The Course of Nonspecific Work-Related Upper Limb Disorders and the Influence of Demographic Factors, Psychologic Factors, and Physical Fitness on Clinical Status and Disability

Abstract

van Eijsden-Besseling MD, van den Bergh KA, Staal JB, de Bie RA, van den Heuvel WJ. The course of nonspecific work-related upper limb disorders and the influence of demographic factors, psychologic factors, and physical fitness on clinical status and disability. Objective To assess the course of nonspecific work-related upper limb disorders (WRULD) and the influence of sociodemographic factors, psychologic factors, and physical fitness on clinical status and functional disability. Design Retrospective cohort study with cross-sectional analysis among computer workers with several stages of nonspecific WRULD; average follow-up 4 years. Sociodemographic and medical characteristics were assessed based on medical records at onset and diagnosis. After informed consent at follow-up, participants received a questionnaire assessing psychologic and physical fitness characteristics. Setting Outpatient department of rehabilitation medicine, University Hospital Maastricht; tertiary referral center for nonspecific WRULD. Participants Computer workers (N=182) with nonspecific WRULD, 18 to 50 years, first consultation 1998 to 2001; those with specific WRULD and incomplete medical records and treatment charts were excluded. Interventions Not applicable. Main Outcome Measures Stage of nonspecific WRULD (clinical status) and Disabilities of Arm, Shoulder and Hand questionnaire [DASH] (functional disability). Results A total of 104 patients (57%) returned the completed questionnaire at follow-up (November 2003). Fourteen percent developed chronic benign pain syndrome, 9% recovered. The remaining (77%) worsened slightly. A higher DASH score was associated with being elderly (unstandardized regression coefficient [B=.64]), being a woman (B=10.42), having a lower educational achievement (B=9.72), and poorer self-reported physical fitness level (B=1.68); lower educational achievement and poorer self-reported physical fitness were associated with a more severe clinical status. Psychologic factors did not influence disability or clinical status. Conclusions The prognosis of computer workers with nonspecific WRULD is not favorable. Those with a lower educational achievement and poorer self-reported physical fitness are at risk for a more severe clinical status and functional disability. Being elderly and a woman are also risk factors for further disability. A prospective cohort study is needed to unravel these relationships. Nevertheless, computer workers with nonspecific WRULD should be encouraged to enter fitness programs.