Low Physical Demands Research Articles

Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users.

BackgroundDesign processes such as human-centered design (HCD), which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of HCD can often conflict with the necessary rapid product development life-cycles associated with the competitive connected health industry.ObjectiveThe aim of this study was to apply a structured HCD methodology to the development of a smartphone app that was to be used within a connected health fall risk detection system. Our methodology utilizes so called discount usability engineering techniques to minimize the burden on resources during development and maintain a rapid pace of development. This study will provide prospective designers a detailed description of the application of a HCD methodology.MethodsA 3-phase methodology was applied. In the first phase, a descriptive “use case” was developed by the system designers and analyzed by both expert stakeholders and end users. The use case described the use of the app and how various actors would interact with it and in what context. A working app prototype and a user manual were then developed based on this feedback and were subjected to a rigorous usability inspection. Further changes were made both to the interface and support documentation. The now advanced prototype was exposed to user testing by end users where further design recommendations were made.ResultsWith combined expert and end-user analysis of a comprehensive use case having originally identified 21 problems with the system interface, we have only seen and observed 3 of these problems in user testing, implying that 18 problems were eliminated between phase 1 and 3. Satisfactory ratings were obtained during validation testing by both experts and end users, and final testing by users shows the system requires low mental, physical, and temporal demands according to the NASA Task Load Index (NASA-TLX).ConclusionsFrom our observation of older adults’ interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials.

Health-related quality of life with long-term retention of the PROSthesis of Antibiotic Loaded Acrylic Cement system following infection resolution in low demand patients.

The study purpose was to (1) evaluate health-related quality of life (HRQL) with the PROSthesis of Antibiotic Loaded Acrylic Cement (PROSTALAC) in situ for infected total hip arthroplasty (THA), (2) determine infection resolution, and (3) compare subjects who underwent second stage surgery with those who retained the PROSTALAC on a longer term basis. Demographics, physical demand level, and comorbidities were recorded prospectively in 29 subjects followed to at least 24 months after initial PROSTALAC insertion. HRQL was evaluated using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and RAND 36-Item Health Survey. Infection resolution was determined using a pre-specified clinical definition. Twenty-five of 29 (86%) subjects' infections resolved. Three subjects died, of whom two had resolved infections. For survivors, 22/26 (85%) completed HRQL evaluations. After PROSTALAC insertion, pain and function improved within 3-6 months and was retained at 24 months. Of those followed to 24 months, 7/22 (32%) subjects underwent second stage surgery. They were higher physical demand subjects ( p = 0.03) than those not undergoing second stage surgery. We found no difference in WOMAC scores at 24 months between those who underwent second stage surgery and those who retained the PROSTALAC ( p > 0.32). The PROSTALAC system for THA appears to allow acceptable HRQL while in situ for at least 2 years in low physical demand patients. Subjects with higher physical demand levels are more likely to undergo second stage surgery. Further evaluation is required to determine whether longer term PROSTALAC retention may be appropriate for specific patient groups.

Effects of touchscreen gesture’s type and direction on finger-touch input performance and subjective ratings

This study examined how finger-touch input performance (i.e. task completion time, failure status, and error rate) and subjective ratings (i.e. performance and physical demand) are influenced by touchscreen gestures’ type and direction. Twenty participants performed one-touch (i.e. drag and swipe) and two-touch (i.e. pinch and spread) gesture tasks on a tablet, using several major directions (i.e. eight directions for one-touch and four directions for two-touch gestures). The results showed that swipe was approximately 4.5 times faster than drag, but pinch and spread showed no significant difference in task completion time. Dragging and pinching showed more failures or higher error rates compared to swiping and spreading, respectively. One-touch gestures in the horizontal directions were rated to have higher performance and lower physical demand than those in the vertical and diagonal directions. Two-touch gestures in the horizontal directions took the shortest time but caused more failures and higher error rates.Practitioner Summary: This study provides evidence for the effects of touchscreen gestures’ type and direction on human performance and subjective ratings, which varied depending on the number of fingers used. Designers should arrange related touchscreen components accordingly, to improve touch-finger input performance and reduce user workload.

The effect of total hip replacement on employment in patients with ankylosing spondylitis.

Although total hip replacement (THR) has been proven to be effective, the effect of THR on employment in ankylosing spondylitis (AS) in Chinese population is still unknown. We aimed to demonstrate whether or not patients with AS returned to work following THR and factors associated with the work ability after THR. We performed a retrospective study including a total number of 128 AS patients undergoing THR between 2009 and 2013. Presurgery and postsurgery data including disease state, work status, type of job, and time of resuming work were collected. Factors associated with early return to work were assessed through ordinal regression. Eighty-seven of 128 patients (68%) were employed within 1year before THR and 98 returned to work after surgery. Among them, 21, 46, and 31 resumed work by 3, 6, and 12months postoperation, respectively. Multivariate ordinal regression showed that patients with unilateral THR, younger age, lower BASFI score, employed presurgery, and low or moderate physical demand were more likely to resume work earlier. Most individuals working presurgery returned to work after THR. For young AS patients with hip involvement, THR is an effective treatment for improving and maintaining work ability.

Establishing the Role of Unlinked Total Elbow Arthroplasty in Low Demand Patients: A Long-Term Follow-up Study.

Experience with total elbow arthroplasty is scarce in most centers. It seems to have a significant rate of associated complications. Most studies are based on non-validated outcome measures and short-term results. We selected patients undergoing unlinked total elbow arthroplasty, with a resultant sample of thirteen cases, with a mean postoperative follow-up of 72 months. We applied the Mayo Elbow Score and all patients underwent an X-ray study, prior to surgery and during the follow-up period. All patients have a systemic inflammatory condition. The mean Mayo score increased from 43 points preoperatively to 70 and 80 points at the intermediate follow-up period (with a mean of 15 months after the operation) and at the time of the latest follow-up evaluation (with a mean of 72 months after the operation). There was an increase in range of motion in all cases. There was one case of mechanical failure and two cases of transient ulnar neuropathy. Elbow dysfunction causes great loss in patient´s quality of life, incapacitating them for the simplest activities. Small improvements in range of motion and pain relief result in significant changes in the patient's functional ability. There is a demand to clarify the performance of total elbow arthroplasty in selected patient groups in order to throw more light on the relative roles of the available implants. The results obtained in this study seem to confirm the long-term benefit of the unlinked arthroplasty in severe joint dysfunction in patients with low physical demand, particularly in rheumatoid arthritis, a common and limiting condition in our population.

Towards best practice in physical and physiological employment standards.

While the scope of the term physical employment standards is wide, the principal focus of this paper is on standards related to physiological evaluation of readiness for work. Common applications of such employment standards for work are in public safety and emergency response occupations (e.g., police, firefighting, military), and there is an ever-present need to maximize the scientific quality of this research. Historically, most of these occupations are male-dominated, which leads to potential sex bias during physical demands analysis and determining performance thresholds. It is often assumed that older workers advance to positions with lower physical demand. However, this is not always true, which raises concerns about the long-term maintenance of physiological readiness. Traditionally, little attention has been paid to the inevitable margin of uncertainty that exists around cut-scores. Establishing confidence intervals around the cut-score can reduce for this uncertainty. It may also be necessary to consider the effects of practise and biological variability on test scores. Most tests of readiness for work are conducted under near perfect conditions, while many emergency responses take place under far more demanding and unpredictable conditions. The potential impact of protective clothing, respiratory protection, load carriage, environmental conditions, nutrition, fatigue, sensory deprivation, and stress should also be considered when evaluating readiness for work. In this paper, we seek to establish uniformity in terminology in this field, identify key areas of concern, provide recommendations to improve both scientific and professional practice, and identify priorities for future research.

An exploratory investigation into the reasons why older people play golf

Purpose: Participation in organised sport is declining. For older Australians, golf is the most popular organised sport, but why golf is popular in this age group is unclear. This study explored why older adults play golf, and the perceived benefits they obtain from doing so. Method: A qualitative descriptive approach directed the study, involving five focus groups with male and female regular golfers (N = 31, aged 55–74 years) from private/semi-private metropolitan and country/regional golf clubs. Reasons for, and perceived benefits of, golf participation were explored. Results: Reasons viewed as unique to golf included a relatively low physical demand allowing play into older age, providing an opportunity to compete (due to the handicap system providing a level playing field) and providing opportunity to exercise without it feeling like exercise. Reasons for participation common to other sports/activities were opportunities for social and community engagement, time for self and time spent with others, and benefits for physical, cognitive, and mental health. Conclusion: These findings provide new insights into the reasons why older adults play golf that might start to explain the relative popularity of golf as a sport for older people. The results may inform recruitment and marketing strategies for the golf industry, whilst contributing to the knowledge base of factors that influence participation in sport for older adults. The study also provides understandings that could be used to guide further research using both qualitative and quantitative methods of inquiry.

Improving Procedure Logging among Gastroenterology Trainees Using a Mobile Application

Background: Gastroenterology (GI) fellows perform endoscopic procedures and are asked to record information regarding the procedure and their involvement. As no standard method for procedure logging exists and retrieval of data can be challenging, we have created a novel mobile device application (MDA) to accomplish this task. Objective: To determine if a novel MDA will allow for improved endoscopic procedure logging and data retrieval. Methods: A 19-item questionnaire was created to assess the current logging practice of GI fellows at our tertiary care academic medical center. Fellows then downloaded the MDA free-of-charge from the iTunes App store. After 8 weeks of MDA use, fellows were asked to complete the same questionnaire and the NASA task load index (TLX). The study was IRB approved. Results: 11 GI fellows were enrolled. Pre-MDA 7 maintained a paper log, 7 computer-based log, and 1 webbased log 83% of procedures completed were logged; 36.4% within 24 hr of procedure completion. Pre-MDA, fellows estimated their Polyp Detection Rate (PDR) to be 54.5% ± 18.8% and attending take-over rate (ATR) 39.25%. Post- MDA, 85.2% of procedures were logged (p=0.47); 54.5% within 24 hr (p=0.38). The MDA recorded PDR was 50% ± 31% (p=0.74) and ATR was 54% (p=0.19). TLX among MDA users demonstrated very low physical demand 8.6 [0, 21], low mental demand 18.3 [14, 25], low effort 27 [10, 60], and high success 84 [76, 100]. Conclusion: MDA procedure logging was efficient and successful. Data was easily retrieved and MDA use was quickly adopted. The MDA may be a useful tool for recording and retrieving procedure logs in a standard fashion.

Critérios para avaliação de incapacidade laborativa na insuficiência cardíaca

<p>Introdução: A Previdência Social, no Brasil, é uma seguradora social que garante a renda do segurado quando ele perde sua capacidade laborativa. Dentre os benefícios concedidos temos a aposentadoria por invalidez, sendo que para sua concessão o segurado deve passar por perícia médica que comprove sua incapacidade total e permanente. Quatorze por cento das aposentadorias por invalidez concedidas nos últimos três anos ocorreram devido a doenças do aparelho circulatório, sendo que a via final das maiorias destas doenças é a insuficiência cardíaca. Objetivo: Identificar critérios para determinar incapacidade total e permanente em segurados portadores de insuficiência cardíaca congestiva em perícias previdenciárias. Metodologia: Revisão bibliográfica, sem limite de data, realizada de abril a agosto de 2014, utilizando os seguintes descritores: insuficiência cardíaca, seguro por invalidez e aposentadoria, nas seguintes bases de dados: Pubmed/Medline; BVS (Biblioteca Virtual de Saúde); Scopus; Web of Science; e Cochrane. A legislação previdenciária foi pesquisada. Resultados: Insuficiência cardíaca pode ser considerada incapacitante para mobilidade, tarefas complexas e tarefas de autocuidado, além de cursar com incapacidade cognitiva moderada ou severa. Insuficiência cardíaca como complicação pós-infarto é forte indicador para aposentadoria precoce, tendo como fator prognóstico positivo para retorno ao trabalho idade menor que 60 anos, fração de ejeção maior que 35%, ausência de financiamento durante o afastamento, ausência de ataques de ansiedade e trabalho com baixa exigência física. Discussão: O Grau III ou IV da insuficiência cardíaca, segundo NYHA e a Previdência Social, cursa com incapacidade que, se permanente, dará direito à aposentadoria por invalidez. Exames complementares não devem ser usados de forma isolada. Idade maior que 60 anos, sexo feminino e alta carga de trabalho são fatores de mau prognóstico. Conclusão: Para a avaliação de capacidade laborativa na insuficiência cardíaca devem ser levados em consideração os achados clínicos, a fração de ejeção, a cognição do examinado, a exigência física do trabalho e as condições de retorno a este, a idade do periciando e a classificação funcional utilizada pela NYHA ou da Previdência Social.</p>

Articular Fractures in the Elderly: to Fix or to Replace? - Distal Humerus

Distal humeral fractures in adults are rare. They are routinely treated by open reduction and internal fixation in an attempt to retain a painless, stable and functional joint. However, even with advances in plate technology, the results of fixation still depend on screw purchase and bone quality. Even if functional results appear to be favourable, complication rates remain quite high. This is particularly true in elderly patients, in whom multifragmentary intraarticular fractures are mostly associated with diminished bone quality. Recent results support the use of primary total elbow arthroplasty in patients with highly comminuted distal humeral fractures. This applies particularly to the elderly with low physical demands, or patients with marked joint destruction from significant preexisting inflammatory joint disease. Although short term results seem to be promising, the intermediate and long term data are still inadequate. There is indeed evidence for a dramatic increase in complications and revision rates over time. Lifelong weight restriction is a major drawback in total elbow arthroplasty. It is unclear whether the primary treatment of distal humeral fractures in the elderly should be open reduction and internal fixation or total elbow arthroplasty. The operation should be selected for the individual patient on the basis of the surgeon's experience and judgment as well possible contraindications. The surgeon should discuss the question openly with the patient.

Impact of a Novel Mobile Device Application for Endoscopic Procedure Logging

Introduction: Gastroenterology (GI) fellows perform endoscopic procedures throughout their years of training and are asked to record basic information regarding the nature of the procedure and their level of involvement. Unfortunately, no standard method for procedure logging exists and retrieval of data can be challenging for both the fellow and program director. Therefore, we have created a novel mobile device application (MDA) for endoscopic procedure logging to overcome these challenges. The MDA is iOS based and allows users to log details of individual procedures performed without including protected health information. Data is then uploaded from the iOS device to a central database on a secure server. The cases can then be easily retrieved and analyzed. A monthly report is also created for users and program directors. We hypothesize that the MDA will allow for improved endoscopic procedure logging and data retrieval. Methods: A 19-item questionnaire was created to assess the current logging practice of the GI fellows at our tertiary care academic medical center. The questionnaire included questions on current logging practice, attending involvement in procedures, and fellows’ estimation of polyp detection rate (PDR). Fellows downloaded the MDA free-of-charge from the iTunes App store. After 8 weeks of MDA use, fellows were asked to complete the same questionnaire and the NASA task load index (TLX). The study was IRB approved. Results: All 11 GI fellows (7 female) were enrolled in the study and received the questionnaire pre-MDA. Seven maintained a paper log, 7 computer-based log, and 1 web-based log. Pre-MDA, 84.9% of procedures completed were logged with 36% logged ≤ 24 hours of procedure completion. Pre-MDA, fellows estimated their PDR to be 54.5%±18.8% and attending take-over rate 39.25%. Post-MDA, 85.2% of procedures were logged (p=0.47) and 54.5% were logged ≤ 24 hours of procedure completion. PDR was 50%±31% (p=0.74) and attending take-over rate was 54% (p=0.19). NASA TLX among MDA users demonstrated very low physical demand 8.6 [0, 21], low mental demand 18.3 [14, 25], low effort 27 [10, 60], and high success 84 [76, 100]. Conclusion: The MDA allowed for efficient and successful procedure logging. Data was retrieved without difficulty and the MDA was quickly adopted into practice. This study suggests that the MDA may be a useful tool for recording and retrieving endoscopic procedures in a standard fashion.

Remain in Work—What Work-Related Factors Are Associated With Sustainable Work Attendance

To analyze if organizational climate and work commitment, demand and control, job strain, social support, and physical demands at work are associated with remain in work (RIW), that is, work attendance without sick leave over 15 days per year. This Swedish cross-sectional study was based on 4013 workers (aged 19 to 64 years), randomly selected from a general population. Data were collected (2008) through postal questionnaire and registers. Fair organizational climate, the combination of fair organizational climate and fair work commitment, high control, and low physical demands were associated with RIW for women and men. This study adds to the rather scarce research findings on factors that promote RIW by identifying work organizational factors and physical prerequisites as being important. Preventive work to create a healthy work environment could be directed at improving organizational climate and reducing physical demands.

Measuring subjective sleepiness at work in hospital nurses: validation of a modified delivery format of the Karolinska Sleepiness Scale

Sleepiness during the work shift is common and can be hazardous to workers and, in the case of nurses, to patients under their care. Thus, measuring sleepiness in occupational studies is an important component of workplace health and safety. The Karolinska Sleepiness Scale (KSS) is usually used as a momentary assessment of a respondent's state of sleepiness; however, end-of-shift measurement is sometimes preferred based on the study setting. We assessed the predictive validity of the KSS as an end-of-shift recall measurement, asking for "average" sleepiness over the shift and "highest" level of sleepiness during the shift. Hospital registered nurses (N=40) working 12-h shifts completed an end-of-shift diary over 4 weeks that included the National Aeronautical and Space Administration Task Load Index (NASA-TLX) work intensity items and the KSS (498 shifts over 4 weeks). Vigilant attention was assessed by measuring reaction time, lapses, and anticipations using a 10-min performance vigilance task (PVT) at the end of the shift. The Horne-Ostberg Questionnaire, Epworth Sleepiness Scale, General Sleep Disturbance Scale, and Cleveland Sleep Habits Questionnaire were also collected at baseline to assess factors that could be associated with higher sleepiness. We hypothesized that higher KSS scores would correlate with vigilant attention parameters reflective of sleepiness (slower reaction times and more lapses and anticipations on a performance vigilance task) and also with those factors known to produce higher sleepiness. These factors included the following: (1) working night shifts, especially for those with "morningness" trait; (2) working sequential night shifts; (3) having low physical and mental work demands and low time pressure; (4) having concomitant organic sleep disorders; and (5) having greater "trait" sleepiness (Epworth Sleepiness Scale). Linear mixed models and generalized linear mixed models were used to test associations that could assess the predictive validity of this format of administering the KSS. Greater sleepiness, as measured by higher KSS scores, was found on shifts with nurses working night shift, the third sequential night compared to the first, those with sleep disorder symptoms (especially insomnia), and in nurses with trait sleepiness on the Epworth scale. Less sleepiness (lower KSS scores) was seen in shifts with a high level of time pressure and in nurses with a biologic predisposition to be more alert in the morning (morningness trait) who worked the day shift. We found partial support for using the Karolinska Sleepiness Scale in the recalled format based on our multiple tests of predictive validity.

Combined Effects of Physical Demands and Shift Working on Low Back Disorders Among Nursing Personnel

The aim of this study was to investigate the synergistic effects of physical demands and shift working on low back disorders (LBDs) among nursing personnel. The study used 2 questionnaires: a self-administered questionnaire composed of parts of Nordic musculoskeletal questionnaire to assess LBDs and job content questionnaire to assess physical demands. The participants were divided into 4 groups: from group 1 (low physical demands day workers) to group 4 (high physical demands shift workers). In regression analysis, high physical demands were associated with the prevalence of LBDs independently (OR 4.4, 95% CI [2.40, 8.00] and p < .05), but there was no association between shift working and LBDs (p > .05). Odds ratio in high physical demands shift workers was 9.33 compared to the reference group (p < .001). Calculated synergistic index was 7.37. Simultaneous impacts of shift working and high physical demands may increase the prevalence of LBDs among nursing personnel.

Job stress dimensions and their relationship to musculoskeletal disorders in Iranian nurses

There is little data available on job stress dimensions and their relationship to musculoskeletal disorders (MSDs) among Iranian nurses. The objectives of this study were to investigate job stress dimensions and examine their relationship to MSDs among nurses of Shiraz University of Medical Sciences (SUMS) hospitals. In this cross-sectional study, 385~randomly selected nurses of SUMS participated. The Persian version of Job Content Questionnaire (P-JCQ) and Nordic MSDs questionnaire were used for data collection. Descriptive statistics and Mann-Whitney U test were applied for data analysis. Decision latitude and social support dimensions had low levels, but psychological and physical job demands as well as job insecurity dimensions had high levels among the nurses. 89.9% of the subjects experienced some form of MSDs during the last 12 months. Lower back symptoms were the most prevalent problem reported (61.8%). Physical isometric loads was the only sub-scale that had significant relationship with MSDs. In the majority of cases, subjects were exposed to high levels of job stress. MSDs prevalence was high. Based on the results, any interventional program for MSDs prevention should focus on reducing physical and psychological job demands as well as increasing decision latitudes.

Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study

ObjectiveThere is no consensus on the treatment of chronic low back pain of disk origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. Material and methodThis is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disk pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). ResultsLumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (p>0.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend toward better results, but none reached statistical significance (p>0.05). ConclusionsThe present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disk origin. While CESI could show some improvement in patients with degenerative lumbar disk disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment.

Too big to hire: factors impacting weight discrimination

PurposeThis study aims to examine the impact of applicant weight and sex, job type and employer attitudes on employee screening decisions.Design/methodology/approachParticipants rated one of four job applicants on their hiring suitability for four different entry‐level jobs with high or low visibility and physical demands. Applicants varied in sex and weight as depicted in a photograph, but their job applications were identical.FindingsResults showed that overweight women experienced weight discrimination when applying for a job that was high in both visibility and physical demands.Research limitations/implicationsFuture research should examine weight discrimination in other racial and ethnic groups and with higher‐level jobs. Future research could also examine hiring decisions using a within‐subjects design to allow comparison across job applicants.Practical implicationsEmployers' perceptions of applicant weight may lead them to make biased decisions about individuals who are overweight during the hiring process particularly for jobs that are high in visibility and physical demands.Social implicationsThere has been an alarming increase in obesity rates in the USA, but there is limited legal protection against weight discrimination. Employers who make stereotyped assumptions about individuals who are overweight may be missing out on valuable workforce talent. Similarly, individuals who are overweight may face discriminatory obstacles in finding work.Originality/valueThis study systematically manipulated two important job characteristics: visibility and physical demands and used a sample of adults as raters.

Infiltración esteroidea epidural por vía caudal en el tratamiento del dolor lumbar crónico de origen discal. Estudio comparativo, prospectivo y aleatorizado

ObjectiveThere is no consensus on the treatment of chronic low back pain of disc origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. Material and methodThis is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disc pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). ResultsLumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (P>.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend towards better results, but none reached statistical significance (P>.05). ConclusionsThe present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disc origin. While CESI could show some improvement in patients with degenerative lumbar disc disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment.

Return to work and workplace activity limitations following total hip or knee replacement

Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA.

Quality of Life, Personality and Use of Pain Medication in Patients with Chronic Back Pain

The aim of the study was to assess whether the functional disability and the quality of life in patients with chronic back pain was associated with some personality traits and whether the use of pain medication in patients with chronic back pain can be predisposed with some personality traits. The study sample comprised 262 older patients with chronic back pain of non-inflammatory origin. The level of disability related to chronic back pain was assessed by Roland-Morris Questionnaire, health-related quality of life was assessed by Short Form 36 and personality traits by Eysenck Personality Questionnaire. Among analyzed personality traits (psychoticism, extraversion, neuroticism, lie tendencies), only neuroticism significantly predicted self-reported disability caused by back pain. Patients on pain medication had significantly worse quality of life and disability caused by back pain, but they did not differ significantly in personality traits compared to patients without pain medication. There were no differences in disability due to back pain and in level of neuroticism between patients who had jobs with higher or lower physical demand. People with higher scores on neuroticism inclined more to report a lower functional disability and the quality of life caused by chronic back pain. Patients on pain medication reported more inferior physical than psychological concept of quality of life. Use of pain medication was not associated with personality traits assessed by Eysenck Personality Questionnaire. In our elderly patients with chronic back pain, lower quality of life was associated with elevated neuroticism score and more frequent use of pain medication.