Biomedical subjects

Michael Feuerstein

Publications and source records attributed to Michael Feuerstein.

15 recordsLinked to original sources

PubMed2003

Individual and combined impacts of biomechanical and work organization factors in work-related musculoskeletal symptoms.

BACKGROUND: Investigations of work-related low back (LB) and upper extremity (UE) disorders have increasingly utilized multivariable models that include biomechanical/physical and work organization factors. However, the nature of any interactive effects is not well understood. METHODS: Using questionnaires, high and low exposure groups for biomechanical/physical factors, cognitive demands, cognitive processing, interpersonal demands, participatory management, skill discretion, and time pressure for 289 individuals (U.S. Marines) were identified. Musculoskeletal symptom status was also determined by questionnaire. Individual and biomechanical-psychosocial combinations were examined in adjusted multivariable logistic regression analyses. RESULTS: Time pressure was associated with both LB and UE symptoms (odds ratio(s) (OR) range = 2.13-3.09), while higher biomechanical exposures were risk factors for LB symptoms (OR = 2.07; 95% confidence intervals (CI): 1.00-4.35) and concurrent LB and UE symptoms (OR = 2.80; CI: 1.35-5.83). Greater risks for concurrent LB and UE symptoms were indicated for combinations involving higher biomechanical exposure and: time pressure (OR = 2.21; CI: 1.19-4.10); cognitive demands (OR = 2.25; CI: 1.23-4.09); cognitive processing (OR = 2.08; CI: 1.16-3.75); interpersonal demands (OR = 2.44; CI: 1.35-4.41); participatory management (OR = 2.50; CI: 1.30-4.81). Results did not suggest any interaction between biomechanical and work organization factors. CONCLUSIONS: While no synergism was indicated, the present findings emphasize the need to consider both biomechanical factors and specific work organization factors, particularly time pressure, in reducing musculoskeletal-related morbidity.

Adult↗

PubMed2003

Clinical and workplace factors associated with a return to modified duty in work-related upper extremity disorders.

Return to work following treatment for a work-related upper extremity disorder (WRUED) is affected by a variety of medical, workplace, and personal factors, and returning to modified duty may ease the transition to normal work activities. This study surveyed 165 federal government employees (127 females, 38 males) who were unable to resume their normal work after filing a workers' compensation claim for a WRUED (<90 days from claim filing) and who volunteered for a randomized study of alternative case management strategies. Before randomization, participants completed a baseline survey of upper extremity (UE) symptoms, functional limitations, and workplace factors. At baseline, 58 participants (35%) were working modified duty and 107 participants (65%) were not working. Compared with participants working modified duty, those who were not working were more likely to report: (a). a diagnosis of mononeuropathy, odds ratio (OR)=3.16 (95% confidence interval (CI)=1.37-7.14) versus enthesopathy, (b). higher pain ratings, OR=1.43 (95% CI=1.01-2.01), (c). greater functional limitations, OR=1.63 (95% CI=1.11-2.38), and (d). higher level of ergonomic stressors, OR=1.62 (95% CI=1.09-2.43) in a multivariable logistic regression. Measures of high risk work styles (fast pace and working despite pain) were associated with greater perceptions of ergonomic exposure, but not with work status. The model had 87.9% sensitivity and 43.1% specificity to correctly classify those not working (overall classification 72.1% correct). The results suggest that modified duty for workers with persistent WRUEDs may be enhanced by assessing perceived functional limitation and ergonomic exposure as well as the type and severity of symptoms.

Arm Injuries↗

PubMed2002

Occupational stress and work-related upper extremity disorders: concepts and models.

BACKGROUND: While research has suggested that interventions targeted at occupational stress (job stress) factors may improve clinical and work outcomes related to work-related musculoskeletal disorders, the emerging hypotheses relating occupational stress to work-related upper extremity disorders (WRUEDs) are not particularly well known among occupational health providers and researchers. METHODS: Generic job stress and health models and multivariable models of WRUEDs were described and evaluated. RESULTS: Models on occupational stress and health/WRUEDs offer unique perspectives on the role of occupational stressors on WRUEDs. However, the limited support for the structure and proposed mechanisms of these models suggest that investigations examining and validating proposed biobehavioral pathways are still needed. DISCUSSION: Difficulties in conceptualizing occupational stress have, in the past, hindered its systematic incorporation into occupational health research and prevention/intervention strategies. The present paper provides a common basis for researchers and practitioners with diverse backgrounds to understand job stress and its relation to WRUEDs in order to enhance future efforts. Given the present limitations in the field and the need for comprehensive approaches to WRUEDs, there is great potential for occupational health researchers and clinicians to advance knowledge in this area.

Arm↗

PubMed2002

Biobehavioral mechanisms of work-related upper extremity disorders: a new agenda for research and practice.

BACKGROUND: Epidemiological studies provide support for the role of organizational and individual psychosocial stressors in work-related upper extremity disorders (WRUEDs). Despite this evidence, the biological plausibility of a relationship between exposure to various psychosocial and work organizational stressors and WRUEDs remains unclear METHODS: The Georgetown Symposium on Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders was held in Washington D.C. on November 6-7, 2000 to improve the understanding of potential biobehavioral mechanisms, identify future areas for research and discuss the implications of this body of knowledge for intervention. This meeting involved presentations and discussions by researchers and clinicians from a number of disciplines (epidemiology, occupational medicine, rheumatology, orthopedics, surgery, internal medicine, psychoneuroimmunology, occupational health psychology, behavioral medicine, psychophysiology and experimental and organizational psychology). RESULTS: The symposium generated several papers addressing the following topics: definitions and job stress models; epidemiological foundations; musculoskeletal and biomechanical models; central nervous system models of recurrent and persistent clinical pain; psychophysiology of work; and implications for intervention. These papers comprise this special issue. DISCUSSION: The present paper summarizes the various contributions to this special issue and provides direction for future research on potential biobehavioral pathways.

Arm↗

PubMed2002

Measurement properties of a self-report index of ergonomic exposures for use in an office work environment.

Office work-related upper extremity symptoms and disorders have been associated with static work posture, repetition, and inadequate recovery in the anatomic structures of the neck and upper extremities. Despite these associations, relatively little research has been conducted on the development of practical measures of these ergonomic exposures. The present study examines the measurement properties of an upper-extremity-specific self-report index of ergonomic exposures. Ninety-two symptomatic office workers completed a Web-based questionnaire measuring demographic variables, ergonomic exposures, pain, job stress, and functional limitations. Comparisons of internal consistency, construct validity, and discriminative and predictive abilities were made between the self-report index and an observational exposure assessment checklist. Results indicated that the self-report index had acceptable measurement properties. Furthermore, higher levels of self-reported ergonomic exposures were associated with upper extremity pain, symptom severity, and functional limitations. In contrast, higher levels of observed exposure were related only to lower levels of general physical function. The self-report measure has potential for use in occupational health surveillance programs for office work environments and as an outcome measure of ergonomic exposure in intervention trials. These results also suggest the need for using multiple methods when assessing ergonomic exposures.

Adult↗

PubMed2002

Impact of case manager training on worksite accommodations in workers' compensation claimants with upper extremity disorders.

Management of the return-to-work process in claimants with work-related upper extremity disorders often poses challenges to the health care provider, claimant, and employer. Modifying workplace ergonomic risk factors as a component of the workplace accommodation process may improve return-to-work outcomes by reducing recurrent pain and discomfort. The present study is a case-control evaluation of the effects of a 2-day training program for nurse case managers that was designed to facilitate the implementation of workplace accommodations within a workers' compensation health care delivery system. After the training, 101 claimants with compensable upper extremity disorders were randomly assigned to case managers with and without training. Overall, 208 accommodations were recommended and 155 of these were implemented (75%). Claimants of trained nurses received 1.5 times as many recommendations for accommodations as claimants managed by nurses not trained in the process, and 1.4 times as many accommodations were implemented, although no differences were found between the two groups in implementation rates. Trained nurses were more likely to recommend accommodations addressing workstation layout, computer-related improvements, furnishings, accessories, and lifting/carrying aids, whereas the untrained nurses were more likely to suggest light duty and lifting restrictions. This study indicates that the training was associated with a change in the practice behavior of case managers regarding the workplace accommodation process. More research is needed to identify barriers to implementation and develop more effective approaches to facilitate worksite accommodations in disabled workers with carpal tunnel syndrome and other persistent upper extremity disorders.

Adult↗

PubMed2002

Ergonomic and psychosocial factors affect daily function in workers' compensation claimants with persistent upper extremity disorders.

Pain and other symptoms associated with work-related upper extremity disorders (WRUEDs) can lead to significant distress, lost function, and disability. Identifying factors associated with decreased upper extremity function may lead to the development of more effective interventions. In this study, participants were 165 government employees (127 female, 38 male) with an accepted workers' compensation claim (< 90 days from claim filing) for a WRUED who were unable to perform their normal work. Participants completed baseline measures of upper extremity functional limitation, symptoms, general health status, problem solving orientation, pain coping, and workplace factors. After controlling for pain and gender in a multiple regression analysis, greater functional limitation was further explained by: (1) upper extremity symptoms other than pain (e.g., sleep disturbance, numbness and tingling), (2) symptoms in one or both hands, (3) feeling overwhelmed by pain, (4) low confidence in problem solving abilities, and (5) higher ergonomic risk factor exposures at work. The final model accounted for 47.4% of the variance in upper extremity function, F(7157) = 4.33, P < 0.05. Mental health status was related to functional limitation in univariate, but not multivariate analyses. These results suggest that improving function in this population may require: (1) pain coping techniques and active problem solving to overcome functional barriers, and (2) reduction of workplace ergonomic risk exposure.

Adult↗

PubMed2002

Measurement properties of the calendar of premenstrual experience in patients with premenstrual syndrome.

OBJECTIVE: To assess the reliability and factor structure of the Calendar of Premenstrual Experiences (COPE) in premenstrual syndrome (PMS) patients. STUDY DESIGN: Healthy women diagnosed with PMS (N = 215) completed daily diaries assessing 22 PMS behavioral and physical symptoms over two consecutive months. RESULTS: Internal consistency (alpha) was high (.93-.94) for the COPE total score and behavioral subscale score and moderately high (.79) for the physical subscale score. Test-retest correlations produced lower estimates of reliability (.55-.59). Four factors, accounting for 64% of the total variance, were extracted: mood symptoms, somatic/cognitive symptoms, appetitive symptoms and fluid retention symptoms. Symptom reports increased in consecutive luteal phases for three of the four factors; however, the factor structure remained consistent in consecutive months. CONCLUSION: The COPE diary is a reliable instrument for identifying fluctuations in behavioral and physical symptoms during the luteal phase, and PMS symptoms can be reliably conceptualized within four factors. Symptom expression may increase in response to daily self-monitoring.

Adult↗

PubMed2001

Working with low back pain: problem-solving orientation and function.

A number of ergonomic, workplace and individual psychosocial factors and health behaviors have been associated with the onset, exacerbation and/or maintenance of low back pain (LBP). The functional impact of these factors may be influenced by how a worker approaches problems in general. The present study was conducted to determine whether problem-solving orientation was associated with physical and mental health outcomes in fully employed workers (soldiers) reporting a history of LBP in the past year. The sample consisted of 475 soldiers (446 male, 29 female; mean age 24.5 years) who worked in jobs identified as high risk for LBP-related disability and reported LBP symptoms in the past 12 months. The Social Problem-Solving Inventory and the Standard Form-12 (SF-12) were completed by all subjects. Hierarchical multiple regression analyses were used to predict the SF-12 physical health summary scale from interactions of LBP symptoms with each of five problem-solving subscales. Low scores on positive problem-solving orientation (F(1,457)=4.49), and high scores on impulsivity/carelessness (F(1,457)=9.11) were associated with a steeper gradient in functional loss related to LBP. Among those with a longer history of low-grade LBP, an avoidant approach to problem-solving was also associated with a steeper gradient of functional loss (three-way interaction; F(1,458)=4.58). These results suggest that the prolonged impact of LBP on daily function may be reduced by assisting affected workers to conceptualize LBP as a problem that can be overcome and using strategies that promote taking an active role in reducing risks for LBP. Secondary prevention efforts may be improved by addressing these factors.

Adult↗

PubMed1994

Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain.

The need to document cost-benefit of comprehensive work rehabilitation services represents a critical requirement for its long-term viability as a treatment option for injured workers. One approach to improving cost-benefit is to identify patients who experience difficulty completing a rigorous goal-oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. Patients (n = 168) presenting with low back pain who participated in a multidisciplinary work rehabilitation program (physical conditioning, work conditioning, work-related pain and stress management, ergonomic consultation, and vocational counseling) were categorized into 2 groups based upon whether they completed the 4 week, 5 day per week program (n = 84) or were discharged prior to program completion (n = 84). T tests were computed for return to work expectation, pain (average pain intensity, fear of re-injury), psychological measures (somatization, dysthymia), perceived work environment (work pressure, control, supervisor support), and disability (duration of work disability, physical disability, perceived disability) variables found in previous studies to affect successful rehabilitation and return to work. The discharged group was marked by lower return to work expectations, and heightened somatization, pain intensity, and perceived disability. In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD-9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Biobehavioral pain profile: development and psychometric properties.

Although a number of self-report indices that measure intensity and psychosocial components of the pain experience are available, these measures do not assess the range of cognitive, behavioral, and physiological reactions frequently associated with pain. This paper describes the initial determination of the psychometric properties of the Biobehavioral Pain Profile (BPP) developed to measure these reactions. The BPP is a 41-item self-report scale tested in a sample of 617 subjects with chronic recurrent pain, chronic non-malignant pain or chronic malignant pain. Kaiser's measure of sampling adequacy was 0.918. Factor analysis revealed 6 theoretically meaningful factors: Environmental Influences, Loss of Control, Health Care Avoidance, Past and Current Experience, Physiological Responsivity, and Thoughts of Disease Progression. Cronbach's alpha scores for the specific subscales ranged from r = 0.77 to r = 0.94. Test-retest reliability for the scales ranged from 0.57 to 0.73. Low correlations among the BPP and general indices of fear, depression, anxiety, body consciousness and social desirability are reported. The BPP appears to provide a unique composite assessment of self-report of behavioral, physiological, and cognitive reactions to pain experienced by individuals with a wide range of pain problems.

Adolescent↗

PubMed1988

Biobehavioral factors in cancer pain.

Despite the presence of pathology in cancer pain, the pain experience in adult cancer patients cannot be totally explained by the extent of such pathology. Unlike chronic benign pain very little research on the role of biobehavioral factors has been conducted to help explain this paradox. The literature on the role of biobehavioral factors in the cancer pain experience is reviewed. A brief review of epidemiology and pathophysiology is presented. Following this, the biobehavioral literature was organized according to research on psychological characteristics and environmental factors. Research addressing affective, cognitive, behavioral and physiological reactions to pain was also discussed. Despite the paucity of studies, the review suggested the following: (1) personality factors do not appear to play a consistent role in the modulation of pain in cancer patients; (2) the work on environmental influences on cancer pain indicate a weak association between such factors as social network and pain intensity; (3) studies on affective state indicate minimal relationships to pain, and lastly, (4) studies on cognitive responses to pain in cancer patients and their influence on the pain experience have not been conducted. To date, in the areas where biobehavioral factors have been investigated, the findings appear modest. However, many potential variables, e.g., self-esteem, the role of family, the role of models, past or current work environments, social learning factors and responses to pain such as fear, somatization and reattribution have not been explored with cancer patients. While the influence of biobehavioral factors in adult cancer pain appear to be relatively modest, the literature is not extensive. Increased efforts at more precisely determining the input of such factors in cancer pain are warranted, particularly given the role of such variables in other recurrent and chronic pain states.

Behavior↗

PubMed1987

A prospective analysis of stress and fatigue in recurrent low back pain.

The purpose of the present study was to determine whether patients with recurrent low back pain display a different pattern of mood fluctuations across days than matched healthy controls and whether these mood states are related to pain occurrence and/or magnitude using a prospective design. The questions addressed are whether mood states prior to a pain episode are associated with the episode or whether mood relates to pain as a secondary reaction. Similarly, the relationship between mood state recorded prior to, during or following pain and magnitude of pain experienced was investigated. Thirty-three ambulatory chronic low back pain patients and an equivalent group of asymptomatic controls matched for age, sex, socioeconomic status, and reported activity level monitored mood state (anxiety, tension, depression, anger, vigor, fatigue, confusion) and pain before breakfast, at 4 p.m. and at bedtime for 14 consecutive days. Groups were successfully matched. Analyses revealed significantly higher levels of tension, anxiety and fatigue and lower levels of vigor in the pain cases. No mood state was predictive of pain onset but fatigue was associated with pain 24 h following pain, indicating fatigue as secondary to pain. While mood state recorded prior to or following pain was unable to predict magnitude of pain, fatigue was associated with the level of pain experienced during the pain episode itself. The findings reveal a pattern of anxiety, tension and fatigue where fatigue is associated with increased pain during the pain episode and is increased 24 h following pain. This fatigue-pain relationship is superimposed upon a continuous elevation of anxiety and tension. These findings suggest the importance of pain management efforts directed at decreasing patients' fatigue levels, and increasing functional endurance while simultaneously reducing anxiety. The results also question the role of negative mood states in the initiation or exacerbation of pain and highlights the influence of physical mood states such as fatigue on pain in low back pain.

Adult↗

PubMed1985

Environmental stressors and chronic low back pain: life events, family and work environment.

Stressors in the family and job environments have been proposed to play a role in the modulation of pain, yet direct empirical support for such a role is limited. The present study investigated the relationship between general stress, family and work environments (perceived social climate), psychological distress (anxiety, depression), and pain experience (sensory, affective, evaluative) in 33 ambulatory chronic low back pain (CLBP) subjects and 35 healthy controls matched for age, sex, socioeconomic status (SES), weight, and height. Results indicated that environmental stressors/social climate measures, including family conflict, family control, and general stress (Social Readjustment Rating Scale), were greater in the CLBP group. Distress measures were also higher in the CLBP group. Characteristics of the family and work environments were found to be more predictive of the affective and evaluative dimensions of pain. Increased family conflict was associated with increased distress and increased pain, while increased family independence was correlated with less distress and increased pain. Less peer cohesion, less physical comfort, and less job clarity were correlated with increased pain, but not distress. Work pressure was associated with decreased depression and less pain. These findings suggested the presence of both stress and operant mechanisms in the modulation of pain in the family, while operant and distraction mechanisms appear to characterize the relationship among work environment factors and pain.

Adaptation, Psychological↗

PubMed1982

Potential biobehavioral mechanisms of recurrent abdominal pain in children.

To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9-14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 +/- 1 degree C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.

Abdomen↗