Specific Musculoskeletal Disorders Research Articles

Designing orthopaedic seat cushion made of rattan using quality function deployment approach

Using ergonomic orthopaedic chairs can address spinal issues, particularly HNP, due to their flexible and elastic properties. By achieving optimal ergonomic design, various positive aspects can be achieved, such as increasing work quality productivity and reducing the cost of injuries or accidents. This research demonstrates diverse product design approaches to enhance posture health ergonomics, address specific musculoskeletal disorder issues, and consider local needs and available materials. Rattan is a tropical vine widely used in the furniture industry and predominantly found in wooded areas such as Indonesia. This research combines market research, morphology, ergonomic study, concept selection, QFD, HoQ, stiffness test, and prototype review. The QFD method was chosen in this study due to its excellence in connecting consumer desires with the product development process. Data of respondents consist of 51 % of respondents were male, 49 % were female, 88 % were aged between 18 and 34 years old, and 10 % were aged between 35 and 54 years old. The approach of 6 stages of product design as the primary framework for developing our product such as: planning, concept development (concept screening, product morphology, concept selection), system-level design, detailed design, testing, refinement and launching. Based on the calculations using the HOQ, it is identified that the primary focus in designing the rattan-based orthopaedic seating, lies in the orthopaedic design that provides maximum comfort for the spine. The comparison results indicate that the stiffness level of rattan weaving is nearly like latex, with a similarity percentage of 89 %. Data analysis using the QFD method indicates that the primary priority aspect is the orthopaedic design, followed by the selection of quality materials, cost-effectiveness, versatility, and appealing design aspects. Rattan's superior air circulation provides comfort by preventing excessive heat accumulation, excellence in strength and durability, ensuring ease of lightweight modelling, and providing more sustainable material.

Orthopedic Research Funding: Assessing the Relationship between Investments and Breakthroughs.

Orthopedic research plays a crucial role in improving patient outcomes for musculoskeletal disorders. This narrative review explores the intricate interplay between funding patterns and the trajectory of breakthroughs achieved in this dynamic field. A meticulous search strategy identified studies illuminating the diverse sources of orthopedic research funding, including public funding (government agencies), philanthropic organizations, private sector investment, and international funding bodies. The review further delved into the spectrum of breakthroughs, encompassing fundamental scientific discoveries, technological advancements, and personalized medicine approaches. Public funding emerged as a significant pillar, supporting foundational research that lays the groundwork for future advancements. Philanthropic organizations addressed specific musculoskeletal disorders, often focusing on patient-centric applications. International funding bodies played a role in supporting research in low- and middle-income countries. Breakthroughs extended beyond cutting-edge prosthetics and minimally invasive surgeries, encompassing fundamental discoveries in areas like gene therapy and biomaterials science. Technological advancements included brain-computer interface prosthetics and 3D-printed implants. Personalized medicine offered the potential for tailored treatments based on individual needs and genetic profiles. This review underscores the complex interplay between funding patterns and breakthroughs in orthopedic research. A multifaceted approach is essential for continued progress. Fostering collaboration, optimizing funding models, and prioritizing both foundational and translational research hold the key to unlocking the true potential of orthopedic research and transforming the lives of patients suffering from musculoskeletal disorders.

Workers’ compensation injuries in aviation manufacturing in the state of Kansas, 2014–2022

IntroductionWorkers’ compensation injuries entail burdensome financial and social costs. This study’s objective was to describe cost and frequency of workplace injuries in aviation manufacturing in the state of Kansas using workers’ compensation data. Manufacturing incurs more workers’ compensation claims in Kansas than any other industry, and aviation contributes more of those claims than any other sub sector. MethodWorkers’ compensation insurance and reporting are required in the state of Kansas. Data were provided by the Kansas Department of Labor (KDOL) and included all closed workers’ compensation claims entailing indemnity and medical costs filed in the state from 2014 to 2022. Cost of claim data were normalized to 2022 U.S. dollars and data were analyzed as a function of percentage and claim cost by body part, type of injury, cause of injury, specific musculoskeletal disorder type, and as a function of age and gender injury rates. ResultsAviation claims entailed a median total cost of $26,941 and represented 8% of all closed claims filed in the state from 2014 to 2022. The grand total direct cost over the nine-year period was $75,404,147. Medical costs comprised 48.6% of all costs, indemnity 45.0%, and legal 6.4%. The most frequently injured body part was the hand/wrist (35.9%) followed by the shoulder (20.6%), and the most expensive body parts were related to the back. Overexertion (38.6%) was the most common cause followed by repetitive motion (22.8%). Work-related musculoskeletal disorders were the most common type accounting for 67.4% of all claims. Men and workers aged 55–64 incurred slightly higher claim rates than average. A sharp decrease in number of claims closed in 2021 coincided with production shutdowns the previous year related to the Covid-19 pandemic and design issues. ConclusionsAviation manufacturing is a key industry in Kansas and this study is the first known to describe costs and frequencies of workplace injuries in the sector using workers’ compensation data. Practical applicationsThis guide to the most problematic and costly injuries in aviation manufacturing helps practitioners prioritize prevention strategies to most effectively reduce workplace injury and helps safety and health practitioners in prioritizing prevention efforts to reduce the most severe and costly aviation manufacturing injuries and illnesses. It also brings attention to some special considerations when working with safety data from 2020 to 2022 related to the Covid-19 pandemic.

Fibromyalgia among University Students: A Vulnerable Population.

Fibromyalgia (FM), a complex musculoskeletal disorder, can affect individuals from different genders having different genetic and psychosocial backgrounds. The prevalence of FM depends specifically on the age, gender, and level of stress of the individual. Since the university student body tackles high levels of academic and non-academic stress, we aimed to assess the prevalence and characteristics of FM among such a vulnerable population. A survey was sent to participants from two major English-speaking private universities in Lebanon; the American University of Beirut (AUB) and the Lebanese American University (LAU). The survey included the modified American College of Rheumatology (ACR) 2016 criteria, the widespread pain index (WPI), the symptoms severity score (SSS), and the duration of presence of such FM symptoms. In addition, the survey evaluated the presence of other specific musculoskeletal disorders among participants. Nevertheless, a 12-item general healthy questionnaire (GHQ-12) was used to assess the presence of anxiety, depression, social dysfunction, and loss of confidence among participants. The survey was sent to a total of 2178 students with 184 complete responses (8.45% response rate). The prevalence of FM among the respondents was 13.6%. Students with FM had a significant personal history of a musculoskeletal disorder other than FM and a significant family history of musculoskeletal disorders. The mean SSS score of the target population, including those with FM and those without FM, was 4.5. Patients with FM were significantly in distress and highly symptomatic as measured by GHQ-12 (Unadjusted OR 3.23 [95% CI 1.32-7.95]). Fibromyalgia seems to be prevalent among university students; in particular, those with other musculoskeletal disorders, those with a family history of musculoskeletal disorders, and those with severe depression and anxiety.

Prevalence, burden of disease, and lost in health state utilities attributable to chronic musculoskeletal disorders and pain in Chile

BackgroundMusculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile.MethodsWe used data from the Chilean National Health Survey carried out in 2016–2017. Six musculoskeletal disorders were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU following an individual and population level approaches. We also calculated the fraction of LHSU attributable to pain.ResultsChronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8–10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders.ConclusionChronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders.

Diagnostic criteria for musculoskeletal disorders for use in occupational healthcare or research: a scoping review of consensus- and synthesised-based case definitions

BackgroundThe aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research.MethodsA scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O’Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria.ResultsIn total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment.ConclusionWe found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria.

H\xe4ufigkeiten muskuloskelettaler Symptome und Erkrankungen in der bev\xf6lkerungsbezogenen NAKO Gesundheitsstudie

ZusammenfassungHintergrundMuskuloskelettale Symptome und Erkrankungen sind in der Bevölkerung sehr weit verbreitet und verursachen hohe Kosten in Gesundheitswesen und Volkswirtschaft.Ziel der ArbeitDie Häufigkeit muskuloskelettaler Symptome und Erkrankungen aus den Bereichen Rückenschmerzen, Osteoporose, Arthrose und Arthritis wurde auf Basis von Daten der bevölkerungsbasierten NAKO Gesundheitsstudie beschrieben.Material und MethodenDie Daten wurden in der ersten Hälfte der NAKO-Basiserhebung von März 2014 bis März 2017 bei Erwachsenen im Alter von 20–75 Jahren erhoben. In die Analysen gingen Daten von 101.779 Interviewteilnehmenden sowie von 9370 Teilnehmenden aus zwei klinischen Untersuchungen ein. Mittels der klinischen Handuntersuchung wurden tastbar geschwollene Gelenke sowie auf Druck schmerzhafte Gelenke identifiziert. Die Winkelstuhluntersuchung lieferte Daten zu Ruheschmerzen am Knie- und Hüftgelenk. Häufigkeiten wurden auf die deutsche Standardbevölkerung 2011 gewichtet.ErgebnisseIn den Selbstberichten der Teilnehmenden im Interview wurden am häufigsten jemals diagnostizierte andauernde Rückenschmerzen (22,5 %) und Arthrosen (20,6 %) angegeben, seltener Osteoporose (2,9 %) und rheumatoide Arthritis (1,9 %). In der Handuntersuchung wurden bei 6,0 % Schmerzen an mindestens einem Fingergelenk festgestellt. Laut Winkelstuhluntersuchung waren 8,2 % von einem Ruheschmerz in mindestens einem Knie betroffen sowie 5,1 % an der Hüfte. Frauen berichteten insgesamt häufiger muskuloskelettale Erkrankungen und Symptome als Männer, der Anteil Betroffener nahm mit dem Alter deutlich zu.DiskussionDie Ergebnisse belegen die große Verbreitung vieler muskuloskelettaler Erkrankungen. Die berichtete Beschwerdelast ist mit Ergebnissen aus früheren bevölkerungsbezogenen Erhebungen vergleichbar.

Prevalence of Musculoskeletal Disorders in Small Scale Food Industry in Karad

Background: Musculoskeletal Disorders or MSDs are injuries and disorders that affect the human body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.). Work activities that involve heavy lifting, awkward postures, bending, twisting or stooping, prolonged sitting or standing and repetitive motions may contribute to the development of these problems. Industrial workers are more prone to develop musculoskeletal disorders. Objectives: Objectives of the study were to the prevalence of common musculoskeletal disorders and survey among the workers. To find out the severity of specific musculoskeletal disorders prevailing in the food industry in Karad. Material and Method: In this observational study, 60 subjects were assessed using Visual analogue scale (VAS), Posture assessment and Nordic questionnaire. Results: Statistical analysis of VAS were found to be extremely significant with a P value of <0.0001. Conclusion: The current study concluded that there are chances of musculoskeletal disorders in small scale food industry workers. The musculoskeletal disorders which appears with maximum duration initiates with neck pain followed by low back pain and knee pain.

PREVALENCE OF OCCUPATIONAL DISEASES AMONG SMALL AND MEDIUM INDUSTRY WORKERS IN MALAYSIA: A SYSTEMATIC REVIEW

Occupational diseases are one of the major health problems related to workplace hazards. However, the epidemiological data for this problem is scarce especially among Small and Medium Industry (SMI) workers. These workers are vulnerable to occupational health problem due to lack of knowledge and implementation of health and safety in the workplace. In Malaysia, most of the SMI workers have limited coverage for basic occupational health services which may worsen their health. Thus, this article aims to provide a review on the burden of occupational health problems among them. The electronic and library searches were used to extract the information from both published and unpublished articles that were not limited to any year of publication until 2017. One hundred and ninety-six published articles and 198 unpublished articles were retrieved from the database. Only 19 published articles and 25 unpublished articles met the eligibility criteria. Prevalence data of occupational diseases/poisoning, including overall and body specific (musculoskeletal disorders) was extracted in raw data from the eligible studies. Prevalent statistics on occupational musculoskeletal diseases (1.3% - 97.6%), noise-induced hearing loss (29.4% - 73.3%), occupational skin diseases (10.5% - 84.3%), respiratory (1.9% - 92.2%) and occupational poisoning (14.9% - 17.7%) among the working population is different within published papers compared to unpublished ones. In Malaysia, there are no specific statistic that give a true picture of the burden of occupational diseases in the SMI. However, this review concludes that musculoskeletal diseases are significant occupational problems among SMI workers.

Quality of life assessment in musculo-skeletal health.

Musculoskeletal disorders affect morbidity, quality of life and mortality, and represent an increasing economic and societal burden in the context of population aging and increased life expectancy. Improvement of quality of life should be one of the priorities of any interventions to prevent and treat musculoskeletal disorders in the ageing population. Two main approaches, namely generic and disease-specific instruments, can be applied to measure health-related quality of life. Among the generic tools available in scientific literature, the short form 36 questionnaire (SF-36) and the Euroqol five item questionnaire (EQ-5D) are two of the most popular questionnaires used to quantify the health related quality of life in people with musculoskeletal disorders. However, because generic tools may not always be able to detect subtle effects of a specific condition on quality of life, a specific tool is highly valuable. Specific tools improve the ability to clinically characterize quality of life in subjects with a specific musculoskeletal disorder, as well as the capacity to assess changes over time in the QoL of these subjects. The recent development of specific tools should help to validate preventive and therapeutic interventions in this field.

Feasibility study of a serious game based on Kinect system for functional rehabilitation of the lower limbs

Summary Introduction Conventional functional rehabilitation costs time, money and effort for the patients and for the medical staff. Serious games have been used as a new approach to improve the performance as well as to possibly reduce medical cost in the future for cognitive rehabilitation and body balance control. The objective of this present work was to perform a feasibility study on the use of a new real-time serious game system for improving the musculoskeletal rehabilitation of the lower limbs. Materials and methods A basic functional rehabilitation exercise database was established with different levels of difficulties. A 3D virtual avatar was created and scaled to represent each subject-specific body. A portable and affordable Kinect sensor was used to capture real-time kinematics during each exercise. A specific data coupling process was developed. An evaluation campaign was established to assess the developed system. Results The squats exercise was the hardest challenge. Moreover, the performance of each functional rehabilitation exercise depended on the physiological profile of each participant. Our game system was clear and attractive for all functional rehabilitation exercises. All testing subjects felt motivated and secure when playing the rehabilitation game. Discussion The comparison with other systems showed that our system was the first one focusing on the functional rehabilitation exercises of the lower limbs. Conclusions Our system showed useful functionalities for a large range of applications (rehabilitation at home, sports training). Looking forward, new in-situation exercises will be investigated for specific musculoskeletal disorders.

Targeted intervention for patellofemoral pain (TIPPS): identifying potential clinical subgroups

Background: Patellofemoral pain (PFP) is a specific musculoskeletal disorder that causes significant pain and dysfunction around the knee cap and knee joint, which can lead to long term limitation in societal participation and physical activity. There is a consensus that conservative intervention should be the first treatment option so PFP is a condition that is commonly referred for physiotherapy. Unfortunately, however, current multi modal approaches to intervention in PFP are failing in the long term. Purpose: Given the poor outcome of current treatment regimens, identification of patellofemoral subgroups is an international priority. Large individual variation in outcome results is consistently reported in response to conservative management, therefore understanding whether subgroups have different outcomes has become imperative. However it is unknown whether subgrouping is possible in PFP. The main purpose of this study was to describe the distribution of PFP patients into different subgroups using six routine clinical assessment test criteria. Methods: Design: Cross-sectional with single point assessment prior to commencement of physiotherapy. Participants with PFP underwent clinical assessment of muscle strength (quadriceps and hip abductor), muscle length (quadriceps, hamstrings, gastrocnemius), patellar mobility and foot posture. The presence of subgroups was explored using two classification techniques: Hierarchical Clustering and Latent Profile Analysis. Results: One hundred and twenty seven of 130 recruited participants had complete assessment data: 66% were female, mean (SD) age was 26 (5.7) years, BMI 25.5 (5.8), and Modified Functional Index Questionnaire (MFIQ) was 34 (17). A three subgroup solution appeared optimal from a modelling and clinical perspective. The three suggested clinical subgroups were characterised as: Strong subgroup (n = 44), weak and tight subgroup (n = 58), pronated feet subgroup (n = 25). An ANOVA and post hoc tests confirmed significant differences between subgroups. Strong subgroup: quadriceps strength 1.5 Nm/kg (0.51), hip abductor strength 1.5 Nm/kg (0.51), lowest patellar mobility of the three groups 9.6 mm (3.43). Weak and tight subgroup: hip abductor strength 0.7 Nm/kg (0.27), shortest quadriceps length 118° (17.9). Pronated feet subgroup: highest FPI 7 (3.0), highest patellar mobility 17.6 mm (4.75). Conclusion(s): This study is the largest conducted to date on subgrouping of PFP. The results lend support to the idea that clinical subgroups exist within the patellofemoral population, with three potential subgroups emerging. The key clinical tests for identifying the three subgroups are strength measurement of the quadriceps and hip abductors, and foot posture index. Patellar mobility and quadriceps flexibility contributed to subgroup profiles, so also appear important to consider when identifying PFP subgroups. Implications: These results fit well with other findings in musculoskeletal research where subgrouping has been successful in informing targeted intervention in low back pain patients and is being increasingly adopted as a strategy for managing patients with shoulder problems. Our next step is explore variation in outcome across the identified PFP subgroups and whether subgroup targeted intervention improves overall patient outcomes.

Targeted intervention for patellofemoral pain (TIPPS): psychosocial characteristics of clinical subgroups

Background: Patellofemoral pain (PFP) is a specific musculoskeletal disorder that causes significant pain and dysfunction around the knee cap and knee joint leading to long term limitation in societal participation and physical activity. PFP is a condition commonly referred for physiotherapy intervention, however long term outcomes are poor. We have undertaken a study to explore the presence of clinical subgroups within the PFP population based on the scores of 6 tests that could be used within routine clinical practice. Our research study identified 3 clinical subgroups: Strong subgroup; Weak and Tight subgroup; Pronated feet subgroup. Purpose: There is mounting evidence that factors such as gender and activity levels influence development and outcome in PFP. There is also interest in whether psychosocial factors and different pain mechanisms play a role in determining potential subgroups. Therefore the main objective of this study was to explore interactions between demographic, clinical and psychosocial characteristics and clinical subgroups. Methods: Observational study, at one time point (commencement of physiotherapy). Demographic (Age; Body Mass Index (BMI)), clinical (Time since onset; Patellar skin fold; Tibialis anterior/patella temperature index; Cold Knees questions), and psychosocial characteristics (numeric pain rating scale (NPRS); International physical activity questionnaire (IPAQ); Modified functional index questionnaire (MFIQ); Short Leeds assessment neuropathic sign and symptoms (SLANSS); EQ-5D-5L; Hopkins symptoms check list (HSCL); Movement specific reinvestment scale (MSRS)) were assessed. Differences between the three clinical subgroups were explored using ANOVA, with post hoc tests, or chi-squared tests. Results: Of 127 participants, 66% were female and the mean age was 26 years (SD 5.7), BMI 25.5 (SD 5.8), time since onset 45 months (SD 55) and MFIQ was 34 (SD 17). The strong subgroup had significant higher function, quality of life and there were proportionally more males in this subgroup. The weak and tight subgroup significantly had the highest BMI, and there was a trend towards the lowest levels of activity. The pronated feet subgroup was significantly younger at time of first assessment and there was a trend for higher mean scores for neuropathic pain (SLANSS). There was no difference in mean scores of other characteristics across the subgroups. Conclusion(s): This study, the largest on PFP subgrouping, provides data on other characteristics of PFP patients and suggests significant differences in non-clinical factors between clinical subgroups. The latter provides support for the existence of clinical subgroups and possible insight into potential intervention strategies. For example, higher function and quality of life in the strong subgroup may suggest a focus on movement control is required whereas the higher BMI in the weak and tight subgroup may suggest adjunct weight management strategies may be needed. The neuropathic pain in the pronated feet subgroup may warrant desensitisation interventions. Implications: Demographic and psychosocial characteristics may be important factors to consider in addition to clinical factors in PFP patients. Such factors are increasingly important in managing patients with other musculoskeletal problems. The next step is to understand the relationship between these factors and treatment outcome. Keywords: Patellofemoral pain; Psychosocial; Subgrouping

Identification of musculoskeletal disorders in medically underserved regions of South America and Vietnam.

Musculoskeletal disorders have been implicated as the leading cause of disability throughout the world, representing a high percentage of the disease burden in many nations. Anecdotal evidence suggests that musculoskeletal pain has become increasingly pervasive, especially among rural populations of developing countries. To characterize specific musculoskeletal disorders in medically underserved regions where these issues have not yet been thoroughly examined. The sample comprised adult residents receiving care during brief medical outreach trips to South America (Peru, Ecuador, and Argentina) and Vietnam from December 2010 to March 2013. Patients completed an anonymous questionnaire on musculoskeletal pain, self-reported health status, and health care-seeking behavior. Demographic information was also obtained. In Vietnam, 295 patients aged 20 to 88 years (mean [SD], 59 [14.7] years) completed the survey, 204 (69%) of whom were women. In South America, 552 patients aged 18 to 86 years (mean [SD], 44 [17.24] years) completed the survey, 398 (72.1%) of whom were women. Among the Vietnamese patients, acute pain was most frequently felt in the knees (132 [44.7%]), which were also the most frequent site of chronic pain (122 [41.4%]). Among the South American patients, acute pain was felt most frequently in the lower back (225 [47%]), and the upper back (253 [46.6%]) was the most frequent site of chronic pain. Associations were found between sex and chronic pain, with women reporting more chronic pain than men in the shoulder (17 [53%] vs 15 [47%], respectively), upper back (85 [79%] vs 22 [21%]), hand/wrist (153 [85%] vs 52 [15%]), and knee (40 [80%] vs 7 [20%]). Men reported more acute knee pain than women (73 [48%] vs 148 [38%], respectively). For patients in both samples, acute pain was associated with chronic pain in the same location for all body parts (P<.01). This study characterized specific musculoskeletal disorders in selected poor and underserved regions in Vietnam and South America. Owing to reported regional differences, the authors recommend that global treatment protocols be developed with a population-specific approach after conducting a needs assessment for musculoskeletal disorders.

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

BackgroundDistal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.Methods/DesignBetween January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.DiscussionResults from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.Trial registrationRegistered on http://www.controlled-trials.com (reference number: ISRCTN79085082).

Pain-related musculoskeletal disorders, psychological comorbidity, and the relationship with physical and mental well-being in Gulf War veterans

Occupational activities such as lifting loads, working in constrained spaces, and training increase the risk of pain-related musculoskeletal disorders (MSDs) in military veterans. Few studies have investigated MSD and psychological disorder in veterans, and previous studies had limitations. This cross-sectional study compared pain-related MSD and psychological comorbidity and well-being between 1381 male Australian 1990–1991 Gulf War veterans (veterans) and a military comparison group (n=1377, of whom 39.6% were serving and 32.7% had previously deployed). At a medical assessment, 2000–2002, reported doctor-diagnosed arthritis or rheumatism, back or neck problems, joint problems, and soft tissue disorders were rated by medical practitioners as nonmedical, unlikely, possible, or probable diagnoses. Only probable MSDs were analysed. Psychological disorders in the past 12months were measured using the Composite International Diagnostic Interview. The Short-Form Health Survey (SF-12) assessed 4-week physical and mental well-being. Almost one-quarter of veterans (24.5%) and the comparison group (22.4%) reported an MSD. Having any or specific MSD was associated with depression and posttraumatic stress disorder (PTSD), but not alcohol disorders. Physical and mental well-being was poorer in those with an MSD compared to those without, in both study groups (eg, veterans with any MSD, difference in SF-12 physical component summary scale medians=−10.49: 95% confidence interval −12.40, −8.57), and in those with MSD and psychological comorbidity compared with MSD alone. Comorbidity of any MSD and psychological disorder was more common in veterans, but MSDs were associated with depression, PTSD, and poorer well-being in both groups. Psychological comorbidity needs consideration in MSD management. Longitudinal studies are needed to assess directionality and causality.

255 Musculoskeletal disorders and psychological comorbidity in Gulf War veterans and the relationship with physical and mental health and wellbeing

ObjectiveTo investigate musculoskeletal disorders, psychological comorbidity, and general physical and mental health and wellbeing in Gulf War veterans and a military comparison group.MethodsCross-sectional study of 1456 male Australian 1990–1991 Gulf...

Musculoskeletal Disorders among First Class Restaurant Workers in Turkey

In this study the author investigates musculoskeletal disorders among first class restaurant workers in the Istanbul area. A self-administered questionnaire was used to obtain information regarding body-site specific work-related musculoskeletal disorders, demographic features, pain intensity, and strategies for pain relief among a sample of first class restaurant workers. The prevalence of work-related musculoskeletal disorders was 59% and was most frequently reported in the ankle/foot region (29%). The highest mean pain intensity score was found in the forearm region. Significant differences were observed between demographic characteristics such as gender, age, education, and coping strategies for alleviation of pain in different sites.

Risk factors for neck and upper extremity disorders among computer users and the effect of interventions: an overview of systematic reviews

ObjectivesTo summarise systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or neck and upper extremity musculoskeletal disorders...

Risk Factors for Neck and Upper Extremity Disorders among Computers Users and the Effect of Interventions: An Overview of Systematic Reviews

BackgroundTo summarize systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or upper extremity musculoskeletal disorders (UEMSDs), or 2) reported on intervention studies among computer users/or office workers.Methodology/Principal FindingsPubMed, Embase, CINAHL and Web of Science were searched for reviews published between 1999 and 2010. Additional publications were provided by content area experts. The primary author extracted all data using a purpose-built form, while two of the authors evaluated the quality of the reviews using recommended standard criteria from AMSTAR; disagreements were resolved by discussion. The quality of evidence syntheses in the included reviews was assessed qualitatively for each outcome and for the interventions.Altogether, 1,349 review titles were identified, 47 reviews were retrieved for full text relevance assessment, and 17 reviews were finally included as being relevant and of sufficient quality. The degrees of focus and rigorousness of these 17 reviews were highly variable. Three reviews on risk factors for carpal tunnel syndrome were rated moderate to high quality, 8 reviews on risk factors for UEMSDs ranged from low to moderate/high quality, and 6 reviews on intervention studies were of moderate to high quality. The quality of the evidence for computer use as a risk factor for CTS was insufficient, while the evidence for computer use and UEMSDs was moderate regarding pain complaints and limited for specific musculoskeletal disorders. From the reviews on intervention studies no strong evidence based recommendations could be given.Conclusions/SignificanceComputer use is associated with pain complaints, but it is still not very clear if this association is causal. The evidence for specific disorders or diseases is limited. No effective interventions have yet been documented.