Musculoskeletal Disorders Research Articles

Postural Assessment of Indian Masons and Prototype Design of Work Table

Indian Masons are engaged in different construction activities like bricklaying, plastering, and concreting work in prolonged standing, sitting, trunk flexion posture at lumbar, squatting, and truck twisting posture to pick the materials, tools and perform bricklaying and plastering work throughout the day. A different study revealed that prolonged working in flexion posture and working in squatting posture without supporting any fixture would cause work-related musculoskeletal disorders gradually. Earlier studies also showed that working in poor posture correlated with work-related musculoskeletal disorders. This study examines the influence of working in trunk flexion posture at the lumbar, trunk twisting, Neck twisting and squatting posture by the masons while performing different masonry work to find the discomfort among the Indian masons. The 64 male masons were observed and video-recorded at different construction sites. The REBA, ERIN, WERA and QEC methods are used for the assessment of exposure on the body. The assessment was performed on real-time images of masons performing bricklaying and plastering work. The REBA, ERIN, WERA and QEC results showed that masons were at high risk due to prolonged working in trunk flexion posture at the lumbar, working with twisting position of the trunk and Neck and squatting posture. The newly developed worktable will help the mason to reduce the risk of work-related musculoskeletal disorders.

Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review.

Musculoskeletal embolization has emerged in recent years as a treatment for chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have demonstrated a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity, to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well-established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intra-articular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most heavily studied musucloskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis. GAE is now supported by multiple prospective studies, including randomized control trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial/lateral epicondylitis), hip (osteoarthritis, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee osteoarthritis and chronic shoulder pain.

Patient Demographics and Factors Influencing Access to General Practitioner Services for Musculoskeletal Pain in the United Kingdom.

Access to general practitioner (GP) services is essential for managing musculoskeletal pain. This study investigates the relationship between patient demographics, co-morbidities, health behaviours and difficulty in accessing GP services in the United Kingdom. Significant associations were explored between age, co-morbidities and ease of securing GP appointments. This analysis provides insights into the barriers patients face and suggests targeted interventions for improving access to primary care. A cross-sectional study was conducted using survey data from participants of various ages, ethnicities and socioeconomic statuses with either localised or generalised musculoskeletal pain. Relationships between key variables, such as age, co-morbidities and difficulty in accessing GP services, were examined using chi-square tests (for nominal variables) and Kruskal-Wallis tests (for nominal and ordinal variables). A total of 503 respondents participated in the online questionnaire. In all, 66% of the respondents were female. The majority of participants were Caucasian (69%), followed by South Asians (19%), with the remainder identifying as Black or of mixed ethnicity. Most respondents (62%) reported experiencing musculoskeletal pain for over 2years. Significant associations were found between the age of the participants and difficulty in accessing GP services (χ2(20)=39, p=0.006), co-morbidities and the impact of delayed GP reviews on patients' musculoskeletal pain (χ2(10)=31, p=0.001), employment status and alternative care choices (χ2(4)=10.99, p=0.027). These results highlight the multifaceted nature of healthcare access for patients of various ages with musculoskeletal pain. Age, co-morbidities and employment status significantly influence access to GP services. Future studies should explore additional systemic healthcare barriers and develop personalised interventions to improve access for high-risk populations.

Management Ergonomics Sector Analysis Oil Palm Plantation

Indonesia, the world’s largest palm oil producer, significantly impacts global crude palm oil (CPO) production. Despite its economic value, manual labor in oil palm plantations often involves non-ergonomic practices, particularly in tasks like loading and unloading, leading to worker fatigue and increased risks of Musculoskeletal Disorders (MSDs). This research aims to evaluate ergonomic risks and MSD prevalence among oil palm workers by analyzing body posture during daily tasks. Data were collected using the RULA method, Nordic Body Map, and environmental measurements, supported by interviews and observations. Findings reveal that improper lifting and posture during harvesting contribute to fatigue and MSDs among workers. Recommendations for improvement include regular ergonomic training, adjustments to work posture, and the addition of safety equipment like fire extinguishers. By implementing these changes, the study seeks to improve worker safety, minimize MSD occurrences, and boost productivity in oil palm plantations. These insights are vital for ensuring sustainable practices in the industry and promoting the well-being of plantation workers.

Repurposed pharmacotherapy: targeting cathepsin L with repurposed drugs in virtual screening.

Proteolytic enzymes are closely associated with cancer and are important in different phases, including tumor growth, angiogenesis, and metastasis. Despite efforts to target matrix metalloproteases (MMPs), clinical trials have often resulted in various side effects such as musculoskeletal pain, joint stiffness, and tendinitis, making them less optimal for chronic cancer treatment. Thus, there is a need for the identification of other protease targets that would provide different approaches towards the management of cancer. Of these targets, Cathepsin L (CatL) is a lysosomal cysteine protease that has been identified as a therapeutic target that is implicated in cancer development and metastasis. In this study, we performed an integrated approach of virtual screening and molecular dynamics (MD) simulations to identify the potential inhibitors of CatL from a library of drugs that have been used for different treatments. Towards this goal, we performed virtual screening of the DrugBank database and found two repurposed drugs, Irinotecan and Nilotinib, against CatL based on their docking profiles, favorable docking scores, and specific interaction with the CatL binding pocket. MD simulations of the Irinotecan and Nilotinib bound structures with CatL were carried out, and the analysis showed that both these compounds could function as CatL inhibitors as the protein-ligand interactions were stable for 300 ns. This study highlights the robustness of these drugs bound to CatL and indicates that they could be repurposed for the treatment of cancer. These findings endorse the use of computer-based approaches for the identification of new inhibitors, and the present study will be a useful resource for future experimental research towards the targeting of CatL in cancer therapeutics.

Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus

BackgroundParacetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted.MethodsThe survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted.ResultsThe results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness.ConclusionsBoth the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

Spinal hyperexcitability in patients with chronic musculoskeletal pain or headache as evidenced by alterations in the nociceptive withdrawal reflex: a systematic review and meta-analysis.

The nociceptive withdrawal reflex (NWR) is a spinal withdrawal reflex induced by painful stimulation. It is a measure of spinal hyperexcitability, which is believed to contribute to chronic musculoskeletal pain (MSKP) and headache. Previous syntheses of the evidence for alterations in the NWR in patients with chronic MSKP and headache needed a comprehensive update. This systematic review and meta-analysis was performed after the Preferred Items for Systematic reviews and Meta-Analyses guidelines. Studies examining NWR-related outcome measures in patients with chronic MSKP and headache compared to pain-free controls were identified through electronic database searches and included after screening against predefined eligibility criteria. Standardized mean differences or mean differences and 95% confidence intervals (CI) were calculated. Thirty-one studies were included in the systematic review and 25 in the meta-analysis. Moderate-quality evidence was found indicating lower NWR threshold (-3.68; 95% CI, -4.56 to -2.80; P < 0.001), larger NWR area (standardized mean difference = 0.69; 95% CI, 0.37-1.01; P < 0.001), and shorter NWR latency (mean difference = -13.68; 95% CI, -22.69, -4.67; P = 0.003) in patients compared to controls. These findings remained robust when performing meta-regressions based on subgroups (ie, headache, fibromyalgia, whiplash-associated disorder, and osteoarthritis). Low-quality evidence demonstrated facilitated temporal summation of NWR threshold (-2.48; 95% CI, -3.13 to -1.83; P < 0.001) in patients compared to controls. Spinal hyperexcitability as evidenced by lowered NWR threshold values and temporal summation of the NWR is present in patients with chronic MSKP and headache. No evidence was found for alterations in NWR duration and NWR magnitude. Future research is needed to address the gap in research on NWR-related outcome measures other than NWR threshold.

Prevalence of Work-Related Musculoskeletal Disorders Among Orthopedic Surgeons in Saudi Arabia: A Systematic Literature Review

Prevalence of Work-Related Musculoskeletal Disorders Among Orthopedic Surgeons in Saudi Arabia: A Systematic Literature Review

Factors Related to Dental Ergonomics Practice Among Indonesian Dentists.

Dentists are at greater risk of work-related musculoskeletal disorders (WMSDs) which can be caused by repetitive movements, improper posture and long working hours. If ergonomic principles are applied in the field of dentistry, they help to prevent occupational ergonomic health hazards and provides more comfort to the dentist and patient. To obtain information regarding dental ergonomics practice of dentists in Indonesia and its related factors. A cross-sectional study was conducted using a purposive sampling method via Google Form to 231 dentists in DKI Jakarta, Indonesia from November to December 2022. The questionnaire consisted of 34 items divided into five sections; socio-demographic, job characteristics, knowledge of dental ergonomics, attitude towards dental ergonomics and the practice of dentists regarding dental ergonomics. Bivariate analysis was conducted using Pearson Chi-square Test. 76.2% dentists have poor dental ergonomics practice. There is a significant relationship (p-value < 0.05) between the practice of dental ergonomics and age group, years of practical experience and level of knowledge. Most Indonesian dentists (76.2%) still lack of dental ergonomics practice. Age, duration of work experience and ergonomic dental practice knowledge are significantly correlated.

Musculoskeletal disorders and risk factors in the modern era: results from the Specchio cohort

Abstract Background Musculoskeletal disorders (MSDs) represent a major challenge for occupational and public health, but data are scarce in Switzerland or concentrated on a few sectors of activities. The aim of this study is to provide results on the prevalence and risk and protective factors of MSDs in the general working-age population of the Geneva canton, Switzerland. Methods A cross-sectional analysis was conducted as part of Specchio population-based cohort study. Prevalence and associations between MSDs and sociodemographic variables, individual behaviour (smoking, physical activity, sleep), health conditions (BMI, chronic diseases), physical and psychological risks at work were examined using regression models. The impact of teleworking was also evaluated. Results 2’733 participants took part in the survey, of which 38% were men, and mean age was 50. Overall prevalence of MSDs was 74% among men and 84% among women. 80% of the individuals experience back pain and 56% shoulder pain. Among individuals who experienced MSDs, 55.2% consulted a healthcare professional. The risk factors for MSDs were female sex (OR = 1.95; 95% IC = 1.55-2.28), body mass index (obese) (2.2; 1.51-3.32), lower education (1.77; 0.84-4.37), smoking (1.65; 1.19-2.35), exposure to physical risks (3.54; 2.78-4.51), stress at work (effort-reward imbalance) (3.23; 2.45-4.29) and a poor work-life balance (2.36; 1.88-2.97). The prevalence of MSDs remained high among workers who telework (78% versus 84% in working population). Conclusions This study, carried out in a large population-based cohort, confirmed several risk factors for MSDs. These results will contribute to the implementation of prevention strategies, especially as teleworking has gained in importance in recent years, which may have aggravated workers’ isolation and stress, sedentariness, and poor body posture. Main message: These data confirm the weight of musculoskeletal disorders and will help implementation of prevention health strategies. Key messages • The relationship between psychosocial risks at work and the occurrence of Musculoskeletal Disorders (MSDs) persists even following adjustment for exposure to physical risks and individual risk factors. • The prevalence of musculoskeletal (MSDs) disorders remained high among workers who telework.

Alcohol intake and patterns of multi-site musculoskeletal pain in the British Whitehall II study

Abstract Background Patterns of multi-site musculoskeletal (MSK) pain and its relationship with alcohol drinking among white-collar employees and retirees remain unclear compared to blue-collar workers. This study aimed to examine the relationship between alcohol drinking and MSK pain through latent class analysis (LCA) in current and retired white-collar employees. Methods We used the data from the 7th phase (2000-2002, n = 6,967, response rate 71.6%) of the British Whitehall II study, chosen for its availability of MSK items and approximately 1:1 ratio of employees to retirees, allowing for an evaluation of the relationship between alcohol drinking and MSK pain by employment status. LCA was used to distinguish patterns of multi-site MSK pain. A multinomial logistic regression model was used to examine the association between alcohol drinking and the identified pain patterns, with analyses conducted separately for employees and retirees. Results We identified five latent classes for pain (back/cervical: 7.1%, cervical: 28.9%, upper limb: 29.4%, combined LBP/upper limb/cervical: 13.2%, and LBP alone: 21.5%). Increased alcohol intake might be associated with elevated odds of upper limb pain in current drinkers, but this could not be statistically confirmed (OR: 1.04, 95% CI: 0.99-1.09). Employment status may modify the association with a significant interaction found between alcohol intake and retirement (p-value: 0.043). Every 7-unit increase in alcohol intake is associated with 18% and 12% higher odds of pain in LBP/UBP/cervical and upper limbs, respectively (95% CI: 1.02-1.37; 1.02-1.23). Conclusions Increased alcohol intake was associated with pain patterns only among retired white-collar employees but not the current ones. Interventions on alcohol consumption could help confirm if, reducing alcohol intake or avoiding hazardous drinking, for white-collar retirees prevents not only upper limb pain but also more complex pain patterns. Key messages • Musculoskeletal pain in white-collar employees and retirees contributes to the cervical and upper extremities, differing from low back/neck pain studies among general or blue-collar workers. • The association between alcohol drinking and pain patterns may differ across employment status. Reducing alcohol intake might be advised to retired drinkers for preventing multi-site pain.

The Role and Interactive Mechanism of Endoplasmic Reticulum Stress and Ferroptosis in Musculoskeletal Disorders

Endoplasmic reticulum (ER) stress is a cellular phenomenon that arises in response to the accumulation of misfolded proteins within the ER. This process triggers the activation of a signalling pathway known as the unfolded protein response (UPR), which aims to restore ER homeostasis by reducing protein synthesis, increasing protein degradation, and promoting proper protein folding. However, excessive ER stress can perturb regular cellular function and contribute to the development of diverse pathological conditions. As is well known, ferroptosis is a kind of programmed cell death characterized by the accumulation of lipid peroxides and iron-dependent reactive oxygen species (ROS), resulting in oxidative harm to cellular structures. In recent years, there has been increasing evidence indicating that ferroptosis occurs in musculoskeletal disorders (MSDs), with emerging recognition of the complex relationship between ER stress and ferroptosis. This review presents a summary of ER stress and the ferroptosis pathway. Most importantly, it delves into the significance of ER stress in the ferroptosis process within diverse skeletal or muscle cell types. Furthermore, we highlight the potential benefits of targeting the correlation between ER stress and ferroptosis in treating degenerative MSDs.

Prevalence and treatment of chronic musculoskeletal pain focused on service gaps: a comparative analysis by age group and body part.

Occupational health, grounded in occupational medicine, aims to enhance the well-being and labor productivity of the working population. Within this realm, there has been growing concern over the increasing instances of labor loss due to diminished physical capacity and the rise in musculoskeletal disorders. Chronic pain is also associated with musculoskeletal disorders. Another pressing issue related to chronic musculoskeletal pain was needed assistance services are underutilized, is referred to as a "service gap". Understanding trends based on age and affected regions of the body is indispensable for developing strategies to address chronic musculoskeletal pain in workers. This study aimed to elucidate age-specific trends in the prevalence and number of pain sites in chronic musculoskeletal pain as well as the patterns of treatment during chronic musculoskeletal pain, categorized by age and affected site. This study was conducted in December 2022 in contract to Cross Marketing Inc. The survey began on December 12, 2022 and ended on December 15, 2022. An online survey was administered to 1,946 participants (973 women and 973 men), and responses were collected, ensuring a roughly equal distribution of samples among men and women across six age groups ranging from their 20 to 70 s. The survey inquired about the presence of chronic pain in each of the eight body parts and the adoption of five different treatments when experiencing pain. Statistical analysis was performed using the chi-square test, with the measurement data categorized by age group and body part. The results indicated a significantly higher prevalence of chronic pain at three or more sites among individuals in their 30 s: the prevalence of pain at each of the eight body sites varied with age. Approximately half of the participants did not engage in specific treatments during episodes of chronic pain. The presence or absence of treatment showed no significant differences according to affected site or age group. This study revealed age- and body part-related relationships with chronic musculoskeletal pain in middle-aged patients and highlighted healthcare service gaps in its management in Japan.

Promotion included in prevention (PIP)

Abstract Issue/problem Every year in Europe more than 20 million visits are carried out on workers. The opportunity to integrate health promotion into prevention is now under the attention of large companies, according to the American model known as Total Worker Health©. Description of the problem The main critical points of this strategy are the correct balance between promotion and prevention efforts and the extension of the projects to small companies. Furthermore, coordination is necessary between all the figures who promote health, particularly in the national health service. Results Occupational risk prevention activities, mandatory in all European countries, have been integrated with health promotion campaigns, addressing health topics chosen in a participatory way. The costs of designing the campaign, information material for employees and data processing are borne by the university, which covers the costs with research funds. No costs are borne by workers or companies. During their medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. In the last 15 years, as many annual campaigns have been conducted. Projects have dealt with: Eating behavior disorders; Post-COVID syndrome; Syncope and presyncope; Headache; Musculoskeletal disorders; Work engagement; Sleep health promotion; Aging; Violence at work; Work organization; Indoor air quality; Mediterranean Diet; Hand skin disorders; Teleworking; Work Ability. More than 30,000 workers from 38 companies participated. Lessons The participatory character of the projects, their simplicity and cost-effectiveness, the integration between occupational medicine and basic medicine demonstrate that PIP projects are economical, sustainable, and effective. Key messages • Health promotion can be integrated into the prevention of occupational risks, without additional costs. • The creation of a network of occupational physicians who are involved in PIP projects respects corporate and professional independence and improves the work culture, health, and safety of workers.

Solutions for reducing the severe economic burden of musculoskeletal diseases

Abstract Issue In Slovenia the big group of over 150 musculoskeletal and connective tissue diseases (MSCTD) constitute a serious public health problem, a major burden on health systems and society as a whole. Patients with these diseases have a poorer quality of life and often retire early. Any early retirement that could have been prevented represents a loss of human capital, which is a major social and economic cost to society. The aim of this study was to analyze the economic burden of the six most common MSCTD in Slovenia for the period from 2020 to 2022, to contribute to a better understanding of this problem and suggest solutions. Methods At the Slovenian National Institute of Public Health, in collaboration with the Faculty of Economics at the University of Ljubljana, we calculated the burden of six most common MSCTD for the period 2020-2022. We used the National Transfer Accounts (NTA) methodology to calculate the indirect costs; direct costs were calculated based on the national routine health data. Results The calculated economic burden of the six most common diagnoses of MSCTD represents 5% of total health expenditure or 0.4% of Slovenian gross domestic product on average. Direct costs amounted to 2% of total health expenditure (hospitalizations 22.5%, costs for medicines 9.3%, first curative visits at the primary level and visits to the outpatient clinic at the secondary level 2.7%). Indirect costs amounted to 3% of total health expenditure. Conclusions Despite the reduced access to the health system due to COVID-19 the economic burden of MSCTD is high in Slovenia and would be significantly higher considering all diagnoses from this group of diseases. The research requires interdisciplinary cooperation between medicine and economics regarding demanding NTA methodology which is innovative in our country. Key messages • One of the main public health priorities in Slovenia should be to raise awareness of MSCTD. • In the light of the aging population prevention activities with focus on MSCTD should be intensified as soon as possible.

Incident heart failure: comparing management and outcome in primary care and hospital settings in Western Sweden 2008-2017

Abstract Background Heart failure (HF) is a major problem in primary care (PC) and hospital care (HC). HF patients managed in these two settings may differ in their demography, comorbidities, treatment and outcomes. Aim We aimed to compare the patient management in PC and HC in the Västra Götaland Region (VGR) in Sweden. Methods The VEGA database is an administrative database includes all patients living in VGR. Patients with a first principal or contributory diagnosis of HF (I50) ≥18 years old between 2008 and 2017 were included. One-year mortality was used as the outcome. Results In total, 62,229 new-onset HF cases were included, with 18,722 identified only in PC and 16,651 in HC. HF patients in PC were older (80.7±10.9 vs 76.1±13.6), more women (57.1% vs 44.9%), with more hypertension, musculoskeletal and mental disorders, but less myocardial infarction. Guideline directed medical therapy was more frequently used in HC despite similar medication before HF diagnosis. Patients in HC had almost 4 times higher all-cause 1-year mortality [3.92 (3.77 - 4.08), p&amp;lt;0.0001] compared with PC after adjustment for age and sex. Over 10-year period, despite decreasing mortality in both settings, hazard ratios for HC vs. PC were significantly increased for all patients (p for interaction 0.0004), which was more marked in female and for 70-80 years old patients. Conclusion Over a 10-year period, not withstanding decreasing mortality in HF patients in both PC and HC settings, differences remain between these two HF populations not only demographic profile and medications but also outcomes.

Dental Emergency Rates at an Expeditionary Medical Facility Supporting Operation Inherent Resolve.

A core objective of U.S. medical services is to ensure the medical and dental readiness of military personnel. Oral diseases, resulting in pain, infection, or functional impairment, greatly affect the operational effectiveness of military personnel. This study aimed to compare the current causes of dental emergencies and the rates of dental disease nonbattle injuries in a deployed setting with those documented in previous research. Additionally, the study sought to determine if these rates have decreased because of preventive measures or potential improvements in overall oral health. Each soldier reporting to the health facility for dental care was screened by a dentist to determine the presence of a dental emergency. The reason for seeking care was classified into 1 of 7 categories and the rate of dental emergencies per 1,000 military members per calendar year was calculated. The majority of emergencies (38.60%) were due to tooth fractures and/or caries. The second most common reason for visiting the dental clinic was pain from a tooth requiring endodontic therapy (16.81%). This was followed by musculoskeletal or nonendodontic tooth pain (16.10%), most often associated with stress. Periodontal issues accounted for 14.33% of emergencies. Teeth requiring extraction made up 7.16% of all emergencies, prosthodontic bonding complications accounted for 5.16%, and orthodontic bonding complications affected 1.84% of individuals. The dental disease nonbattle injuries rates determined from the current study were 154 emergencies per 1,000 personnel per year for Air Force members and 264 emergencies per 1,000 personnel per year for Army members, which align with previous research findings. The results of this study confirm that dental emergencies continue to be a threat to overall readiness in deployed environments. The primary etiologic factor in the current study was as a result of tooth fracture and/or caries.

CULTURAL adaptation and validation of the Indonesian version of the Roland-Morris disability questionnaire: A psychometric analysis

BACKGROUND: Epidemiological evidence underscores low back pain (LBP) as a prevalent and consequential musculoskeletal disorder, posing a significant public health challenge. Patient-reported outcome measures (PROMs) play a crucial role in the diagnostic process for LBP, with the Roland-Morris Disability Questionnaire (RMDQ) being a commonly utilized tool in evaluating LBP. OBJECTIVE: This cross-sectional study aimed to cross-culturally adapt and validate the Indonesian version of the 24-item-RMDQ among nonspecific LBP (NSLBP) patients. METHODS: The RMDQ scales underwent forward-backwards translation, readability, and content validity assessments with NSLBP patients (n = 137), with a mean age of 38.6±11.8 years (59% female). Psychometric testing included assessments of internal consistency and 1-week test-retest reliability, convergent validity with pain numeric rating scale (PNRS), and the Physical Component Summary (PCS) and Mental Component Summary (MCS) of quality of life (Short Form 12). The construct validity using confirmatory factor analyses (CFA). RESULTS: The findings of this study indicated a good internal consistency (Cronbach α= 0.80) of the translated instrument. Moderate to good repeatability estimates of all RMDQ items were demonstrated with the total ICC of the total RMDQ score of 0.90 [95%CI (0.85–0.94)]. The instrument correlations with PNRS, PCS, and MCS were 0.54, 0.60, and 0.23, respectively. The goodness-of-fit test further affirmed an acceptable fit of the data, although low factor loadings were found in several RMDQ items. CONCLUSION: Although the factor structure of the RMDQ scale warrants further investigation, the overall findings support its suitability for clinical application in Indonesian NSLBP patients.

Inter-regional Hospital Patients’ mobility: Is co-operation better than competition?

Abstract Background According to Italian law, citizens are free to choose their preferred place of care across the national territory. This study aims to analyze the associations between patients’ mobility between Tuscany (Italy) and other Italian regions and the complexity of Diagnosis Related Groups (DRGs) provided for these hospitalizations. Methods A retrospective study was conducted using 2019 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patients’ attractions, and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using the Odds Ratio. The analysis was performed using STATA software, and the significance level was set at 95%. Results For Digestive Diseases, patients from non-border regions were more likely to be attracted to Tuscan hospitals for HS DRGs (OR: 1.37 95%CI: 1.08-1.74; p &amp;lt; 0,05), while for Musculoskeletal Diseases those from non-border regions were less likely to be attracted for HS DRGs (OR: 0.51 95%CI: 0.47-0.56; p &amp;lt; 0,05). For Nervous Diseases (OR: 3.08 95%CI: 2.18-4.37; p &amp;lt; 0,05), for Ear, Nose, Mouth And Throat Diseases (OR: 2.41 95%CI: 1.52-5.03; p &amp;lt; 0,05) and for Hepatobiliary And Pancreas Diseases (OR: 4.55 95%CI: 2.71-7.68; p &amp;lt; 0,05), Tuscan patients were more likely to escape to non-border regions for HS DRGs, while for Musculoskeletal Diseases (OR: 0.76 95%CI: 0.68-0.84; p &amp;lt; 0,05) they were less likely to be admitted to non-border regions for HS DRGs. Conclusions The results suggest the necessity of establishing mobility agreements between regions, particularly for high-specialty DRGs. In fact, the provision of mobility care economically benefits the receiving (creditor) region, which provides the medical service, but is not advantageous to the patient’s region of residence (debtor). Key messages • Monitoring mobility flows is critical to improve identify possible lack of supply of resources. • There is a need to develop interregional mobility agreements to ensure better cooperation between different regional health systems.

Disability trends among elderly Ukrainians in war conditions: a 10-year retrospective study

AimNon-communicable diseases (NCDs) in elderly are a significant problem in Ukraine. It is expected that the ongoing war will augment this problem. The study aimed to analyze the trends of disability due to NCDs s in newly-diagnosed elderly patients between 2013 and 2023.MethodsThis retrospective study included data obtained from the official document “Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation” commissioned by the Ministry of Health of Ukraine. The data on disability due to NCDs s were obtained from for 2013–2023.ResultsDuring the 2013–2021 the average number of disabled elderly patients due to NCDs per 10,000 elderly persons was significantly lower in compare with working-age. During the first year of full-scaled war the average number of disabled elderly patients due to NCDS s per 10,000 elderly persons dramatically increased by 2-fold, and in 2023 – by 2.8-fold against 2013 value (p < 0.05), while in working-age the disability rate increased significantly only in 2023 by 1.4-fold compared to the pre-war level. In 2013–2021 the main causes of disability among those related to NCDs in elderly were cardiovascular diseases, followed by cancer. In 2022 compared to the pre-war level, the indicators of disability of the elderly due to CVD increased by 1.5 times, due to cerebrovascular diseases - by 2.2 times, due to cancer - by 1.7 times, due to musculoskeletal diseases - by 2 times (p < 0.05). The most significant increase in the number of elderly people with disabilities during the full-scale war occurred due to coronary artery disease - by 55.1%, and osteoarthritis - by 83.4% from baseline in 2013. It estemated the differences in indicators of disability of elderly between regions of Ukraine, significantly higher indicators of disability of the elderly due to cardiovascular diseases, cancer, cerebrovascular diseases, musculoskeletal diseases were noted in the frontline regions.ConclusionsData on primary disability among elderly Ukrainians indicates a significant increase in NCDs-related disability during the war in compare with working population, especially in frontline regions and regions with a high concentration of displaced persons. In this structure of NCDs-related increasing disability, CVD, oncology and musculoskeletal diseases system prevailed.