Upper-limb Musculoskeletal Disorders Research Articles

Musculoskeletal Disorders Related to Upper Limb Disability after One-Year Lung Cancer Resection.

Lung resection represents the main curative treatment in lung cancer; however, this surgical process leads to several disorders in tissues and organs. Previous studies have reported cardiovascular, pulmonary, and muscular disturbances that affect the functional capacity of these patients in the short, mid, and long term. However, upper limb impairment has been scarcely explored in the long term, despite the relevance in the independence of the patients. The aim of this study was to characterize the upper limb impairment in survivors of lung cancer one year after pulmonary resection. In this observational trial, patients who underwent lung cancer surgery were compared to control, healthy subjects matched by age and gender. Upper limb musculoskeletal disorders (shoulder range of motion, pain pressure threshold, nerve-related symptoms) and functional capacity (upper limb exercise capacity) were evaluated one-year post-surgery. A total of 76 survivors of lung cancer and 74 healthy subjects were included in the study. Significant differences between groups were found for active shoulder mobility (p < 0.05), widespread hypersensitivity to mechanical pain (p < 0.001), mechanosensitivity of the neural tissue (p < 0.001), and upper limb exercise capacity (p < 0.001). Patients who undergo lung cancer surgery show upper limb musculoskeletal disorders and upper limb functional impairment after a one-year lung resection. This clinical condition could limit the functionality and quality of life of patients with lung cancer.

Barriers and facilitators to engaging with a digital self-management programme for painful distal upper limb musculoskeletal disorders: A qualitative exploratory study.

People living with a painful distal upper limb musculoskeletal disorder (DUL-MSD) often experience pain, difficulty in doing everyday tasks and a reduced quality of life. Currently, there are challenges in the treatment of DUL-MSDs, highlighting the need to develop innovative approaches to rehabilitation. A potential solution is to develop and implement a digital self-management rehabilitation programme focussing on optimising recovery, improving function and reducing pain. Before developing this programme, we aimed to identify the barriers and facilitators to using a digital health intervention (DHI) for self-management of DUL-MSDs. This study aimed to investigate the potential barriers and facilitators to using a DHI with people living with DUL-MSDs and healthcare professionals (HCPs). A qualitative exploratory study was carried out with purposely selected participants consisting of 15 participants with DUL-MSDs and 13 HCPs. Three focus groups (FGs) and four semistructured interviews with DUL-MSD participants and semistructured interviews with 13 HCPs were conducted. FGs and interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. To address challenges in the care and management of DUL-MSDs, both HCPs and people living with a DUL-MSD welcomed the development of a DHI. This study identified several barriers and facilitators that would influence engagement with a digital intervention. Findings suggest that in developing a DHI, attention needs to be paid to digital design features, usability, tailoring, personalisation and consideration of how well usual care could be replicated digitally without direct HCP involvement. The identified digital design features of importance to participants will inform the design of a digital self-management rehabilitation programme for people living with DUL-MSDs. Addressing the barriers and facilitators to engagement with a DHI is essential in ensuring its relevance and acceptability to those who will use it. Patient and Public Involvement and Engagement (PPIE) was integral throughout the study. PPIE members contributed to the development and planning of this study, checked and confirmed the relevance of the findings and are involved in the dissemination plans.

Multimodal sensorimotor assessment of hand and forearm asymmetries: a reliability and correlational study.

Effective rehabilitation of upper limb musculoskeletal disorders requires multimodal assessment to guide clinicians' decision-making. Furthermore, a comprehensive assessment must include reliable tests. Nevertheless, the interrelationship among various upper limb tests remains unclear. This study aimed to evaluate the reliability of easily applicable upper extremity assessments, including absolute values and asymmetries of muscle mechanical properties, pressure pain threshold, active range of motion, maximal isometric strength, and manual dexterity. A secondary aim was to explore correlations between different assessment procedures to determine their interrelationship. Thirty healthy subjects participated in two experimental sessions with 1 week between sessions. Measurements involved using a digital myotonometer, algometer, inclinometer, dynamometer, and the Nine-Hole Peg test. Intraclass correlation coefficients, standard error of the mean, and minimum detectable change were calculated as reliability indicators. Pearson's correlation was used to assess the interrelationship between tests. For the absolute values of the dominant and nondominant sides, reliability was 'good' to 'excellent' for muscle mechanical properties, pressure pain thresholds, active range of motion, maximal isometric strength, and manual dexterity. Similarly, the reliability for asymmetries ranged from 'moderate' to 'excellent' across the same parameters. Faster performance in the second session was consistently found for the Nine-Hole Peg test. No systematic inter-session errors were identified for the values of the asymmetries. No significant correlations were found between tests, indicating test independence. These findings indicate that the sensorimotor battery of tests is reliable, while monitoring asymmetry changes may offer a more conservative approach to effectively tracking recovery of upper extremity injuries.

Effects of computer use on upper limb musculoskeletal disorders and function in academicians

Objectives. This study aimed to investigate the effects of academician’s demographic characteristics and computer usage habits on upper limb musculoskeletal disorders (MSDs) and function. Methods. A cross-sectional observational study was conducted with 100 academicians. Data were collected using questionnaires, which included the patient-rated wrist evaluation questionnaire – Turkish version (PRWE-T), the Cornell musculoskeletal discomfort questionnaire – Turkish version (CMDQ-T), the upper extremity functional index – Turkish version (UEFI-T), demographic characteristics and average daily computer usage time. Results. A low-level significant correlation was found between the age of the individuals and the CMDQ-T forearm (p = 0.044; r = 0.202) and CMDQ-T wrist (p = 0.001; r = 0.337) scores. Women had higher CMDQ-T neck scores and lower UEFI-T scores than men (p < 0.05). Academicians who used computers for 6 h a day or more had higher PRWE-T and CMDQ-T neck, shoulder, upper arm and forearm scores, and had a lower UEFI-T score (p < 0.05). Conclusion. Neck, shoulder, upper arm and forearm symptoms were higher and upper extremity function was impaired in academicians who used computers for 6 h a day or more. Besides, gender and age were associated with upper limb MSDs and function, but occupation duration did not affect those outcomes in academicians.

Musculoskeletal disorders of the upper and lower limb: Prevalence among patients in Eastern province, Saudi Arabia.

To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy. Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb). A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, p<0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, p<0.001). This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.

The Effect of Chronic Dietary Protein Manipulation on Amino Acids' Profile and Position Sense in the Elderly Suffering from Type 2 Diabetes Mellitus.

Dietary protein with adequate essential amino acids effectively stimulates protein synthesis and improves muscle mass. Musculoskeletal disorders in lower or upper limbs are not uncommon among patients with type II diabetes mellitus (T2DM). Therefore, this study primarily examines the effects of chronic dietary protein manipulation on amino acids' profile and position sense in the elderly suffering from T2DM. A total of 26 individuals suffering from non-insulin-dependent T2DM (age > 55 years old) participated in a 12 week nutritional intervention. The subjects were randomly assigned and the control group received 0.8-1.0 g protein/kg/day, while the intervention group received 1.2-1.5 g protein/kg/day. Lean body mass, muscle strength, and position sense were assessed at baseline, as well as at the 6th and 12th week of the intervention. Only in the intervention group, the essential amino acids intake met the current nutritional recommendations (p < 0.05), while, by the 12th week, only the intervention group showed significant improvement in the muscle strength of knee (p < 0.05) and shoulder (p < 0.05) extension. On the contrary, in the control group, a significant decline in appendicular lean mass (p < 0.05) was observed by the 12th week. Position sense at the knee joint revealed a tendency for improvement in the intervention group by the 12th week (main effect of time p = 0.072). In the present investigation, it was revealed that the higher protein intake in the intervention group seemed to have positive effects on muscle strength and nearly positive effects on position sense.

Artificial intelligence in diagnosing upper limb musculoskeletal disorders: a systematic review and meta-analysis of diagnostic tests.

The integration of artificial intelligence (AI) in radiology has revolutionized diagnostics, optimizing precision and decision-making. Specifically in musculoskeletal imaging, AI tools can improve accuracy for upper extremity pathologies. This study aimed to assess the diagnostic performance of AI models in detecting musculoskeletal pathologies of the upper extremity using different imaging modalities. A meta-analysis was conducted, involving searches on MEDLINE/PubMed, SCOPUS, Cochrane Library, Lilacs, and SciELO. The quality of the studies was assessed using the QUADAS-2 tool. Diagnostic accuracy measures including sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR, NLR), area under the curve (AUC), and summary receiver operating characteristic were pooled using a random-effects model. Heterogeneity and subgroup analyses were also included. All statistical analyses and plots were performed using the R software package. Thirteen models from ten articles were analyzed. The sensitivity and specificity of the AI models to detect musculoskeletal conditions in the upper extremity were 0.926 (95% CI: 0.900; 0.945) and 0.908 (95% CI: 0.810; 0.958). The PLR, NLR, lnDOR, and the AUC estimates were found to be 19.18 (95% CI: 8.90; 29.34), 0.11 (95% CI: 0.18; 0.46), 4.62 (95% CI: 4.02; 5.22) with a (P < 0.001), and 95%, respectively. The AI models exhibited strong univariate and bivariate performance in detecting both positive and negative cases within the analyzed dataset of musculoskeletal pathologies in the upper extremity.

Study on therapeutic management of carpal tunnel syndrome

Carpal tunnel syndrome has long been considered a pathology requiring surgical intervention. Over the years, therapeutic management has become increasingly complex, with improvements observed in patients benefiting from orthopedic, surgical, ergotherapeutic and physiotherapeutic treatments, tailored to individual possibilities. The objective of this case study is to observe whether individualized and adapted kinetic treatment based on specific, non-specific and comprehensive means, succeeds in optimizing the results within the QuickDASH-Score for a 64-year-old patient following surgical intervention for carpal tunnel syndrome. The QuickDASH analyses physical function, pain and other symptoms associated with various types of upper limb musculoskeletal pathologies and disorders. The initial evaluation score was 47 points, with the physiotherapy program carried out over a six-months period. The main objectives included pain, edema, and inflammation control; enhancing joint range of motion within physiological limits in affected areas; preventing muscle-tendon retractions; and fostering independence in daily activities. The final evaluation had 32 points, signifying a 15-point improvement and achievement of the objective, resulting in enhanced quality of life. Physiotherapy in carpal tunnel syndrome is a meticulously applied treatment that alleviates specific symptoms. It's crucial to educate patients on how physiotherapy contributes to full functional recovery, as premature ending can have significant adverse effects on quality of life.

Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand (DASH) and the Shortened Version of the DASH (QuickDASH) in People With Musculoskeletal Disorders: A Systematic Review and Meta-Analysis.

The objective of this study was to perform a meta-analysis of the minimal clinically important difference (MCID) of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its shortened version (ie, the QuickDASH). MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Scopus were searched up to July 2022. Studies on people with upper limb musculoskeletal disorders that calculated the MCID by anchor-based methods were included. Descriptive and quantitative synthesis was used for the MCID and the minimal detectable change with 90% confidence (MDC90). Fixed-effects models and random-effect models were used for the meta-analysis. I2 statistics was computed to assess heterogeneity. The methodological quality of studies was assessed with the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist for measurement error and an adaptation of the checklist for the studies on MCID proposed by Bohannon and Glenney. Twelve studies (1677 patients) were included, producing 17 MCID estimates ranging from 8.3 to 18.0 DASH points and 8.0 to 18.1 QuickDASH points. The pooled MCIDs were 11.00 DASH points (95% CI = 8.59-13.41; I2 = 0%) and 11.97 QuickDASH points (95% CI = 9.60-14.33; I2 = 0%). The pooled MDC90s were 9.04 DASH points (95% CI = 6.46-11.62; I2 = 0%) and 9.03 QuickDASH points (95% CI = 6.36-11.71; I2 = 18%). Great methodological heterogeneity in the calculation of the MCID was identified among the primary studies. Reasonable MCID ranges of 12 to 14 DASH points and 12 to 15 QuickDASH points were established. The lower boundaries represent the first available measure above the pooled MDC90, and the upper limits represent the upper 95% CI of the pooled MCID. Reasonable ranges for the MCID of 12 to 14 DASH points and 12 to 15 QuickDASH points were proposed. The lower boundaries represent the first available measure above the pooled MDC90, and the upper limits represent the upper 95% CI of the pooled MCID. Information regarding the interpretability of the 2 questionnaires was derived from very different methodologies, making it difficult to identify reliable thresholds. Now clinicians and researchers can rely on more credible data. The proposed MCIDs should be used to assess people with musculoskeletal disorders. Heterogeneity was found related particularly to the anchor levels used in the primary studies. To promote comparability of MCID values, shared rules defining the most appropriate types of anchoring will be needed in the near future.

Risk Analysis of Upper Limb Musculoskeletal Disorders in Industrial Skin Measurement Workers Using the Assessment of Repetitive Task Method

In the leather industry production process in the Piyungan area of Yogyakarta, Indonesia, the operators do a lot of repetitive activities with intensity and frequency of movement for a long time, for 8 hours in a sitting position. Operators measure on average 4700 pieces of leather per day. This leads to fatigue and complaints of musculoskeletal disorders (MSDs). For this reason, research was conducted to measure the level of risk of MSDs and improve them to reduce muscle complaints. This research was conducted experimentally on all skin-cutting operators at companies in the Piyungan area of Yogyakarta. Measurement of the risk level of upper limb musculoskeletal disorders using the Assessment of Repetitive Tasks (ART) method. The data was analyzed based on ART scores obtained, ranging from low, medium, and high risk level scores. The conclusion of the results showed that the risk level of upper limb musculoskeletal disorders in this skin measurement operator included medium and high risk levels on the left and right upper limb operators. Improvements that can be made to reduce the level of risk are improvements to work facilities in the form of chairs, additional short rest periods, and stretching muscles before and after doing work on all skin measurement production operators.

Musculoskeletal disorders, associated factors, and literature review for intervention according to gender.

The relationship of risk factors with musculoskeletal disorders and their intervention is a topic of interest, given their prevalence among workers. Thus, analyzing risk factors from approaches such as the gender perspective may be an alternative. To analyze risk factors in a health entity with a high prevalence of musculoskeletal disorders in upper limbs and to describe possible intervention measures according to scientific evidence, from a gender perspective. This is an analytical study. A questionnaire was applied to 93 workers on demographic aspects, presence of factors related to the environment, the task, and the organization, extra-work activities related to musculoskeletal disorders in the upper limbs. Chi-square was used to identify significant relationships between the sex variable and individual, occupational, and non-occupational factors, corroborated by Fisher's test and prevalence ratio. According to the associations identified, a literature review was carried out to establish possible strategies. Significant relationships were found between the sex variable and task-related factors such as the presence of repetitive or sudden movements (p < 0.05), supporting postulates of labor segregation. According to the literature consulted, the effectiveness of activities such as physical preparation and adaptation of the workplace under professional guidance, training activities, and breaks is discussed. It is important to review organizational factors. By identifying significant relationships between the sex variable and task-related factors, the present study contributes to the postulate of labor segregation, in terms of concentration of female labor in activities with particular working conditions. Regarding literature and actions, it is important to generate more studies from this perspective.

Biomechanical requirements of meat cutting tasks: A pilot study quantifying tasks sustainability and assistance required at the wrist

The meat processing industry is particularly affected by distal upper limb musculoskeletal disorders. This pilot study aims at proposing a methodology able to quantify biomechanical requirements of meat cutting tasks at butchers’ dominant wrist and, when necessary, at estimating the assistance needed to reach sustainability. Six professional butchers repeatedly cut pieces of pork. Joint angles were recorded using a motion capture system, cutting forces using an instrumented knife. Sustainability was computed by the maximal acceptable effort method. Assistance requirements were computed for isolated stressful exertions and for overall work cycle sustainability. Five butchers exceeded the sustainability threshold for wrist flexion. Ulnar or radial deviation torques were excessive for 2 and 3 of them, respectively. Extension torques were sustainable. The peak assistive torque for isolated exertions was at most 1.1Nm, 1.6Nm and 1.1Nm, and the percentage of assistance for overall sustainability was at most 60%, 56% and 56% for wrist flexion, ulnar and radial deviation, respectively.

Construct validity, test–retest reliability, and responsiveness of the Arabic version of the upper limb functional index

BackgroundThe upper limb functional index (ULFI) is a widely used self-report outcome measure questionnaire with robust psychometric properties to assess the upper limb musculoskeletal disorders (UL-MSDs). This study aimed to investigate the psychometric properties of the Arabic version of ULFI (ULFI-Ar).MethodsIn this observational study, 139 patients (87 male, 52 females with mean age of 38.67 ± 13.04 year) with various UL-MSD’s, completed the ULFI-Ar, Disability of Arm, Shoulder, and Hand questionnaire (DASH-Arabic), and numeric pain rating scale (NPRS-Arabic). All participants determined the factor structure, and the construct validity. A subgroup of the participants determined test–retest reliability (n = 46) and responsiveness (n = 27).ResultsThe ULFI-Ar construct validity obtained by the expletory factor analysis as one-factor structure, demonstrated an excellent test–retest reliability [intraclass correlation coefficient (ICC2:1) = 0.95], measurement error [standard error of measurement (SEM) = 4.43%; minimal detectable change at 90% confidence interval (MDC90) = 10.34%], medium internal responsiveness [Cohen’s d = 0.62 and standard response of mean (SRM) = 0.67], strong external responsiveness DASH-Arabic (r =—0.90; p < 0.001), and negative strong correlation with NPRS-Arabic (r =—0.75, p < 0.001).ConclusionsThe ULFI-Ar is a valid, reliable, and responsive self-report questionnaire to assess UL-MSDs in Arabic speaking patients.

Quantification of the Risk of Musculoskeletal Disorders of the Upper Limb Using Fuzzy Logic: A Study of Manual Wheelchair Propulsion.

For manual wheelchair users, overuse of the upper limbs can cause upper limb musculoskeletal disorders, which can lead to a loss of autonomy. The main objective of this study was to quantify the risk level of musculoskeletal disorders of different slope propulsions in manual wheelchair users using fuzzy logic. In total, 17 spinal cord injury participants were recruited. Each participant completed six passages on a motorized treadmill, the inclination of which varied between (0° to 4.8°). A motion capture system associated with instrumented wheels of a wheelchair was used. Using a biomechanical model of the upper limb and the fuzzy logic method, an Articular Discomfort Index (ADI) was developed. We observed an increase in articular discomfort during propulsion on a slope with increasing discomfort at the shoulder, elbow and wrist, due to an increase in kinetics. There was a kinetically significant change in the kinetic global ADI (22 to 25%) and no change in the kinematic. The ADI increased from 14 to 36% during slope propulsion for each joint. The quantification of the level of discomfort helps us to highlight the situations with the most high-risk exposures and to identify the parameters responsible for this discomfort.

PREVALENCE OF UPPER EXTREMITY MUSCULOSKELETAL DISORDERS AMONG TRAINED AND UNTRAINED WEIGHTLIFTERS OF GUJRANWALA

Background: Weightlifting is a competitive sport that is played by many people. The basis of performing such exercise is to increase the mass of muscle and symmetry. The risk of injury during heavy lifting at work or during free time is a well-recognized problem. Injuries may occur due to heavy weightlifting in extreme joint positions. Older weightlifters may sustain greater percentages of joint sprains and muscle strains during resistance training, while younger athletes would bear a greater percentage of injuries linked to accidents. Objectives: The objective is to find the prevalence of upper extremity musculoskeletal disorders among Gujranwala's trained and untrained weightlifters. Methodology: It was a comparative cross-sectional study. A convenient sampling technique was used. A sample size of 180 participants was taken. Standard Nordic questionnaire and Quick Dash Questionnaire were used. Results: This study showed that a high percentage of weightlifters had difficulty in performing their regular tasks and jobs due to pain in their neck region. The maximum frequency of MSK Disorders was found in the shoulder region among untrained weightlifters and 41.1% felt symptoms in the last 7 days while exercising. A high percentage (38.9%) of weightlifters felt symptoms in the last 3 months. Overall results of the study show that Upper Limb Musculoskeletal Disorders were seen as common in both trained and untrained weightlifters with no significant difference between the both. Conclusion: All the findings of the study strongly support that the untrained weightlifters showed slightly more prevalence in MSK disorders of the shoulder region, wrist, and hand as compared to trained weightlifters.

Frequency of Work-Related Musculoskeletal Disorders of Upper Limb among Dentists of Division Gujranwala

Background: Faulty and poor posture has been a cause of musculoskeletal disorders (MSDs) among dentists. Due to the nature of their work, they are more prone to develop upper limb MSDs in the upper limbs. Objectives: To find out the frequency of work-related musculoskeletal disorders of upper limbs among dentists of division Gujranwala. Methods: It was a cross-sectional study conducted in Gujranwala Division, Pakistan, from April 2022 to July 2022. Convenience sampling technique was used to collect the data. The study included 250 male and female dentists, aged 25-40 years, having working hours &gt; 5 hours and with work experience of at least 1-2 years, both from the public and private sectors of the Gujranwala Division. The work-related musculoskeletal disorders were determined using Nordic Musculoskeletal Questionnaire. The data were analyzed by SPSS version 23. Results: Among the study participants, there were 127(50.8%) females and 123 (49.2%) males. The mean age of the participants was 32.77±6.23 years. Musculoskeletal disorders of the upper limbs were found in 231(92.2%) participants. The most common region involved were; the shoulder in 141 (56.4%), the wrist in 82 (32.2%) followed by the elbow in 8 (3.2%). Among the participants, 141(56.4%) worked in different work slots of 8-10 hours. One hundred and seventy-one participants were habitual of working in a sitting posture. Conclusion: Upper Limb Musculoskeletal disorders are highly prevalent among dentists of the Gujranwala Division with the major regions involved being the shoulder and wrist

Comparative study of the saddle chair with two other conventional types of chair on the risk of musculoskeletal disorders and perceived comfort in dentists

Introduction: dentists often have to adopt awkward, asymmetric, static postures and tilt their heads forward while working. If this situation continues for a long time every day, it leads to excessive pressure on the involved muscles and joints and causes symptoms such as pain and discomfort, especially in the neck, shoulders, back, and waist. Considering the importance of prevention, and early treatment of musculoskeletal disorders among dentists, this research investigates the effect of three types of chairs used in dentistry on the risk of musculoskeletal disorders and the comfort perceived by dentists using each chair.&#x0D; Materials and Methods: This is a descriptive cross-sectional study conveyed in Tehran, the capital city of Iran. The present study includes a survey of a group of 70 male dentists. In this study, three types of chairs were compared. To evaluate body comfort, Corlette, and Bishop’s local discomfort questionnaire was used. The RULA method was used to determine the risk of upper limb musculoskeletal disorders and to assess each dentist's body condition.&#x0D; Results: The highest level of comfort was reported in the saddle model chair (the difference in the average intensity of discomfort before and after the work shift in the whole body = 12.39), the third type chair (13.04), and the second type chair (18/76). The dentists' posture evaluation results showed that the final score of RULA in three types of chairs varies from a minimum of 3 to a maximum of 7.&#x0D; Conclusion: According to the results of the study, the average intensity of discomfort in the whole body after using the saddle chair compared to the state before using it has significantly decreased compared to the other two types of chairs, which implies the positive effect of using the saddle chair in reducing musculoskeletal discomfort. The results of posture evaluation indicate that the use of the saddle chair, compared to the other two chairs, improves the working conditions and facilitates the work.

Cross-Cultural Adaptation and Measurement Properties of the Upper Limb Functional Index (ULFI) for Greek-Speaking Patients.

The upper limb functional index (ULFI) is a widely used outcome measure for patients with upper limb musculoskeletal disorders (ULMSDs) that is available in several languages.Our purpose was to develop the Greek version of the ULFI and test its test-retest reliability, validity, and responsiveness in a cohort of patients with ULMSD. We used a merged methodology of published guidelines and recommendations for the translation and cross-cultural adaptation process. One hundred patients with ULMSDs completed the ULFI-Gr on three occasions: baseline, 2-7 days later to evaluate repeatability, and 6 weeks later to assess responsiveness.Participants completed the quick disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and a numerical pain rating scale (NPRS) to evaluate convergent validity. Also, a global rating of change (GROC) scale was used to evaluate responsiveness. Minor wording adaptations were required during the translation and cross-cultural adaption of the questionnaire. Factor analysis resulted in two main factors explaining 40.2% of the total variance. The ULFI-Gr was found to be reliable (intraclass correlation coefficient: 0.97, 95% confidence interval: 0.95-0.99) with a small measurement error (standard error of measurement: 3.34%, minimal detectable change: 7.79%). The ULFI-Gr showed a strong negative correlation with the Quick-DASH (-0.75), a moderate to strong negative correlation with the NPRS (-0.56), and a good level of responsiveness (standardized response mean: 1.31, effect size: 1.19). The ULFI-Gr can be used as a reliable, valid, and responsive patient-reported outcome measure to evaluate the functional status of patients with ULMSDs.

Relationship Between Manual Wheelchair Using Skills and Upper Limb Musculoskeletal Disorders in Patients With Spinal Cord Injury: A Musculoskeletal Ultrasonography Study.

The aims of this study are to investigate the relationship between wheelchair skills and upper limb pathologies detected by ultrasound and to identify independent predictors of joint pathologies. Forty-five patients who were paraplegic because of spinal cord injury were included. Demographic and clinical data were evaluated. The Spinal Cord Independence Measure III and Wheelchair Skills Test Questionnaire was administered. Shoulder, elbow, and wrist joints of both upper limbs were evaluated with ultrasound. Nineteen patients (42.2%) had musculoskeletal pain in their upper limbs. The most painful area was shoulder (14, 31.1%), followed by elbow (8, 17.7%), and wrist (3, 6.6%), respectively. The Wheelchair Skills Test Questionnaire scores were worse in patients with elbow effusion ( P = 0.041) and lateral epicondyle spur formation ( P = 0.006). In the multivariate logistic regression analysis, independent predictors for joint pathologies in ultrasound were Spinal Cord Independence Measure total score, higher body mass index, older age, working with physical strength, female sex, duration of wheelchair usage, higher level of injury, and wheelchair skills (all P < 0.05). Among the risk factors for joint pathologies identified in this study, the ability to use wheelchairs, which is a modifiable risk factor, should be considered in the rehabilitation process and improved.

P070 Results of a consensus process to determine the elements of a complex digital intervention for distal upper limb musculoskeletal disorders

Abstract Background/Aims Painful distal upper limb (DUL) musculoskeletal disorders (MSDs), including hand, wrist and elbow problems, are common but lack effective self-management tools. The Digital-My Arm Pain Programme (D-MAPP) aims to develop and test a digital self-management intervention for DUL-MSDs. This project aimed to determine the elements required for the D-MAPP intervention package. Methods A review of self-management interventions for DUL-MSDs identified 31 potential intervention elements. Subsequently, the elements were grouped into three overarching categories; Information and self-management advice, Information on treatment options, and Features of an exercise programme. Next, we employed Delphi methodology to develop consensus on the intervention elements from key stakeholders: Healthcare professionals who manage DUL-MSDs and people with a DUL-MSD (pwDUL-MSDs). A three-round modified online/postal Delphi questionnaire was used, with collation and presentation of results in subsequent rounds. Participants scored the importance of including each element in the D-MAPP intervention using a 9-point Likert scale; 1-3 limited importance, 4-6 important but not critical, 7-9 critical. Consensus was pre-defined as &amp;gt; 70% of both healthcare professionals and pwDUL MSDs scoring an element in the same category. During each round, participants could suggest additional intervention elements for inclusion in the subsequent round. Results 23 healthcare professionals from a range of disciplines (including occupational therapists, physiotherapists, rheumatologists and orthopaedic surgeons) and 19 pwDUL-MSD completed round one; 83% and 89%, respectively, completed all three rounds. Round 1, consensus was achieved for 24 of the 31 elements, which were all deemed as critical to include in the D-MAPP intervention (Table 1). Two elements were suggested by participants and added to round 2. Two additional elements reached consensus as being critical in Round 2, and one further element reached consensus for inclusion in the third round. Six potential intervention elements did not reach a consensus. Conclusion Healthcare professionals and patients reached consensus on 27 elements, all of which were deemed as critical to include in the D-MAPP intervention. However, agreement among stakeholders on the importance level was not achieved for six potential elements. Following this work, the critically important elements will be developed through a co-design process to build the D-MAPP digital intervention. L. Brading: None. K. Kane: None. G. McHugh: None. K. Dziedzic: None. J. Adams: None. S. Chopra: None. L. Swaithes: None. K. Walker-Bone: None. G. Macfarlane: None. P. Conaghan: None. S. Kingsbury: None.