Musculoskeletal Fatigue Research Articles

Demystifying the Positive Antinuclear Antibody Test in Children: A Clinical Review

A 15-year-old girl presented with knee pain, associated with a positive antinuclear antibody (ANA). She denied joint swelling or morning stiffness and remained physically active despite the pain. A physical examination was unremarkable except for articular hypermobility. Laboratory results were also unremarkable. Therefore, the positive ANA was determined to be nonspecific, and not concerning. In the evaluation of children with musculoskeletal complaints, unusual rash, or fatigue, an ANA assessment is frequently considered. When is this test most likely to be useful? What is the appropriate follow up for a positive result? Which results are concerning for an autoimmune process? This article reviews the literature to address these practical concerns. Understanding the indications for ordering an ANA, and the correct interpretation of a positive ANA, may reduce unnecessary referrals and costly tests. Moreover, the misperception that a positive ANA indicates a rheumatologic disease can cause significant patient and parental anxiety.

Are Developmental Coordination Disorder (DCD)/Dyspraxia and/or Joint Hypermobility Syndrome inherent determinants of physical inactivity

Background: The annual health burden of physical inactivity in the UK is estimated to be £1.06 billion. The World Health Organisation recommendations are for adults to be engaged in moderate intensity physical activity for at least half an hour a day on five days a week. It is possible that there are inherent conditions which influence physical activity participation. Children with Developmental Coordination Disorder (DCD)/Dyspraxia are noted to be less physically active than their peers. DCD/Dyspraxia is a neurodevelopmental disorder affecting motor function and organisation; continues into adulthood and associated with Joint Hypermobility Syndrome (JHS). JHS is a multisystemic disorder characterised by chronic pain, musculoskeletal and autonomic symptoms and fatigue.

Relationship Between Fatigue and Musculoskeletal Discomfort in a University Setting

The musculoskeletal health of employees can affect an organization’s effectiveness. Also, the fatigue that an employee may experience can affect their productivity and morale on the job. Little research has been done to compare the relationship between musculoskeletal health and fatigue and its effect on workplace employees. PURPOSE: To compare musculoskeletal discomfort and employee demographics between those reporting low shift fatigue and those reporting moderate-high shift fatigue. METHODS: The subjects were University staff (N= 174, Age=46.2+13.3, Males = 53%). The questionnaire response rate was 55%. An ANOVA model was used to analyze the questionnaire. The questionnaire included variables of: gender, height, weight, shift fatigue, physical job demands, and musculoskeletal discomfort values. The fatigue and musculoskeletal scales ran from 0–5, with 0 being no fatigue/no discomfort and 5 being very fatigued/very uncomfortable. High fatigue (>3) and low fatigue (<2) groups were selected for comparison based on the end of shift fatigue. RESULTS: Those employees experiencing moderate-high fatigue (n=57) in comparison to those reporting low fatigue (n=117) have a higher body mass index (BMI) (30.5±8.4 vs. 26.4±4.6, p<0.01), higher fatigue in the first five minutes of work (1.0±1.5 vs. 0.3±0.9, p<0.001), and significantly (p<0.01) higher discomfort in all measured body parts. The body parts with the greatest difference between high and low fatigue were the upper back (2.3±1.8 vs. 0.8±1.1), legs (1.9±1.7 vs. 0.7±1.2), buttocks (1.7±1.7 vs. 0.6±1.1), neck (1.9±1.6 vs. 0.8±1.1), shoulders (2.0±1.8 vs. 0.8±1.2) and lower back (2.5±1.8 vs. 1.4±1.4). CONCLUSION: Based on the results, there is a relationship between body discomfort and fatigue at work. It appears that the upper back discomfort is most related to the change in fatigue over shift. More research is needed to determine if interventions that target musculoskeletal discomfort areas such as the upper back will reduce employee fatigue in an effort to improve morale, productivity and overall health.

A universal rig for supporting large hammer drills: Reduced injury risk and improved productivity

Drilling holes into concrete with heavy hammer and rock drills is one of the most physically demanding tasks performed in commercial construction and poses risks for musculoskeletal disorders, noise induced hearing loss, hand arm vibration syndrome and silicosis. The aim of this study was to (1) use a participatory process to develop a rig to support pneumatic rock drills or large electric hammer drills in order to reduce the health risks and (2) evaluate the usability of the rig. Seven prototype rigs for supporting large hammer drills were developed and modified with feedback from commercial contractors and construction workers. The final design was evaluated by laborers and electricians (N=29) who performed their usual concrete drilling with the usual method and the new rig. Subjective regional fatigue was significantly less in the neck, shoulders, hands and arms, and lower back when using the universal rig compared to the usual manual method. Usability ratings for the rig were significantly better than the usual method on stability, control, drilling, accuracy, and vibration. Drilling time was reduced by approximately 50% with the rig. Commercial construction contractors, laborers and electricians who use large hammer drills for drilling many holes should consider using such a rig to prevent musculoskeletal disorders, fatigue, and silicosis.

A study of migraine characteristics in joint hypermobility syndrome a.k.a. Ehlers-Danlos syndrome, hypermobility type.

Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two clinically overlapping heritable connective tissue disorders strongly associated with musculoskeletal pain, fatigue and headache. Migraine with or without aura is considered the most common form of headache in JHS/EDS-HT. In this population of chronically ill patients, we investigated whether migraine characteristics were different from those of a control population of migraine patients. The study was carried out on 33 selected JHS/EDS-HT patients, diagnosed according to current criteria. Sixty-six migraine subjects matching age and gender were consecutively selected as controls (MO group) among patients attending our Headache Clinic. JHS/EDS-HT and MO were screened for a series of headache characteristics, such as frequency, intensity, age of onset, level of disability, use of rescue and prophylactic medications. Differences between the two groups were tested by using independent group comparisons. Results showed that in JHS/EDS-HT: (1) migraine has an earlier onset (12.6 vs 17 years of age; p = 0.005); (2) the rate of migraine days/month is higher (15 vs 9.3 days/month; p = 0.01); (3) accompanying symptoms are usually more frequent; (4) HIT-6 and MIDAS scores are higher (p = 0.04 and p = 0.03); (5) efficacy of rescue medication is almost identical, although, total drug consumption is significantly lower (p < 0.04). Joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type patients have a more severe headache syndrome with respect to the MO group, therefore demonstrating that migraine has a very high impact on quality of life in this disease.

ERGONOMIC BASED MODIFICATION OF HAND GRINDER TO IMPROVE PHYSIOLOGICAL RESPONSES, AND TO INCREASE PRODUCTIVITY AND USER SATISFACTION

Hand grinder is one of the tools used in manufacturing jobs, particularly for metal processing. Grinding is usually performed in the finishing process of a product, such as removing the ridges of welded joint. This tool has two main parts, namely the grinding disc and the electrical power motor for driving its spindle. Based on the work sampling in the several manufacturing shops, workers spent 20% of eight hours working time for grinding process. Observations and interview with several operators found some problems in the using of hand grinders such as fatigue and musculoskeletal complaints due to not ergonomic shape, size, vibration, and noise. This study aimed to improve a hand grinder design through ergonomic assessment. Twenty two parameters of assessment were identified by a questionnaire to 16 samples of hand grinder users. By considering those parameters and using the Microsoft Visual Basic 6.0, the ergonomic assessment software was created. The recommendations from the ergonomic assessment suggest that the hand grinders be modified by equipping them with two dumping covered handles. To determine the effects of the modification to the hand grinders, furthermore, the improved hand grinders were applied in the experimental research used treatment by subject design. Variables in the research were user physiological responses regard to musculoskeletal complaints, fatigue, energy expenditure, productivity and satisfaction. The research was conducted in March until August 2012 with 16 participated samples. The samples in the research were randomly selected from the students of Industrial Engineering Department of Atma Jaya Yogyakarta University. The data were analyzed statistically for descriptive analysis, normality test by Shapiro-Wilk, and the compare means analysis by t-paired test and Wilcoxon with significance level of 5%. The results of data analysis showed that the use of the modified hand grinder being yielded better results: 19.6% decrease in musculoskeletal complaints (p = 0.001), 17.7% decrease in fatigue (p = 0.004), 20.9% decrease in energy expenditure (p= 0.017), 15.97% increase in productivity (p=0.041) and 29.9% increase in satisfaction (p = 0.001). Empirically, it can be concluded that ergonomic based modification of hand grinders able to improve physiological responses in terms of musculoskeletal complaints, fatigue, energy expenditure, and increase productivity and user satisfaction.

Fibrofog and fibromyalgia: a narrative review and implications for clinical practice

Patients with fibromyalgia often report forgetfulness as well as declines in cognitive function, memory, and mental alertness-symptoms that have been termed "fibrofog" in popular and electronic media as well as in professional literature. "Fibrofog" is the subjectively experienced cognitive dysfunction associated with fibromyalgia and is a clinically important yet comparatively less well-studied aspect of the disorder; it includes loss of mental clarity (mental fogginess) as well as attention and memory impairment. Although until recently cognitive symptoms have been largely ignored, these symptoms can be more disturbing than the widespread pain and can change these patients' lives, sometimes dramatically so. Whereas widespread musculoskeletal pain, tenderness, and fatigue may be the hallmark symptoms of fibromyalgia, patients rank cognitive dysfunction highly in terms of disease impact. This review addresses (1) the prevalence of self-reported cognitive disturbances in fibromyalgia, (2) the clinical presentation of fibrofog, (3) neuropsychological test performance, with particular attention to discrepancies between self-report and test results, (3) clinical correlates of impaired cognitive function in fibromyalgia, (4) neurobiology relevant to cognitive disturbances in fibromyalgia, and (5) clinical management of fibrofog. Although the pathophysiology of fibromyalgia remains an enigma, evidence suggests that it may be a brain disorder, with cognitive deficits ("fibrofog") reflecting disturbed centrally mediated processes.

Posturedontics: How does dentistry fit you?

Dentists are at high risk for musculoskeletal disorders (MSD's) due to their work. MSD's is an umbrella term for number of injuries affecting different parts of the body, including joints, muscles, tendons, nerves that can arise from sudden exertion or making the same motions repeatedly. These injuries can develop over time and can lead to long-term disability. Dental professional often develop musculoskeletal problems due to bad working habits, uncomfortable physical posture causing unnecessary musculoskeletal loading, discomfort and fatigue. Ergonomic principles when it is applied, it will help to reduce stress and eliminate many potential injuries and disorders associated with the overuse of muscles, bad posture, and repeated tasks. This can be accomplished by using a proper dental chair, lighting and the selection of ergonomically-friendly equipment to fit the dental professionals physical capabilities and limitations. This review addresses about the basics of ergonomics, positioning, viewing, handling, and prevention of MSD's.

Design of Compliant Bamboo Poles for Carrying Loads

Carriage of heavy loads is common in developing countries and can impart large repetitive forces on the body that could lead to musculoskeletal fatigue and injury. Compliant bamboo poles have been used to carry heavy loads in Asia for generations and could be a low-cost, sustainable, and culturally acceptable way to minimize the forces acting on the body during load carriage. Experimental evidence of running with a 15 kg load suspended from a pair of compliant poly(vinyl chloride), or PVC, poles shows that the poles act as a vibration-isolating suspension, which can reduce the peak forces on the body during locomotion. However, it is currently not well-understood how to design and optimize poles for load carrying such that the peak forces on the body are minimized during carrying. Further, current users of bamboo poles do not have a reliable way to measure forces on the body and so cannot empirically optimize their poles for force reduction. Our objective is to determine the geometric and material design parameters that optimize bamboo poles for load carriage and to develop recommendations that could make it easier for load carriers to fabricate well-suited poles. Our approach is to synthesize a predictive model of walking and running from the field of biomechanics, which can predict the peak forces on the body as a function of pole stiffness, with a bending beam model of the bamboo pole that relates pole geometry and material to the effective pole stiffness. We first check our model's ability to predict the experimental results from a well-established study with PVC poles. We then extend the predictive design study to include a wider range of stiffness values and pole geometries that may be more effective and realistic for practical load carrying situations. Based on stiffness, deflection, strength, and pole mass design constraints, we specify an appropriate range of dimensions for selecting bamboo poles to carry a 15 kg load. The design methodology presented could simplify the selection and design of bamboo carrying poles in order to reduce the likelihood of musculoskeletal injury.

Long-term Discomfort Evaluation: Comparison of Reported Discomfort between a Concept Elevated Driving Posture and a Conventional Driving Posture

Mounting a seat higher in a vehicle, in comparison to a conventional driving posture, will benefit vehicle design by reducing vehicles’ mass and as a result, possibly reducing emissions over the lifecycle of the vehicle. This paper reports on a study with the objective of comparing reported long-term discomfort between a concept elevated posture seat and a production conventional driving posture seat. A sample of 20 commercial drivers (10 males, 10 females) aged 19-65, were recruited for the study. A concept seat was developed from a seat fitting trial study [1] and a second rig was designed and constructed to replicate a benchmark production seat in a conventional LCV driving posture. In two separate trials, participants were required to perform a driving simulation task whilst exposed to whole-body vibration and report their discomfort in 10minute intervals over 50-minutes of driving. Results indicated that at 50-minutes of driving, there were significant differences in reported discomfort for the right shoulder and the lower back between the postures, with the conventional posture having the higher discomfort ratings. Additionally, the musculoskeletal fatigue effects for both postures (progression of discomfort over time) fell in line with the literature.

Detection of IgM antibrucella antibody in the absence of IgGs: a challenge for the clinical interpretation of brucella serology.

The use of enzyme-linked immunosorbent assay (ELISA) for the detection of IgG and IgM antibodies antibrucella has become widespread in the diagnosis of human brucellosis. IgM anti-Brucella antibodies are indicative of acute infection. Between 2009–2013, 5307 patients were evaluated for serologic diagnosis at the Microbiology Laboratory of the Albacete General Hospital. A ELISA IgM-positive, IgG-negative anti-Brucella antibody serology pattern was detected in 17 of those patients. Epidemiology data, symptoms, laboratory data, treatment and outcome from these patients were reviewed. Sixteen patients presented with musculoskeletal pain, fatigue and/or fever and 1 was asymptomatic. Five patients received treatment with doxycycline combined with rifampin, gentamycin or streptomycin during 6–12 weeks, with no improvement. None of the 17 patients were finally diagnosed with brucellosis. Our results indicate that anti-Brucella IgM positive serology, per se, is not enough to diagnose acute brucellosis and other methods should be used for confirmation. Brucella serology data should be interpreted taking into account the patient's clinical history and epidemiological context.

한 대학병원 근무자의 신체 부담과 근골격계 증상이 직무 스트레스에 미치는 영향

This study examined the effects of the symptoms of musculoskeletal disorder and the burden of the body on work stress in a university hospital workers. The research surveyed 679 subjects. The relevant factors affecting the job stress were found to be female, young people age group, unmarried, shift work, work more than 8 hours, short experience workers. The work stress was significantly higher in the non-smoker (p=0.000), regular exercise/sports(p=0.022) and non-drinking(p=0.038) groups. In addition, the mental fatigue, presence of musculoskeletal symptoms, fatigue level, and marital status increase the risk of the work stress. The results showed that the burden of the body and musculoskeletal disorders are related interactively with each other.

Fibromyalgia symptoms and medication requirements respond to parathyroidectomy

Fibromyalgia (FM), an ill-defined symptom complex, is characterized by musculoskeletal pain, headache, depression, fatigue, and cognitive decline, symptoms also seen commonly in primary hyperparathyroidism (PHP). Prevalence of concurrent PHP and FM and response to parathyroidectomy (PTX) of those with both conditions are unknown. We reviewed prospective data of 4,000 patients with sporadic PHP who had PTX from 1995 to 2013 examining perioperative symptoms and medication usage for those with diagnosed FM. Cure was defined by normocalcemia at ≥ 6 months. Of 2,184 patients, 80 (4%) had a prior diagnosis of FM. Of evaluable FM patients, 97.3% had definitive cure of PHP. After PTX, 89% had improvement in ≥ 1 symptom attributed to FM, with improved cognition/memory most common (80%). Improvement in ≥ 2, ≥ 3, and ≥ 4 FM symptoms was appreciated by 71%, 43%, and 25%, respectively. Quality of life and wellness improved in >50%. Postoperative use of drugs prescribed for FM often improved or resolved (narcotics, 77%; anti-inflammatories, 74%; "FM-specific medications," 33%; antidepressants, 30%); 21% discontinued all FM medications postoperatively. FM is common in patients operated on for sporadic PHP. Of those with both conditions, after PTX 89% appreciate symptom response and 77% and 21% had a decrease in or discontinuation or medications, respectively. Before diagnosing FM, providers should exclude PHP, which is surgically correctable.

Stress among dentists in Yemen

Abstract Objective: The objective of this study was to assess the stress level among Yemeni dentists and to evaluate their stress manifestations and stress management. Materials and methods: Nearly 368 dentists were given a self-administered questionnaire and 119 returned the filled questionnaire form. A questionnaire was composed of four sections including, demographic information, professional practice characteristics, work stress factors and response of dentist to stress as well as methods to deal with stress. 56 females and 63 males were incorporated, 83.2% of them were general dental practitioners. The descriptive data were analyzed and Chi-square, t -test and F tests were used for statistical significance ( P Results: The response rate was 32.3%. Of the whole, 71.4% of them were aged less than 30 years, 73.1% have experience less than 5 years. Among stressors, those related to dental procedure have highest mean scores (SD) of stress 2.93 (1.46). The most prevalent factors that contribute to stress were uncooperative patients (72.3%), amount of work (too much, too little) (60.5%) and constant drive for technical perfection (54.6%). Stress was reflected in dentists by many signs among them are musculoskeletal fatigue in 63% and nervousness in 57.1%. Praying and reading the Quran was reported by over two thirds (70.6%) of the participants to manage stress. Conclusions: Dentistry is a stressful profession in Yemen. Lack of experience, low income, uncooperative patients, and dental procedure-related factors were the main significant factors that caused stress. Political instability in the country and the lack of laws governing the dental profession in addition to conservative nature of the community may be considered as sources of stress.

Gaze and viewing patterns in microsurgery

Gaze disruptions in surgery have been associated with suboptimal surgical workflow, and human factor tools have been developed to quantify these events in cardiovascular and laparoscopic surgeries. Disruptions to workflow may be a particular concern in microsurgery because looking away from the microscope can cause the surgeon to lose view of delicate and precise tasks occurring at the surgical site. However, these viewing patterns in microsurgery have not been investigated. The purpose of this study is to quantify the gaze and viewing patterns during the microsurgery procedure. Event-based task analysis was performed for 14 surgeons performing microsurgery. Results found that average length of procedure was 70±33 minutes. Surgeons were observed to primarily interact with microscope 83±9% during microsurgery. Surgeons were observed to look away from the microscope in order to examine the tool area, patient site, and rest. Frequency of gaze away from the microscope was observed to be 11 disruptions per 10 minutes. Observed gaze demands of microsurgery and the limited opportunity for rests may impact surgeon performance and their risk for musculoskeletal fatigue.

The functional exercise capacity and its correlates in obese treatment-seeking people with binge eating disorder: an exploratory study

Purpose: The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity. Methods: Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented. Results: The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1 ± 75.8 m versus 682.7 ± 98.4, p < 0.05) compared to non-obese controls. No significant differences were found between obese participants with and without BED. Participants with BED reported significantly (p < 0.05) more musculoskeletal pain and fatigue after the walk test than obese and non-obese controls. A forward stepwise regression analysis demonstrated that sports participation and perceived physical strength explained 41.7% of the variance on the 6MWT in obese participants with BED. Conclusion: Physical activity participation, physical self-perception and perceived physical discomfort during walking should be considered when developing rehabilitation programs for obese people with BED.Implications for RehabilitationRehabilitation programmes in people with binge eating disorder should incorporate a functional exercise capacity assessment.Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers.Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.

A model for musculoskeletal disorder-related fatigue in upper limb manipulation during industrial vegetables sorting

In the agro-industrial sector there are many activities whose urgent rhythms can cause a considerable exposure to bio-mechanical risk factors. In the vegetable sorting sector the workers are subject to a several biomechanical risks, with due to repetitive movements of upper limbs, and operations that require a remarkable degree of strength.Preventing the fatigue associated to repetitive movements of upper limbs means also prevent the risk of musculoskeletal disorders related to this kind of operations. A thorough study of the workers' exposure to repetitive manual movements has been carried out, with the aim of setting up the necessary measures to reduce the risk factors. This paper proposes an original model for assessing the musculoskeletal disorder-related fatigue resulting from vegetable sorting. The test of the model was carried out in a particular case and results plead in favor of the need of process re-evaluation in terms of risks and musculoskeletal disorder issues. Relevance to industryThis study proposes an original model for assessing musculoskeletal disorder-related fatigue resulting from vegetable sorting. It states the relevance of process re-evaluation in terms of risks and timing issues. Results can be used as guidelines to adapt workplaces and work tasks.

0072 Lower-extremity musculoskeletal discomfort and fatigue in automotive assembly workers

ObjectivesTo characterise the prevalence of musculoskeletal discomfort and fatigue of the lower extremities (LE) in a large sample of workers in a large, unionised automotive assembly facility. To assess whether...

THU0305 Effect of Oral Coenzyme Q10 Supplementation on Clinical Symptoms and Oxidative Stress in Fibromyalgia Patients: A Randomized Trial

BackgroundFibromyalgia (FM) is a common and complex clinical condition characterized by chronic widespread musculoskeletal pain, fatigue and muscle tenderness. The pathophysiology of FM is still not well elucidated. In recent...

THU0327 Efficacy of Vitamin D Supplementation in the Treatment of Fibromyalgia: Randomized Controlled Trial

BackgroundFibromyalgia (FM) is a condition characterized by chronic widespread musculoskeletal pain (MSK), fatigue and muscle tenderness. In addition, many patients have mood disturbances, report fatigue, disrupted sleep, balance disorders and...