (IRR) of knee osteoarthritis increased steeply with cumulative years as a baggage handler. Although the exposure-response pattern became weaker and statistically nonsignificant (P ≈ .10) when adjusting for age, the risk of knee osteoarthritis was still increased in baggage handlers at the highest exposure level. Additional analyses showed that the association between age and osteoarthritis was stronger for baggage handlers (IRR = 2.09; 95% CI: 1.68-2.60) than for referents (IRR = 1.58; 95% CI: 1.53-1.63), indicating that knee osteoarthritis occurred at a younger age among baggage handlers than in the reference group. CONCLUSIONS The results of this prospective cohort study support that long-term heavy lifting increases the risk of knee osteoarthritis.
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Affiliation(s)
- Sigurd Mikkelsen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ellen B Pedersen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Karina L Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Tine Alkjaer
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen N, Denmark
- The Department of Physical and Occupational Therapy, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Henrik Koblauch
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Erik B Simonsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Higuchi T, Koseki H, Yonekura A, Chiba K, Nakazoe Y, Sunagawa S, Noguchi C, Osaki M. Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy. BMC Musculoskelet Disord 2019; 20:409. [PMID: 31484580 PMCID: PMC6727502 DOI: 10.1186/s12891-019-2764-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO. Methods Thirty-two cases involving 35 knees that had undergone HTO and the same number that had undergone TCVO for knee osteoarthritis were retrospectively evaluated. Characteristics of both groups did not differ significantly. Lower limb alignment, bone morphology, joint congruity, and joint instability were measured in standing full-length leg and knee radiographs obtained before and after surgery. Results Radiological features in the TCVO group included greater frequencies of advanced knee OA grade, varus lower limb malalignment, depression of the medial tibial plateau, and varus-valgus joint instability compared to the HTO group before surgery. However, tibial morphology, alignment of the lower limb, and joint instability improved to comparable levels after surgery in both groups. Conclusions TCVO appears preferable in cases with advanced knee OA, destroyed or inclined medial tibial plateau, widened and subluxated lateral joint, and high varus-valgus joint instability.
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Affiliation(s)
- Takashi Higuchi
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan. .,Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Nakazoe
- Department of Orthopedic Surgery, Wajinkai Hospital, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Chieko Noguchi
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Schmajuk G, Trupin L, Yelin E, Blanc PD. Prevalence of Arthritis and Rheumatoid Arthritis in Coal Mining Counties of the United States. Arthritis Care Res (Hoboken) 2019; 71:1209-1215. [PMID: 30875457 DOI: 10.1002/acr.23874] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Exposure to inhaled mineral dust, in particular silica, is associated with increased odds of rheumatoid arthritis (RA) and other autoimmune diseases. We studied the association of RA with work-related coal and silica exposure in the Appalachian region of the US. METHODS We carried out a random-digit dialed telephone survey in selected counties in Appalachia that had elevated coal workers' pneumoconiosis mortality. Our study cohort included men ages ≥50 with any employment history, and we assessed exposure to coal mining employment, other work-related dust, and ergonomic factors. We ascertained self-reported physician diagnosis of any arthritis and of RA with glucocorticoid treatment. We used multivariable logistic regression analysis to estimate the odds ratios (ORs) and associated population attributable fraction (PAF) estimates. RESULTS Among the 973 men who met study entry criteria (mean ± SD ages 66 ± 10 years; 54% ever smokers), 266 (27%) reported coal mining work and 189 (19%) reported other work-related silica exposure. There were 517 men (53%), who reported any arthritis and 112 (12%) whose disease met the study definition of RA. Adjusting for covariates, coal mining was associated with elevated odds of RA (OR 3.6 [95% confidence interval (95% CI) 2.1-6.2]), which accounted for a PAF of 33% (95% CI 26-40%) of the men studied. For any arthritis, the coal mining-associated OR was 2.3 (95% CI 1.6-3.2), with an associated PAF of 20% (95% CI 14-25%). CONCLUSION In this population of older males living in a coal mining region, we estimated that 20% of arthritis and 33% of RA may be attributable to coal mining work.
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Affiliation(s)
- Gabriela Schmajuk
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
| | | | | | - Paul D Blanc
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
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Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers. Cochrane Database Syst Rev 2019; 7:CD012886. [PMID: 31334564 PMCID: PMC6646952 DOI: 10.1002/14651858.cd012886.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Work-related musculoskeletal disorders are a group of musculoskeletal disorders that comprise one of the most common disorders related to occupational sick leave worldwide. Musculoskeletal disorders accounted for 21% to 28% of work absenteeism days in 2017/2018 in the Netherlands, Germany and the UK. There are several interventions that may be effective in tackling the high prevalence of work-related musculoskeletal disorders among workers, such as physical, cognitive and organisational interventions. In this review, we will focus on work breaks as a measure of primary prevention, which are a type of organisational intervention. OBJECTIVES To compare the effectiveness of different work-break schedules for preventing work-related musculoskeletal symptoms and disorders in healthy workers, when compared to conventional or alternate work-break schedules. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, SCOPUS, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform, to April/May 2019. In addition, we searched references of the included studies and of relevant literature reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of work-break interventions for preventing work-related musculoskeletal symptoms and disorders among workers. The studies were eligible for inclusion when intervening on work-break frequency, duration and/or type, compared to conventional or an alternate work-break intervention. We included only those studies in which the investigated population included healthy, adult workers, who were free of musculoskeletal complaints during study enrolment, without restrictions to sex or occupation. The primary outcomes were newly diagnosed musculoskeletal disorders, self-reported musculoskeletal pain, discomfort or fatigue, and productivity or work performance. We considered workload changes as secondary outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts for study eligibility, extracted data and assessed risk of bias. We contacted authors for additional study data where required. We performed meta-analyses, where possible, and we assessed the overall quality of the evidence for each outcome of each comparison using the five GRADE considerations. MAIN RESULTS We included six studies (373 workers), four parallel RCTs, one cross-over RCT, and one combined parallel plus cross-over RCT. At least 295 of the employees were female and at least 39 male; for the remaining 39 employees, the sex was not specified in the study trial. The studies investigated different work-break frequencies (five studies) and different work-break types (two studies). None of the studies investigated different work-break durations. We judged all studies to have a high risk of bias. The quality of the evidence for the primary outcomes of self-reported musculoskeletal pain, discomfort and fatigue was low; the quality of the evidence for the primary outcomes of productivity and work performance was very low. The studies were executed in Europe or Northern America, with none from low- to middle-income countries. One study could not be included in the data analyses, because no detailed results have been reported.Changes in the frequency of work breaksThere is low-quality evidence that additional work breaks may not have a considerable effect on musculoskeletal pain, discomfort or fatigue, when compared with no additional work breaks (standardised mean difference (SMD) -0.08; 95% CI -0.35 to 0.18; three studies; 225 participants). Additional breaks may not have a positive effect on productivity or work performance, when compared with no additional work breaks (SMD -0.07; 95% CI -0.33 to 0.19; three studies; 225 participants; very low-quality evidence).We found low-quality evidence that additional work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 1.80 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 15 participants), when compared to work breaks as needed (i.e. microbreaks taken at own discretion). There is very low-quality evidence that additional work breaks may have a positive effect on productivity or work performance, when compared to work breaks as needed (MD 542.5 number of words typed per 3-hour recording session; 95% CI 177.22 to 907.78; one study; 15 participants).Additional higher frequency work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 11.65 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 10 participants; low-quality evidence), when compared to additional lower frequency work breaks. We found very low-quality evidence that additional higher frequency work breaks may not have a considerable effect on productivity or work performance (MD -83.00 number of words typed per 3-hour recording session; 95% CI -305.27 to 139.27; one study; 10 participants), when compared to additional lower frequency work breaks.Changes in the duration of work breaksNo trials were identified that assessed the effect of different durations of work breaks.Changes in the type of work breakWe found low-quality evidence that active breaks may not have a considerable positive effect on participant-reported musculoskeletal pain, discomfort and fatigue (MD -0.17 on a 1-7 NRS scale; 95% CI -0.71 to 0.37; one study; 153 participants), when compared to passive work breaks.Relaxation work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue, when compared to physical work breaks (MD 0.20 on a 1-7 NRS scale; 95% CI -0.43 to 0.82; one study; 97 participants; low-quality evidence). AUTHORS' CONCLUSIONS We found low-quality evidence that different work-break frequencies may have no effect on participant-reported musculoskeletal pain, discomfort and fatigue. For productivity and work performance, evidence was of very low-quality that different work-break frequencies may have a positive effect. For different types of break, there may be no effect on participant-reported musculoskeletal pain, discomfort and fatigue according to low-quality evidence. Further high-quality studies are needed to determine the effectiveness of frequency, duration and type of work-break interventions among workers, if possible, with much higher sample sizes than the studies included in the current review. Furthermore, work-break interventions should be reconsidered, taking into account worker populations other than office workers, and taking into account the possibility of combining work-break intervention with other interventions such as ergonomic training or counselling, which may may possibly have an effect on musculoskeletal outcomes and work performance.
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Affiliation(s)
- Tessy Luger
- University of TübingenInstitute of Occupational and Social Medicine and Health Services ResearchWilhelmstrasse 27TübingenGermany72074
| | - Christopher G Maher
- University of SydneySydney School of Public HealthLevel 10 North, King George V Building, Missenden Road, CamperdownSydneyNSWAustralia2050
| | - Monika A Rieger
- University of TübingenInstitute of Occupational and Social Medicine and Health Services ResearchWilhelmstrasse 27TübingenGermany72074
| | - Benjamin Steinhilber
- University of TübingenInstitute of Occupational and Social Medicine and Health Services ResearchWilhelmstrasse 27TübingenGermany72074
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Abstract
Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.
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Affiliation(s)
- David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - Sita Bierma-Zeinstra
- Departments of General Practice and Orthopaedic Surgery, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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A Deep Neural Network-Based Method for Early Detection of Osteoarthritis Using Statistical Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071281. [PMID: 30974803 PMCID: PMC6480580 DOI: 10.3390/ijerph16071281] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/29/2019] [Accepted: 04/07/2019] [Indexed: 11/25/2022]
Abstract
A large number of people suffer from certain types of osteoarthritis, such as knee, hip, and spine osteoarthritis. A correct prediction of osteoarthritis is an essential step to effectively diagnose and prevent severe osteoarthritis. Osteoarthritis is commonly diagnosed by experts through manual inspection of patients’ medical images, which are usually collected in hospitals. Checking the occurrence of osteoarthritis is somewhat time-consuming for patients. In addition, the current studies are focused on automatically detecting osteoarthritis through image-based deep learning algorithms. This needs patients’ medical images, which requires patients to visit the hospital. However, medical utilization and health behavior information as statistical data are easier to collect and access than medical images. Using indirect statistical data without any medical images to predict the occurrence of diverse forms of OA can have significant impacts on pro-active and preventive medical care. In this study, we used a deep neural network for detecting the occurrence of osteoarthritis using patient’s statistical data of medical utilization and health behavior information. The study was based on 5749 subjects. Principal component analysis with quantile transformer scaling was employed to generate features from the patients’ simple background medical records and identify the occurrence of osteoarthritis. Our experiments showed that the proposed method using deep neural network with scaled PCA resulted in 76.8% of area under the curve (AUC) and minimized the effort to generate features. Hence, this methos can be a promising tool for patients and doctors to prescreen for possible osteoarthritis to reduce health costs and patients’ time in hospitals.
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Konstari S, Sares-Jäske L, Heliövaara M, Rissanen H, Knekt P, Arokoski J, Sundvall J, Karppinen J. Dietary magnesium intake, serum high sensitivity C-reactive protein and the risk of incident knee osteoarthritis leading to hospitalization-A cohort study of 4,953 Finns. PLoS One 2019; 14:e0214064. [PMID: 30908508 PMCID: PMC6433216 DOI: 10.1371/journal.pone.0214064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/06/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives To study whether low dietary magnesium (Mg) intake and serum high sensitivity C-reactive protein (hs-CRP) predict the development of clinical knee osteoarthritis (OA). Methods The cohort consisted of 4,953 participants of a national health examination survey who were free of knee and hip OA at baseline. Information on the incidence of knee OA leading to hospitalization was drawn from the National Care Register for Health Care. During the follow-up of 10 years, 123 participants developed incident knee OA. Dietary magnesium intake was assessed on the basis of a food frequency questionnaire from the preceding year. We used Cox’s proportional hazards model to estimate the strength of the association between the tertiles of dietary Mg intake and incident knee OA, adjusted for baseline age, gender, energy intake, BMI, history of physical workload, leisure time physical activity, injuries, knee complaints, the use of Mg supplements, and serum hs-CRP levels. Results At baseline, dietary Mg intake was inversely associated with serum hs-CRP even after adjustment for all the potential confounding factors. During the follow-up, the adjusted hazard ratios (with their 95% confidence intervals) for incident knee OA in dietary Mg intake tertiles were 1.00, 1.28 (0.78–2.10), and 1.38 (0.73–2.62); the p value for trend was 0.31. Serum hs-CRP level at baseline did not predict incident knee OA. Conclusions The results do not support the hypothesis that low dietary Mg intake contributes to the development of clinical knee OA, although Mg intake is inversely associated with serum hs-CRP level.
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Affiliation(s)
- Sanna Konstari
- Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
- * E-mail:
| | - Laura Sares-Jäske
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Markku Heliövaara
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Harri Rissanen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Paul Knekt
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jouko Sundvall
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
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Retirement Expectations of Older Workers with Arthritis and Diabetes Compared with Those of Workers with No Chronic Diseases. Can J Aging 2019; 38:296-314. [DOI: 10.1017/s0714980818000685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉLes plans de retraite des adultes atteints de maladies chroniques sont peu connus. Dans le cadre de cette étude, des travailleurs canadiens âgés de 50 à 67 ans provenant d’un regroupement national de 80 000 personnes (arthrite, n = 631 ; diabète, n = 286 ; arthrite et diabète, n = 111 ; aucune maladie chronique invalidante, n = 538) ont participé à une enquête transversale sur ce sujet. Les questions posées aux participants traitaient de l’âge prévu pour leur départ à la retraite, de leurs plans de travail futurs, de la possibilité d’un départ hâtif à la retraite et de la transition vers la retraite. Des analyses de khi-carré, de variance et des régressions ont permis d’évaluer les attentes et les facteurs qui y étaient associés. Les travailleurs souffrant d’arthrite et de diabète avaient des plans de retraite semblables à ceux des participants sains, malgré leurs problèmes de santé, et ces plans concordaient avec les attentes associées au fait de travailler jusqu’à un âge de retraite conventionnel. Toutefois, le nombre de répondants souffrant d’arthrite ou de diabète qui avaient prévu une retraite anticipée était plus élevé que celui des participants en bonne santé. Contrairement aux prévisions, la part de la variance associée aux facteurs liés à la santé était moindre que celle des autres facteurs en ce qui concerne les attentes en matière de retraite. Ces résultats mettent en lumière la complexité des attentes liées à la retraite et soulignent l’importance de l’adéquation personne-travail, malgré la présence de maladies.
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Gold JE, Kurowski A, Gore RJ, Punnett L. Knee pain in nursing home workers after implementation of a safe resident handling program. Am J Ind Med 2018; 61:849-860. [PMID: 30156000 PMCID: PMC6430608 DOI: 10.1002/ajim.22902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Approximately 25-30% of nursing personnel experience knee pain (KP). We sought to identify physical and psychosocial work exposures, and personal factors related to prevalent, incident, and persistent KP 5-8 years after safe resident handing program (SRHP) implementation in nursing homes. METHODS Health and exposure information was obtained from worker surveys 5-6 years ("F5") and 7-8 years ("F6") post-SRHP implementation. Prevalent KP correlates were examined at F5; persistent and incident KP predictors were analyzed at F6, utilizing robust Poisson multivariable regression. RESULTS F5 KP prevalence (19.7%) was associated with combined physical exposures, and with either high job strain or low social support, in separate models. Two-year persistent KP was similarly associated with these psychosocial exposures. Being overweight was associated with KP in all analyses. CONCLUSIONS The SRHP program did not eliminate knee physical loading, which should be reduced to prevent nursing home worker KP. Workplace psychosocial exposures (high job strain, low social support) also appeared germane.
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Affiliation(s)
- Judith E. Gold
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
- Gold Standard Research Consulting, Bryn Mawr, Pennsylvania
| | - Alicia Kurowski
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Rebecca J. Gore
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
| | - ProCare Research Team
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Laura Punnett
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
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Brennan-Olsen SL, Solovieva S, Viikari-Juntura E, Ackerman IN, Bowe SJ, Kowal P, Naidoo N, Chatterji S, Wluka AE, Leech MT, Page RS, Sanders KM, Gomez F, Duque G, Green D, Mohebbi M. Arthritis diagnosis and symptoms are positively associated with specific physical job exposures in lower- and middle-income countries: cross-sectional results from the World Health Organization's Study on global AGEing and adult health (SAGE). BMC Public Health 2018; 18:719. [PMID: 29884171 PMCID: PMC5994040 DOI: 10.1186/s12889-018-5631-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In higher income countries, work-related squatting and heavy lifting have been associated with increased arthritis risk. Here, we address the paucity of data regarding associations between arthritis and work-related physical stressors in lower- and middle-income countries. METHODS Data were extracted from the Study on global AGEing and adult health (SAGE) Wave 1 (2007-10) for adults (aged ≥50 years) from Ghana, India, Russia and South Africa for whom detailed occupation data was available (n = 21,389; 49.2% women). Arthritis cases were identified using a symptom-defined algorithm (current) and self-reported doctor-diagnosis (lifetime). A sex-specific Job Exposure Matrix was used to classify work-related stressors: heavy physical work, kneeling/squatting, heavy lifting, arm elevation and awkward trunk posture. Using the International Standard Classification of Occupations, we linked SAGE and the Job Exposure Matrix. Logistic regression was used to investigate associations between arthritis and work-related stressors, adjusting for age (10 year age groupings), potential socioeconomic-related confounders, and body mass index. Excess exposure risk due to two-way interactions with other risk factors were explored. RESULTS Doctor-diagnosed arthritis was associated with heavy physical work (adjusted odds ratios [OR] 1.12, 95%CI 1.01-1.23), awkward trunk posture (adjusted OR 1.23, 95%CI 1.12-1.36), kneeling or squatting (adjusted OR 1.25, 95%CI 1.12-1.38), and arm elevation (adjusted OR 1.66, 95%CI 1.37-2.00). Symptom-based arthritis was associated with kneeling or squatting (adjusted OR 1.27, 95%CI 1.08-1.50), heavy lifting (adjusted OR 1.33, 95%CI 1.11-1.58), and arm elevation (adjusted OR 2.16, 95%CI 1.63-2.86). Two-way interactions suggested excess arthritis risk existed for higher body mass index, and higher income or education. CONCLUSIONS Minimization of occupational health risk factors is common practice in higher income countries: attention should now be directed toward reducing work-related arthritis burden in lower- and middle-income countries.
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Affiliation(s)
- Sharon L. Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3, WHCRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC 3021 Australia
- Department of Medicine-Western Health, St Albans, Australia
| | | | | | - Ilana N. Ackerman
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steven J. Bowe
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Paul Kowal
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Nirmala Naidoo
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | | | | | - Richard S. Page
- Deakin University, Geelong, Australia
- Barwon Centre for Orthopaedic Research and Education, Barwon Health, Geelong, Australia
| | - Kerrie M. Sanders
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3, WHCRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC 3021 Australia
- Department of Medicine-Western Health, St Albans, Australia
- Deakin University, Geelong, Australia
| | - Fernando Gomez
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3, WHCRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC 3021 Australia
- Department of Medicine-Western Health, St Albans, Australia
- Health Faculty, University of Caldas, Manizales, Colombia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3, WHCRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC 3021 Australia
| | - Darci Green
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3, WHCRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC 3021 Australia
- Department of Medicine-Western Health, St Albans, Australia
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Tennant LM, Chong HC, Acker SM. The effects of a simulated occupational kneeling exposure on squat mechanics and knee joint load during gait. ERGONOMICS 2018; 61:839-852. [PMID: 29192542 DOI: 10.1080/00140139.2017.1411529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/23/2017] [Indexed: 06/07/2023]
Abstract
Occupational kneeling is associated with an increased risk for tibiofemoral knee osteoarthritis. Forces on the knee in the kneeling posture, as well as the greater incidence of meniscus tears among workers, likely contribute to the increased risk. We hypothesise that an additional mechanism may contribute - altered neuromuscular control due to prolonged high knee flexion. Forty participants (20 male, 20 female) completed an evaluation of gait and squatting before, immediately following, and 30 min following a 30 min simulated occupational kneeling exposure. An increase in the peak external knee adduction moment and a delay in vastus medialis activation onset during walking were observed post-kneeling, as well as increased frontal plane knee motion during squatting. This was the first investigation to find changes in high flexion transitions as a result of kneeling. Greater frontal plane knee motion may increase the risk for meniscal tears, and subsequently, knee osteoarthritis. Practitioner Summary: A 30 min simulated occupational kneeling exposure resulted in small but significant gait changes. The greatest effect was on frontal plane knee movement during squatting, which is especially relevant to occupations requiring frequent kneeling/squatting. This increased motion may indicate an increased risk of injury, which supports a link to knee osteoarthritis.
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Affiliation(s)
- Liana Michele Tennant
- a Faculty of Applied Health Sciences, Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Helen Christina Chong
- a Faculty of Applied Health Sciences, Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Stacey Marie Acker
- a Faculty of Applied Health Sciences, Department of Kinesiology , University of Waterloo , Waterloo , Canada
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Munugoda IP, Wills K, Cicuttini F, Graves SE, Lorimer M, Jones G, Callisaya ML, Aitken D. The association between ambulatory activity, body composition and hip or knee joint replacement due to osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2018; 26:671-679. [PMID: 29474994 DOI: 10.1016/j.joca.2018.02.895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between ambulatory activity (AA), body composition measures and hip or knee joint replacement (JR) due to osteoarthritis. DESIGN At baseline, 1082 community-dwelling older-adults aged 50-80 years were studied. AA was measured objectively using pedometer and body composition by dual-energy X-ray absorptiometry. The incidence of primary (first-time) JR was determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Log binomial regression with generalized estimating equations were used to estimate the risk of JR associated with baseline AA and body composition measures, adjusting for age, sex, X-ray disease severity, and pain. RESULTS Over 13 years of follow-up, 74 (6.8%) participants had a knee replacement (KR) and 50 (4.7%) a hip replacement (HR). AA was associated with a higher risk of KR (RR 1.09/1000 steps/day, 95% CI 1.01, 1.16) and a lower risk of HR (RR 0.90/1000 steps/day, 95% CI 0.81, 0.99). Body mass index (BMI) (RR 1.07/kg/m2, 95% CI 1.03, 1.12), total fat mass (RR 1.03/kg, 95% CI 1.01, 1.06), trunk fat mass (RR 1.05/kg, 95% CI 1.00, 1.09), and waist circumference (RR 1.02/cm, 95% CI 1.00, 1.04) were associated with a higher risk of KR. Body composition measures were not associated with HR. CONCLUSIONS An objective measure of AA was associated with a small increased risk of KR and a small reduced risk of HR. Worse body composition profiles were associated with KR, but not HR. Altogether this may suggest different causal pathways for each site with regard to habitual activity and obesity.
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Affiliation(s)
- I P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - K Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia.
| | - S E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.
| | - M Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - M L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Isaramalai SA, Hounsri K, Kongkamol C, Wattanapisitkul P, Tangadulrat N, Kaewmanee T, Yuenyongviwat V. Integrating participatory ergonomic management in non-weight-bearing exercise and progressive resistance exercise on self-care and functional ability in aged farmers with knee osteoarthritis: a clustered randomized controlled trial. Clin Interv Aging 2018; 13:101-108. [PMID: 29398910 PMCID: PMC5775746 DOI: 10.2147/cia.s144288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Ergonomic hazards are the most important cause of knee osteoarthritis (OA) in aged para rubber farmers. Ergonomic management comprising improvement of working conditions and muscle-strengthening exercise has been well documented in terms of workers' health benefit. However, those interventions were not adequate to sustain the advantage. Few studies have demonstrated the effect of integrating participatory ergonomic management (PEM) in non-weight-bearing exercise (NWE) and progressive resistance exercise (PRE), and none has focused on aged para rubber farmers with knee OA. Purpose This study investigated the effect of PEM-NWE, PEM-PRE, and standard treatment (ST) on self-care and functional ability in the aged population. Materials and methods A single-blinded, clustered randomized controlled trial was carried out. Participants (n=75) from three different communities in southern Thailand were randomly assigned to PEM-NWE, PEM-PRE, and ST. Self-care and functional ability (pain, stiffness, and physical function) were examined at baseline (B), during the intervention at Week 5 (W5), and after its completion at Week 9 (W9). Mean comparison of those outcomes over time was made using Generalized Linear Mixed Models (GLMMs). Results Compared to the standard treatment, the means of both groups, PEM-NWE and PEM-PRE, were significantly increased in self-care and functional ability. However, no significant difference between PEM-NWE and PEM-PRE was found. Conclusion Either or both interventions should be incorporated into nursing practice in order to promote occupational health and enhance quality of work life for Thai aged farmers. Further study on their cost-effectiveness is highly recommended.
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Affiliation(s)
| | - Kanokwan Hounsri
- Research Center for Caring System of Thai Elderly, Faculty of Nursing
| | - Chanon Kongkamol
- Research Unit of Holistic Health and Safety Management in Community, Faculty of Medicine
| | | | | | | | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal disorders in workers. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tessy Luger
- University of Tübingen; Institute of Occupational and Social Medicine and Health Services Research; Wilhelmstrasse 27 Tübingen Germany 72074
| | - Christopher G Maher
- The University of Sydney; Sydney School of Public Health; Level 10 North, King George V Building, Missenden Road, Camperdown Sydney NSW Australia 2050
| | - Monika A Rieger
- University of Tübingen; Institute of Occupational and Social Medicine and Health Services Research; Wilhelmstrasse 27 Tübingen Germany 72074
| | - Benjamin Steinhilber
- University of Tübingen; Institute of Occupational and Social Medicine and Health Services Research; Wilhelmstrasse 27 Tübingen Germany 72074
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Hubertsson J, Turkiewicz A, Petersson IF, Englund M. Understanding Occupation, Sick Leave, and Disability Pension Due to Knee and Hip Osteoarthritis From a Sex Perspective. Arthritis Care Res (Hoboken) 2017; 69:226-233. [PMID: 27110664 DOI: 10.1002/acr.22909] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/10/2016] [Accepted: 04/05/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the association between occupation and risk for sick leave or disability pension due to knee or hip osteoarthritis (OA) from a sex perspective. METHODS We conducted a population-based study including residents ages 40-70 years in the Skåne region, Sweden (2007) and working in the included job sectors (n = 165,179). We retrieved data on cause-specific sick leave and disability pension (2007-2012) and linked to individual information on occupation and education (2007). Occupations were classified into job sectors. We calculated sex-specific, age-adjusted odds ratios (ORs) of sick leave and disability pension due to OA in traditionally female-dominated job sectors (health care, child care, and cleaning) and traditionally male-dominated job sectors (construction, farming, metal work, or transportation) compared to business and administration. RESULTS Of all eligible subjects, 2,445 had sick leave or disability pension due to knee or hip OA. Adjusted for age, the risk of sick leave due to knee OA was increased for women working in health care, with an OR of 3.3 (95% confidence interval [95% CI] 2.6-4.2), child care OR 2.9 (95% CI 2.2-3.8), and cleaning OR 3.0 (95% CI 2.2-4.1), as was the risk for disability pension. The risk was increased also for persons working in occupations with higher educational requirements. The risk was similarly increased in male-dominated sectors. In female-dominated job sectors the risk of sick leave and disability pension due to knee OA, but not hip OA, was higher than that for other musculoskeletal diseases. CONCLUSION Traditionally female-dominated occupational sectors are associated with an increased risk of sick leave and disability pension due to knee OA.
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Affiliation(s)
- Jenny Hubertsson
- Lund University, and Skåne University Hospital, Epidemiology and Register Centre South, Lund, Sweden
| | | | - Ingemar F Petersson
- Lund University, and Skåne University Hospital, Epidemiology and Register Centre South, Lund, Sweden
| | - Martin Englund
- Lund University, Skåne University Hospital, Epidemiology and Register Centre South, Lund, Sweden, and Boston University School of Medicine, Boston, Massachusetts
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The Association between Osteoarthritis and Occupational Clusters in the Korean Population: A Nationwide Study. PLoS One 2017; 12:e0170229. [PMID: 28099527 PMCID: PMC5242527 DOI: 10.1371/journal.pone.0170229] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/31/2016] [Indexed: 01/29/2023] Open
Abstract
Osteoarthritis (OA) is a considerable health problem worldwide. It is known to be associated with certain occupational risk factors. We examined the prevalence rate of OA by occupational cluster. Data were collected from the Korea National Health and Nutrition Examination Surveys (2010-2013). The total number of unweighted sample size was 9,905 participants: 4,460 men and 5,445 women, and OA prevalence was 5.3% and 18.4% respectively. OA patients were defined as participants with knee/hip joint pain and radiographic change of knee/hip joint. Occupational type was classified as either white, pink, blue, or green collar based on the occupational characteristics following physical demand: white for manager and professionals; pink for clerks and service/sales workers; blue for craft/trade workers, machine operators and assemblers, and elementary manual workers; and green for agricultural/fishery workers. We calculated the odds ratios (ORs) and 95% confidence intervals (95% CI) for the odds of a participant's having OA according to the occupational cluster, with gender stratification. The multiple logistic regression model showed that, compared to the white collar group, the ORs of the pink, blue, and green collar workers were 1.23 (95% CI 0.64-2.36), 1.85 (95% CI 1.18-2.88), and 2.91 (95% CI 1.86-4.54), respectively, in males, and 2.53 (95% CI 1.71-3.73), 2.86 (95% CI 1.94-4.21), and 3.90 (95% CI 2.60-5.83), respectively in females. The prevalence rate of OA was associated with the occupational cluster, in order from highest to lowest: green, blue, pink, and white collar.
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Dulay GS, Cooper C, Dennison EM. Knee pain, knee injury, knee osteoarthritis & work. Best Pract Res Clin Rheumatol 2015; 29:454-61. [PMID: 26612241 DOI: 10.1016/j.berh.2015.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/07/2015] [Indexed: 01/06/2023]
Abstract
Symptomatic knee osteoarthritis (OA) can be viewed as the end result of a molecular cascade which ensues after certain triggers occur and ultimately results in irreversible damage to the articular cartilage. The clinical phenotype that knee OA can produce is variable and often difficult to accurately predict. This is further complicated by the often poor relationship between radiographic OA and knee pain. As a consequence, it can be difficult to compare studies that use different definitions of OA. However, the literature suggests that while there are multiple causes of knee OA, two have attracted particular attention over recent years; occupation related knee OA and OA subsequent to previous knee injury. The evidence of a relationship, and the strength of this association, is discussed in this chapter.
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Affiliation(s)
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; Victoria University, Wellington, New Zealand.
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Herquelot E, Bodin J, Petit A, Ha C, Leclerc A, Goldberg M, Zins M, Roquelaure Y, Descatha A. Incidence of Chronic and Other Knee Pain in Relation to Occupational Risk Factors in a Large Working Population. ANNALS OF OCCUPATIONAL HYGIENE 2015; 59:797-811. [PMID: 25711951 DOI: 10.1093/annhyg/mev010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 01/14/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the incidence of chronic and other knee pain (KP) in relation to occupational and personal risk factors among workers representative of a general working population. METHODS Of 3710 workers in a French region included in a surveillance network for musculoskeletal disorders (2002-2005), 2332 completed a follow-up questionnaire in 2007-2009 (Cosali cohort). The questionnaires included questions on musculoskeletal symptoms, and personal and occupational exposure. Incident cases of KP in 2007-2009 (i.e. with KP at follow-up but not at baseline) were dichotomized into chronic KP (>30 days in the previous year) and other KP. Associations between incident KP and personal and occupational factors at baseline were studied separately according to sex using multinomial logistic regression. RESULTS Of the 1616 respondents without KP at baseline, 122 (7.5%) reported chronic KP and 243 (15.0%) reported other KP. The incidence rate of chronic KP was estimated at 19.6 per 1000 worker-years (95% CI: 16.3-23.5). After adjustment for age and body mass index, significant associations were found between incident chronic KP and handling loads >4kg [odds ratio (OR) 2.1 (1.2-3.6) for men, OR 2.3 (1.1-5.0) for women] and kneeling >2h a day for men [OR 1.8 (1.0-3.0)]. CONCLUSIONS This study highlights the high frequency of chronic KP in the working population and the role of occupational factors in its incidence, in particular those kneeling and handling loads.
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Affiliation(s)
- Eléonore Herquelot
- 1.Population-based Epidemiologic Cohorts Unit, Inserm, UMS 011, F-94807 Villejuif, France 2.Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France
| | - Julie Bodin
- 3.Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), LUNAM Université, Université d'Angers, F-49000 Angers, France
| | - Audrey Petit
- 3.Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), LUNAM Université, Université d'Angers, F-49000 Angers, France
| | - Catherine Ha
- 4.Département santé travail, Institut de veille sanitaire (InVS), F-94410 Saint-Maurice, France
| | - Annette Leclerc
- 1.Population-based Epidemiologic Cohorts Unit, Inserm, UMS 011, F-94807 Villejuif, France 2.Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France
| | - Marcel Goldberg
- 1.Population-based Epidemiologic Cohorts Unit, Inserm, UMS 011, F-94807 Villejuif, France 2.Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France
| | - Marie Zins
- 1.Population-based Epidemiologic Cohorts Unit, Inserm, UMS 011, F-94807 Villejuif, France 2.Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France
| | - Yves Roquelaure
- 3.Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), LUNAM Université, Université d'Angers, F-49000 Angers, France
| | - Alexis Descatha
- 1.Population-based Epidemiologic Cohorts Unit, Inserm, UMS 011, F-94807 Villejuif, France 2.Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France 5.AP-HP, Occupational Health Unit, Poincaré University Hospital, F-92380 Garches, France
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