Upper-extremity Musculoskeletal Disorders Research Articles

Comparison of multi-task ergonomic assessment methods for risk of upper extremity and low back musculoskeletal disorders

Work-related musculoskeletal disorder of upper extremity multi-task assessment methods (Revised Strain Index [RSI], Distal Upper Extremity Tool [DUET]) and manual handling multi-task assessment methods (Revised NIOSH Lifting Equation [RNLE], Lifting Fatigue Failure Tool [LiFFT]) were compared. RSI and DUET showed a strong correlation (rs = 0.933, p < 0.001) where increasing risk factor exposure resulted in increasing outputs for both methods. RSI and DUET demonstrated fair agreement (κ = 0.299) in how the two methods classified outputs into risk categories (high, moderate or low) when assessing the same tasks. The RNLE and LiFFT showed a strong correlation (rs = 0.903, p = 0.001) where increasing risk factor exposure resulted in increasing outputs, and moderate agreement (κ = 0.574) in classifying the outputs into risk categories (high, moderate or low) when assessing the same tasks. The multi-task assessment methods provide consistent output magnitude rankings in terms of increasing exposure, however some differences exist between how different methods classify the outputs into risk categories.

Exploratory and Confirmatory Factor Analyses Support the Unidimensionality of the Arabic Quick Disabilities of the Arm, Shoulder and Hand

The objective of this investigation was to assess the structural validity of the Arabic Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) in individuals suffering from upper extremity musculoskeletal disorders, utilizing both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A group of participants with upper extremity musculoskeletal disorders attending physical therapy clinics were recruited. Upon their initial visit to physical therapy, participants were requested to complete the Arabic versions of the QuickDASH, as well as the Numeric Pain Rating Scale. In order to determine the number of factors, parallel analysis was employed in the EFA, while maximum likelihood was utilized for extraction. The fit of the model identified using EFA was subsequently examined using CFA, incorporating multiple fit indices. The outcomes of the EFA indicated the existence of a one-factor structure, accounting for a considerable 50.22% of the total variance. It was observed that all of the QuickDASH items displayed loadings on the single factor, with values ranging from 0.35 to 0.77. However, the multiple fit indices obtained from the CFA did not provide sufficient support for the fit of the initially proposed unidimensional structure. The data showed good fit to the unidimensional model after adding error covariance: chi-square = 100.52 [degrees of freedom (df) = 40, P &lt; 0.001], chi-square/df = 2.51, Tucker–Lewis index = 0.94, comparative fit index = 0.95, root mean square error of approximation = 0.077 [90% confidence interval (CI) = 0.058-0.096], and standardized root mean residual = 0.048. Ultimately, the findings from the EFA provided evidence supporting the unidimensionality of the Arabic QuickDASH, while the CFA supported the unidimensionality of the QuickDASH after addressing the issue of local dependency between some scale items.

Structural Validity of the Arabic Upper Extremity Functional Index Using Exploratory and Confirmatory Factor Analysis

The upper extremity functional index (UEFI) is a commonly used patient-reported outcome measure with good measurement properties. The Arabic UEFI has been reported to have sufficient reliability and construct validity, but its structural validity has not been examined yet. The aim of this study was to examine the structural validity of the Arabic UEFI using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) in patients with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders attending physical therapy clinics were recruited. Participants were asked at their initial visit to physical therapy to complete the Arabic versions of the UEFI, and the numeric pain rating scale. In the EFA, the number of factors was determined using parallel analysis and maximum likelihood was used for extraction. The fit of the structural model identified using EFA was examined using CFA with multiple fit indices. The results of the EFA suggested one factor structure accounting for 57.22% of the total variance. All the UEFI items showed substantial loadings on the single factor that ranged from 0.51 to 0.85. The CFA multiple fit indices did not support the fit of the unidimensional structure at the first run of the analysis. Adding error covariance to items of similar function led to good fit of the data to the modified unidimensional model; χ 2 = 665.94 (df = 162, P &lt; 0.001), χ 2/df = 2.88, Tucker–Lewis index (TLI) = 0.91, comparative fit index (CFI) = 0.92, root mean square error of approximation (RMSEA) = 0.086 (90% CI = 0.077-0.095), and standardized root mean residual (SRMR) = 0.045. The results of the EFA supported this unidimensional structure of the UEFI while the CFA supported this unidimensional structure after accounting for possible response dependency among some of the items. Clinicians and researchers can use one total score for the Arabic UEFI that reflects the level of upper extremity function.

Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial

BackgroundMusculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes. ObjectiveTo compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders. MethodsWe conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate. ResultsIn total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035). ConclusionsThis study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs.Trial registration: ClinicalTrials.gov (NCT02702466) retrospectively registered.

Concurrent validity study of QuickDASH with respect to DASH in patients with traumatic upper extremity amputation

BackgroundThe Disability of the Arm, Shoulder and Hand Outcome Measure (DASH) is a validated patient-reported outcome measure (PROM) for many upper extremity musculoskeletal disorders. In patients with severe traumatic conditions, limited evidence exists regarding the equivalence between DASH and its shortened version, QuickDASH, which is more feasible in clinical practice. The rationale of this study was to analyze the concurrent validity of QuickDASH with respect to DASH in patients with traumatic upper extremity amputation.MethodsThis study is based on a consecutive cohort of traumatic upper extremity amputation patients treated with replantation or revision (completion) amputation at Tampere University Hospital between 2009 and 2019. We estimated the concurrent validity of QuickDASH with respect to DASH by correlation coefficients, mean score differences, Bland–Altman plots, and distribution density. Additionally, we assessed internal reliability with Cronbach’s alpha coefficients and item-total correlations.ResultsWe found a very strong linear correlation between DASH and QuickDASH scores (r = 0.97 [CI 95% 0.97–0.98], p < 0.001). The mean difference between DASH and QuickDASH was minor (MD = -1, SD 4 [CI95% from -1 to 0] p = 0.02). The mean sub-score for the activity domain was higher for QuickDASH than DASH (MD = -3 [CI95% from -4 to -3] p < 0.000) and lower for the symptom domain (MD = 7 [CI95% from 6 to 9] p < 0.000). The Bland and Altman plot showed good agreement between DASH and QuickDASH scores, but there was measurement error in QuickDASH with high scores (r = -0.20, [CI95% from -0.31 to -0.09], p = 0.001).ConclusionQuickDASH demonstrates higher total scores than the full DASH and emphasizes rating of activity over symptoms. Still, on average the differences in total scores are likely less than the MCID of DASH, and consequently, this study shows that QuickDASH can be recommended instead of the full DASH when assessing a traumatic condition.Trial registrationRetrospectively registered.

An Umbrella Review of Systematic Reviews for Chuna (or Tuina) Manual Therapy on Musculoskeletal Disorders

Background: To provide clinicians with reliable evidence an umbrella review of systematic reviews (SRs) on Chuna manual therapy (CMT) for musculoskeletal disorders was performed to synthesize important outcomes.Methods: There were eight databases (Cochrane, EMBASE, MEDLINE, CNKI, KMBASE, KISS, Scienceon, and OASIS) searched as well as the international database Prospective Register of Systematic Reviews in health and social care until August 2023. SRs of randomized controlled trials involving patients with musculoskeletal conditions, limited to interventions explicitly labeled as “Chuna” or “Tuina” in English, Chinese, or Korean language were retrieved. Two reviewers independently conducted selection and data extraction, and SR quality was assessed using A Measurement Tool to Assess Systematic Reviews tool (low, medium, or high quality).Results: This review included 32 SRs, categorized by cervical (&lt;i&gt;n&lt;/i&gt; = 4), thoracolumbar (&lt;i&gt;n&lt;/i&gt; = 7), upper extremity (&lt;i&gt;n&lt;/i&gt; = 5), lower extremity (&lt;i&gt;n&lt;/i&gt; = 9), and other musculoskeletal disorders (&lt;i&gt;n&lt;/i&gt; = 7). Quality assessments determined that three SRs were of “high” quality, two were “low” quality, and the remaining SRs were of “medium” quality. CMT was consistently reported to demonstrate superior outcomes: an effective rate was observed in 17 of 19 SRs, CMT was effective at reducing pain in 12 of the 16 SRs, and functional outcomes of CMT were observed in 8 of 12 SRs. No serious adverse events were reported.Conclusion: CMT may be a safe and effective treatment for various musculoskeletal disorders based on the limited number of studies and the low quality of included SRs.

Responsiveness and Minimal Important Change of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) in Patients with Upper Extremity Musculoskeletal Disorders.

The aim of this study was to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) and to quantify its minimal important change (MIC) for improvement. People with upper extremity musculoskeletal problems who were receiving physical therapy were evaluated at baseline and again during a follow-up appointment, with a median time frame of 7 days between the two testing sessions (range of 6 to 72 days). The participants completed the Arabic DASH, Global Assessment of Function (GAF), Numeric Pain Rating Scale (NPRS) and Global Rating of Change Scale (GRC). The responsiveness of the Arabic DASH was assessed by examining the pre-specified hypotheses. The MIC for improvement was determined using the receiver operating characteristic method (MICROC) and the predictive modeling method (MICpred). As hypothesized, a change in the Arabic DASH demonstrated a significant positive correlation with changes in the GAF (r = 0.69), NPRS (r = 0.68) and GRC (r = 0.73). Consistent with our hypotheses, the DASH change scores could be used to differentiate between participants who improved and those who did not improve (area under the receiver operating characteristic curve = 0.87), and they showed a large magnitude of change (effect size = 1.53, standardized response mean = 1.42) in patients who improved. All the hypotheses specified a priori were supported by the results. The Arabic DASH MICROC and MICpred were estimated to be 14.22 and 14.85. The interaction between the DASH change and baseline score was not a significant predictor of status (improved vs. not improved) (p = 0.75), indicating that the DASH MIC was not baseline-dependent. The Arabic DASH demonstrated sufficient responsiveness, supporting the idea that the Arabic DASH is capable of detecting changes in upper extremity function over time. The value of the Arabic DASH MIC was similar when estimated using the predictive modeling and ROC methods, and the MIC was not dependent on baseline status.

Responsiveness of the Arabic Quick Disabilities of the Arm, Shoulder and Hand in Patients with Upper Extremity Musculoskeletal Disorders.

This study aimed to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand short version (Quick-DASH) in patients with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders (N = 88) under physical therapy care were assessed at initial visit and later at a follow-up visit, and they completed the Arabic Quick-DASH, DASH, Numeric Pain Rating Scale (NPRS), Global Assessment of Function (GAF), and the Global Rating of Change Scale (GRC). Responsiveness of the Arabic Quick-DASH was assessed by examining six pre-defined hypotheses. Consistent with the pre-defined hypotheses, the Arabic Quick-DASH changes scores exhibited significant positive correlation with the change in DASH (r = 0.98), GAF (r = 0.67), NPRS (r = 0.72), and the GRC (r = 0.78). As hypothesized, the Arabic Quick-DASH showed a large effect size above the pre-determined level (ES = 1.61, SRM = 1.49) in patients who reported improved upper extremity function. The Arabic Quick-DASH change score discriminated between patients who reported improvement versus no improvement in upper extremity function (area under the receiver operating characteristic curve = 0.90). The results supported 100% (six out of six) of the pre-defined hypotheses. The Arabic Quick-DASH demonstrated sufficient responsiveness where all the pre-defined hypotheses were supported, leading to the established validity of the Arabic Quick-DASH change score as a measure of change in upper extremity function and symptoms. The minimal importance change in the Arabic Quick-DASH needs to be determined in future studies.

Development and validation of a work-related risk score for upper-extremity musculoskeletal disorders in a French working population.

The aim was to develop an easy-to-use risk score based on occupational factors and to validate its performance to identify workers either having (diagnostic setting) or developing (prognostic setting) upper-extremity musculoskeletal disorders (UEMSD). This study relied on data from the Cosali prospective cohort conducted in a French working population. Diagnostic status for six UEMSD at inclusion and at follow-up was assessed by a standardized clinical examination. Data on occupational factors were collected through a self-administered questionnaire completed before the clinical examination at inclusion. The risk score was derived from a prediction model developed on data of 2,468 workers included in 2002-2003, and the validation sample is composed of 1,051 workers included later in 2004-2005. The prognostic performance of the risk score was assessed in workers without UEMSD at baseline. A total of 13% and 12% of workers had a UEMSD at inclusion in the development and validation sample. The developed risk score includes physical, organizational and psychosocial factors at work. In the validation sample, this score had acceptable performance for identifying workers having or not UEMSD at baseline (AUC: 0.60 [95% CI 0.57 to 0.63]), in particular the negative predictive value was high (89%-90%). The baseline risk score showed similar performance for predicting incident UEMSD at follow-up examination. This score can be useful as a first-line risk assessment tool, especially for excluding the low-risk work situations from further intervention by an ergonomist. Further validation studies are needed to determine its performance among various working populations.

Relating in-vivo Strain of the Flexor Digitorum Superficialis Tendon with Grip Force

Epidemiological studies have shown a relationship between hand exertion and risk of developing distal upper extremity musculoskeletal disorders (DUEMSDs). Recently, fatigue-failure models were proposed for estimating the risk of DUEMSD development. However, models that incorporate tendon strain are primarily based on in-vitro data and may be better informed using in-vivo data. This methodological pilot study aimed to establish an approach for correlating grip force and spatiotemporal strains of the flexor digitorum superficialis (FDS) tendon using ultrasound imaging. Three image texture correlation techniques to measure in-vivo strains were explored and compared: digital image correlation, direct deformation estimation, and StrainNet, a novel deep learning neural network for strain prediction. StrainNet resulted in more accurate strain measurements than conventional image assessment tools, enabled continuous prediction of FDS tendon strain, and allowed for comparison of median bulk tissue strain during isometric contraction to grip force. Future work will study more participants and viscoelastic behavior.

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.

Comparison of Musculoskeletal Symptoms of Neck and Shoulder among Different Types of Hand Held Device Users

Background: Prolonged and forceful utilization of hand-held devices has contributed to a global increase in upper extremity and cervical musculoskeletal disorders. These pathologies are directly associated with excessive use of mobile phones and similar devices. Aim: To evaluate the impact of diverse hand-held devices on musculoskeletal (MSK) symptoms in the neck and shoulder and investigate the relation between usage duration and MSK symptoms in the neck and shoulder region. Methods: This study utilized an observational design with a self-structured questionnaire approved by the Department of Physical Therapy at Sargodha Medical College. The sample consisted of 300 young adults aged 21 to 28 years, selected through convenient sampling across different academic years. Data collection involved the distribution of a comprehensive questionnaire, ensuring meticulous responses and privacy. Inclusive criteria included 2nd to final year students, while exclusions maintained homogenity. Results: Among the 300 participants, 76% experienced musculoskeletal discomfort in the neck and shoulder regions, while 24% were asymptomatic. Specifically, 57% reported pain, 16% had numbness, 5% experienced cramping, and 22% felt stiffness. Moreover, 55% of the total population reported some level of pain on Visual Analog Scale, while 45% were pain-free. The study highlights the need for ergonomic design considerations in hand-held devices to minimize the risk of musculoskeletal symptoms in neck and shoulder regions. The findings can guide development of user education programs and workplace interventions to promote proper posture and exercises for individuals using hand-held devices, thereby reducing musculoskeletal discomfort. Conclusion: Excessive utilization of handheld devices is intricately associated with cervico-brachial discomfort, revealing correlations between device typology, duration of usage, postural alignments, and musculoskeletal symptoms. Keywords: Hand-held devices, musculoskeletal symptoms, neck and shoulder discomfort

Effects of sex and age on work-related upper extremity musculoskeletal disorders in Ontario, Canada.

Effective targeting of workplace upper extremity musculoskeletal disorder (MSD) prevention strategies requires the identification of demographic groups most at risk. Workers' compensation data provides an effective means of surveillance of MSDs at the population level. The primary purpose of this study was to identify the effects of age and sex on rates of tendon injuries of the wrist and hand, carpal tunnel syndrome (CTS), epicondylitis, and soft tissue shoulder injuries in Ontario, Canada between 2000-2019 using workers' compensation data from the Association of Workers Compensation Boards of Canada (AWCBC). Age and sex specific rates of lost-time injury claims from the four identified injury categories as well as "non-specific" upper extremity MSDs which did not fit into the four categories were calculated by standardizing injury claim totals with "at-risk" population estimates from the Canada Labour Force Survey. A multiple regression analysis was used to analyze the effects of age and sex on rates of specific injury claims. Statistically significant age and sex effects were identified for rates of claims from tendon injuries of the wrist and hand, CTS, and shoulder injuries, while only age effects were significant for epicondylitis. Between 2000-2019, rates of claims from the four injury categories studied and the magnitude of the age and sex effects declined substantially over time. Detailed surveillance of workplace ergonomic hazards in Ontario workplaces is needed to determine what is causing rates of upper extremity claims to decline.

Comparison of Musculoskeletal Symptoms of Neck and Shoulder among Different Types of Hand Held Device Users

Introduction: Prolonged and forceful utilization of hand-held devices has contributed to a global increase in upper extremity and cervical musculoskeletal disorders. These pathologies are directly associated with the excessive use of mobile phones, tablets, and similar devices. Objectives: The study aimed to evaluate the impact of diverse hand-held devices on musculoskeletal (MSK) symptoms in the neck and shoulder and investigate the relation between usage duration and MSK symptoms in the neck and shoulder region. Materials and Methods: This study utilized an observational design with a self-structured questionnaire approved by the Department of Physical Therapy at Sargodha Medical College. The sample consisted of 300 young adults aged 21 to 28 years, selected through convenient sampling across different academic years. Data collection involved the distribution of a comprehensive questionnaire, ensuring meticulous responses and privacy. Inclusive criteria included 2nd to final year students, while exclusions maintained homogeneity. Rigorous standards were followed, enhancing reliability and validity, and facilitating a comprehensive exploration of musculoskeletal health in the medical college student population. Results: Among the 300 participants, 76% experienced musculoskeletal discomfort in the neck and shoulder regions, while 24% were asymptomatic. Specifically, 57% reported pain, 16% had numbness, 5% experienced cramping, and 22% felt stiffness. Moreover, 55% of the total population reported some level of pain on the Visual Analog Scale, while 45% were pain-free. Conclusion: Excessive utilization of handheld devices is intricately associated with cervico-brachial discomfort, revealing correlations between device typology, duration of usage, postural alignments, and musculoskeletal symptoms. Keywords: hand-held devices, musculoskeletal symptoms, neck and shoulder discomfort

Responsiveness of the Arabic Upper Extremity Functional Index in Patients with Upper Extremity Musculoskeletal Disorders.

The aim of this study was to examine the ability of the Arabic Upper Extremity Functional Index (UEFI) to detect change over time in upper extremity function (responsiveness) in patients with upper extremity musculoskeletal disorders. Patients receiving physical therapy care for their upper extremity musculoskeletal disorders completed the Arabic UEFI; Disabilities of the Arm, Shoulder and Hand (DASH); Numeric Pain Rating Scale (NPRS); Global Assessment of Function (GAF); and the Global Rating of Change Scale (GRC) at the initial visit and later at a follow-up assessment. Responsiveness was examined by testing predefined hypotheses regarding the correlations between the change scores in the Arabic UEFI and the other measures. The Arabic UEFI change scores demonstrated a significant positive correlation with the change in the DASH (r = 0.94), GAF (r = 0.65), NPRS (r = 0.63), and GRC (r = 0.73), which was in line with the predefined hypotheses. The Arabic UEFI change scores demonstrated a pattern of correlation with changes in other outcome measures that are consistent with the argument that the Arabic UEFI change scores represent a change in upper extremity function. The responsiveness of the Arabic UEFI was supported, and its use to monitor changes in upper extremity function in patients with upper extremity musculoskeletal disorders was supported.

Validity and Reliability of the Persian Version of WOrk-Related Questionnaire for UPper Extremity Disorders (WORQ-UP).

Background: We aimed to evaluate the validity and reliability of the Persian version of the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) questionnaire in a working population with upper extremity musculoskeletal disorders. Methods: We enrolled 181 patients with upper extremity conditions to complete the Persian WORQ-UP. A total of 35 patients returned after 1 week to complete the questionnaire again. To test the construct validity, patients responded to the Persian Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) at the first visit. The correlation between Quick-DASH and the WORQ-UP was assessed using Spearman correlation coefficient. Internal consistency (IC) was tested using Cronbach's alpha, and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Results: Spearman correlation coefficient was 0.630 (p < 0.001), indicating a strong correlation between Quick-DASH and WORQ-UP. Cronbach's alpha was 0.970, which is considered excellent. ICC for the total score of the Persian WORQ-UP was 0.852 (0.691-0.927), indicating good to excellent reliability. Conclusions: Our study demonstrated that the Persian version of the WORQ-UP questionnaire has excellent reliability and IC. Construct validity showed a moderate to strong correlation between WORQ-UP and Quick-DASH, which provides a platform for the workers' population to assess the extent of disability and follow the progress along the treatment course. Level of Evidence: Level IV (Diagnostic).

Low Back Pain and Upper-Extremity Musculoskeletal Disorders in French Postal Workers Driving Light-Duty Vehicles for Mail and Parcel Delivery.

Occupational driving of light-duty vehicles (LDVs) became increasingly important in parcel delivery faced with the explosive growth of e-commerce. Since musculoskeletal disorders (MSDs) represent the most reported driving-related health problem, we aimed to analyze the risk of low back pain (LBP) and upper-extremity musculoskeletal disorders (UEMSDs) associated with driving LDVs for parcel delivery. In 306 postal workers exposed to driving and 100 unexposed workers, information on occupational driving, physical/psychosocial constraints, and work organization were collected via a questionnaire. MSDs were assessed using the Nordic Questionnaire, 14 additional questions regarding LBP, and a standardized clinical examination for UEMSDs. Statistical modeling consisted of multivariable logistic regression for UEMSDs and the item response theory approach for LBP. UEMSDs were associated with the distance of rural rounds and inversely associated with urban/mixed delivery rounds. Handling heavy loads was associated with LBP, and high physical demands during delivery rounds were related to MSDs. Karasek dimensions and mobbing actions were associated with MSDs. Work recognition, driving training, using an automatic gearbox, and the utilization of additional staff during peak periods were inversely associated with MSDs. Our results suggest that the distance driven in rural settings and high physical demands were associated with MSDs, while some organizational factors could protect from MSDs.

Reliability Analysis of Observation-Based Exposure Assessment Tools for the Upper Extremities: A Systematic Review.

(1) Background: The objectives of this systematic review were to (i) summarize the results of studies evaluating the reliability of observational ergonomics exposure assessment tools addressing exposure to physical risk factors associated with upper extremity musculoskeletal disorders (MSDs), and (ii) identify best practices for assessing the reliability of new observational exposure assessment tools. (2) Methods: A broad search was conducted in March 2020 of four academic databases: PubMed, Science Direct, Ergonomic s, and Web of Science. Articles were systematically excluded by removing redundant articles, examining titles and abstracts, assessing relevance to physical ergonomics and the upper extremities, and article type. (3) Results: Eleven articles were included in the review. The results indicated no singular best practice; instead, there were multiple methodological approaches researchers chose to use. Some of the significant variations in methodologies include the selection of reliability coefficients, rater and participant selection, and direct vs. digital observation. (4) Conclusion: The findings serve as a resource summarizing the reliability of existing observational risk assessment tools and identify common methods for assessing the reliability of new observational risk assessment tools. Limitations of this review include the number of databases searched, the removal of truncation symbols, and the selection of keywords used for the initial search.

Shoulder-specific rehabilitation combined with aerobic exercises versus solely shoulder-specific rehabilitation in patients with type 2 diabetes mellitus: study protocol for a randomized controlled superiority trial

BackgroundMusculoskeletal disorders are very common in patients with diabetes mellitus (DM). The upper limb is one of the regions that is most frequently affected generally presenting limited joint mobility, pain, and a decreased muscle strength. Most clinical trials with a focus on shoulder musculoskeletal rehabilitation are carried out in patients who do not present DM. Thus, the purpose of the present study is to compare the effects of two distinct treatment protocols (conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises versus solely conventional shoulder musculoskeletal rehabilitation) on shoulder pain, function, strength, kinematics, and supraspinatus tendon thickness in patients with type 2 DM after 12 weeks of intervention and a subsequent follow-up at week 20.MethodsA randomized controlled superiority trial will be conducted. Participants with a clinical diagnosis of type 2 DM of both sexes, age between 40 and 70 years, presenting shoulder pain will be randomly assigned to one of the following groups: (1) conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises; (2) solely conventional shoulder musculoskeletal rehabilitation. All individuals will be evaluated before starting the treatment protocol (baseline) and at the end of treatment (post 12 weeks) and as a follow-up at 20 weeks. The shoulder function assessed by the SPADI (Shoulder Pain and Disability Index) questionnaire will be considered as primary outcome; the secondary outcome will be shoulder pain, measured with NPRS scales. Other outcomes will include range of motion, measured using a digital inclinometer; isometric shoulder muscle strength, measured using a manual muscle dynamometer; shoulder kinematics, measured using three-dimensional inertial units measurement; supraspinatus tendon thickness, measured using an ultrasound; AGE accumulation, using a skin autofluorescence measurement; and HbA1c (hemoglobin a1c), fasting glucose and lipid profile measured by a simple blood test.DiscussionDM is a highly prevalent disease and a public health problem worldwide, and the upper extremity musculoskeletal disorders in DM are barely recognized and largely underestimated. In this way, it would be interesting to analyze if the combination of aerobic exercises with conventional musculoskeletal rehabilitation protocols could generate better results in the functionality, pain, mobility and an improvement in the biochemical aspects related to the hyperglycemia of these patients compared to solely the conventional musculoskeletal rehabilitation.Trial registrationClinicalTrials.gov NCT04817514. Registered on March 26, 2021.

Job-related stress associated with work-related upper extremity musculoskeletal disorders (UEMDs) in municipal waste collectors: the moderation and mediation effect of job support

BackgroundSince the policy of “keeping trash off of the ground” in Taiwan, long-term exposure to repetitive motion in waste collection process results in high risk of upper extremity musculoskeletal disorders (UEMDs). Thus, we assessed the moderation and mediation effects of job-related stress and job support on work-related UEMDs among municipal waste collectors.MethodsA cross-sectional study was conducted in two cities located at northern Taiwan during 2018–2019. 626 municipal waste collectors voluntarily participated and anonymously filled out a structured questionnaire. The moderation and mediation effects of effort-reward imbalance (ERI) and social support on UEMDs were analyzed by Haye’s Process Macro Model.ResultsPrevalence of UEMDs in municipal waste collectors were 43.4% for neck, 56.0% for shoulder, 24.1% for upper back, and 33.1% for hand/wrist. There was high prevalence of shoulder (72.2%), neck (48%), and upper back (30%) in female workers compared to male, most significantly in shoulders. In univariate and multivariate analysis, high ERI and low job support were significantly associated with ORs of 3.11 (95% CI:1.58–6.13) for elbow, 2.79 (95% CI:1.39–5.56) for shoulder, 3.39 (95% CI:1.64–7.00) for upper back and 3.83 (95% CI:1.98–7.41) for hand/wrist. Prevalent UEMDs were positively associated with high ERI in municipal waste collectors but negatively with job support. The moderation effects of ERI and job support on UEMDs, of which the measured synergy index exceeded one, were 18.24 for shoulder, 3.32 for elbow, and 2.45 for hand/wrist, but mediation effects were not significant.ConclusionsThis study found municipal waste collectors with work-related upper extremity disorders were significantly associated with work-related psychological risk factors. Therefore, waste collection cannot only to be improved by semi-automatic and automatic processes but immediate intervention programs for the reduction of psychological risk factors is needed promptly.