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PubMed1999

Prognostic factors for the development of fibromyalgia in women with self-reported musculoskeletal pain. A prospective study.

OBJECTIVE: To estimate the risk of developing fibromyalgia (FM) in women with self-reported pain and to estimate the relative risk of a series of variables. METHODS: As part of a population study, 214 women with self-reported pain were interviewed and examined in 1990 and 1995. In 1990, 39 of these women fulfilled the American College of Rheumatology criteria for FM. The other 175 women represented a continuum of pain extent from nonchronic pain to chronic widespread pain, and were assessed as individuals at risk for developing FM. Potential risk factors for FM were registered in 1990 and analyzed by bivariate and multiple statistical methods in the total sample and also in a subgroup of 115 women with limited pain. RESULTS: Forty-three (25%) women developed FM. Having > or = 4 associated symptoms, pain of > or = 6 years' duration, back pain, alternately hard/loose stools, and self-assessed depression were found to be predictors. Pain in the lower arm and a feeling of swelling were more weakly associated. In women with limited pain, pain > or = 6 years' duration, > or = 4 associated symptoms, not feeling refreshed in the morning, and paresthesia were found to be predictors. A weaker association was found with self-assessed depression and a lack of formal education. CONCLUSION: A high cumulative incidence of FM was found and a diversity of predictors for FM were identified in the total sample and also in women with limited pain. Of the variables that were part of the FM syndrome, back pain predicted FM, while tender points and pain in the neck did not. Moreover, > or = 4 associated symptoms, self-assessed depression, and longlasting pain were shown to be important predictors.

Adult↗
PubMed1996

Assembly work in Indonesia and in Sweden--ergonomics, health and satisfaction.

Work conditions in industrial production vary substantially between different cultures. In the present study the aims were to identify differences between Swedish and Indonesian assembly industry workers regarding work environment factors, health and job satisfaction, and to find associations between work environment factors, and the health measures. Data were collected by a questionnaire from 326 Swedish and 136 Indonesian assembly industry workers, interviews and from company documents. The prevalence of musculoskeletal symptoms was high in both groups. Stress and psychosomatic symptoms had higher prevalences in the Swedish group, which also rated their work conditions as worse in most respects. Work tasks were physically heavier in Indonesia, but less monotonous and with lower demands on productivity. The Indonesians were more satisfied with their jobs. Physical job demands were associated with musculoskeletal symptoms. Competence development was associated with increased job satisfaction. Conflicts and harassments at work were associated with stress and psychosomatic symptoms. Job pressure, especially deficient planning of the jobs was associated with lower job satisfaction, psychosomatic and stress symptoms in the Swedish group. Implications for job design in the two cultures are presented.

Cross-Cultural Comparison↗
PubMed2004

The development of an ergonomics training program to identify, evaluate, and control musculoskeletal disorders among nursing assistants at a state-run veterans' home.

Nursing assistants (NAs) who work in nursing and personal care facilities are twice and five times more likely, respectively, to suffer a musculoskeletal disorder compared to service industries and other health care facilities, respectively. The purpose of this study was to develop an ergonomics training program for selected NAs at a state-run veterans' home to decrease musculoskeletal disorders by 1) developing questionnaires to assess musculoskeletal stress, 2) evaluating the work environment, 3) developing and using a training package, and 4) determining the application of the information from the training package by NAs on the floor. Results show two new risk factors not previously identified for nursing personnel in the peer-reviewed literature. Quizzes given to the nursing personnel before and after training indicated a significant improvement in understanding the principles of ergonomics and patient-handling techniques. Statistical analysis comparing the pre-training and post-training questionnaires indicated no significant decrease in musculoskeletal risk factors and no significant reduction in pain or discomfort or overall mental or physical health.

Ergonomics↗
PubMed2004

Global core recommendations for a musculoskeletal undergraduate curriculum.

OBJECTIVE: To develop core recommendations for the learning outcomes of an undergraduate curriculum in musculoskeletal conditions for any parts of the globe. METHODS: Recommendations were developed by wide consultation with experts in orthopaedics, rheumatology, osteoporosis, and rehabilitation from all parts of the world who had interest and experience in these specialties, with the support of international and national societies. All possible knowledge, skills, and attitudes that might be of relevance to musculoskeletal conditions were initially considered and then reduced to those considered essential for all doctors. RESULTS: The recommendations focus on (a) basic skills to assess and diagnose musculoskeletal problems; (b) the competency to assess specific common or urgent musculoskeletal problems; (c) the theoretical background of the conditions and their management; and (d) the core knowledge necessary to support diagnosis and management, including basic sciences. At the end of the course, all students should be able to differentiate normal from abnormal locomotor symptoms in a patient, determine the relevant investigations and interpret the results, formulate a limited differential diagnosis, recognise the impact of the problem on the individual patient, and make an appropriate management plan. CONCLUSIONS: The recommendations set global standards for the minimum level of competence in managing patients with musculoskeletal problems. They define what all doctors should know when graduating from medical school, regardless of further specialisation. They are intended to form the basis of a curriculum for a musculoskeletal course and can be adapted for any medical school in any country throughout the world.

Clinical Competence↗
PubMed2026

The musculoskeletal pain literacy questionnaire (MSK-PLq) - Part 1: Development of a preliminary version through a systematic review and Delphi consensus.

OBJECTIVE: Chronic musculoskeletal (MSK) pain is a leading cause of disability worldwide, and self-management is a first-line approach recommended by international clinical guidelines. Access to evidence-based information that enhances health literacy may support patients' engagement in their self-management and treatment decision-making, potentially reducing disease burden and pain. However, no tool currently exists to assess health literacy specifically in MSK pain. This study aimed to develop and describe the preliminary version of a knowledge-based questionnaire to evaluate MSK pain literacy, the Musculoskeletal Pain-Literacy questionnaire (MSK-PLq). METHODS: A systematic literature review identified existing health literacy instruments and generated a preliminary list of domains. A two-round Delphi study with 22 panellists (19 experts and three people living with chronic MSK pain), followed by consensus meetings, was used to refine domains and items (≥70% agreement). Readability was assessed using the Flesch Reading Ease (FRE) score and three stakeholders were consulted to review the questionnaire for comprehensibility, clarity, and face validity. RESULTS: Six domains were retained (Understand, Access, Appraise, Apply, Digital, Beliefs), comprising 20 items in the preliminary version of MSK-PLq. Readability was acceptable (mean FRE 74, indicating fairly easy reading), and subject feedback supported the questionnaire's clarity and face validity. CONCLUSIONS: The preliminary version of the MSK-PLq is proposed as the first knowledge-based tool to assess functional, interactive, and critical aspects of MSK pain literacy. It may have applications in clinical practice, research, education, and digital health, by informing tailored patient education and supporting self-management strategies, although further psychometric validation is required.

Humans↗
PubMed1999

The experience of pain from the shoulder-neck area related to the total body pain, self-experienced health and mental distress. The Malmö Shoulder-Neck Study group.

The present paper presents the relationship between the total body-pain (TBP) score, defined as the total number of areas shaded on a pain drawing, and the pain from one area, the Shoulder-Neck (SN), among subjects in or out of full-time gainful work respectively. Furthermore, relationships between pain-score, self-experienced health (SEH) and level of mental distress, measured with the General Health Questionnaire (GHQ) were investigated. The analyses is based on a general population sample of 8,116 men and women, 45-60 years of age, completing a questionnaire in the Malmö Shoulder Neck Study. The TBP-score was higher with increasing pain from the SN area, being out of full-time work and among women. Independently of working status, the SEH decreased with increasing pain in the SN area, which was enhanced, by increasing TBP-score. The proportion of women out of full-time gainful work was twice as high as for men. Women showed the same SEH levels with regard to their pain status, independently of their working status while men working full-time scored higher than women did. Oppositely, men out of full-time work had the lowest SEH in relation to their pain status. The GHQ scores of mental distress varied essentially in the same way as the SEH did. The results emphasize the need for an assessment of the number of pain locations and which one that first gave symptoms when studying possible causal relationships between low force musculoskeletal load and development of localized pain. If such data are not collected in epidemiological studies on causes for musculoskeletal pain it will at best lead to unnoticed effect modifications. At worst a potential confounding situation may occur. The relationship between the self-experienced health, mental distress and chronic pain identifies chronic pain as a major public-health problem and suggests a multidisciplinary approach in the treatment and rehabilitation already before work capacity is lost.

Adaptation, Psychological↗
PubMed2005

Musculoskeletal modeling and dynamic simulation of the thoroughbred equine forelimb during stance phase of the gallop.

Because thoroughbred racehorses have a high incidence of forelimb musculoskeletal injuries, a model was desired to screen potential risk factors for injuries. This paper describes the development of a musculoskeletal model of the thoroughbred forelimb and a dynamic simulation of the motion of the distal segments during the stance phase of high-speed (18 m/s) gallop. The musculoskeletal model is comprised of segment, joint, muscle-tendon, and ligament information. The dynamic simulation incorporates a proximal forward-driving force, a distal ground reaction force model, muscle activations, and initial positions and velocities. A simulation of the gallop after transection of an accessory ligament demonstrated increased soft tissue strains in the remaining support structures of the distal forelimb. These data were consistent with those previously reported from in vitro experimental data and supported usefulness of the model for the study of distal forelimb soft tissue mechanics during the stance phase of the gallop.

Animals↗
PubMed1999

Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements.

BACKGROUND: The present study was performed to determine whether there is a difference, with regard to functional outcome and quality of life, between endoprosthetic replacement and rotationplasty for the treatment of malignant tumors of the distal part of the femur or the proximal part of the tibia. METHODS: Sixty-seven patients, between the ages of eleven and twenty-four years at the time of the diagnosis, had a malignant tumor of the distal part of the femur or the proximal part of the tibia. A rotationplasty was performed in thirty-three patients, and an endoprosthetic replacement was done in thirty-four patients. The median duration of follow-up was six years and one month (range, two years to sixteen years and two months). The scale developed by the Musculoskeletal Tumor Society was used to evaluate the functional results. Quality-of-life issues were assessed with the questionnaire developed by the European Organization for Research and Treatment of Cancer. RESULTS: The patients who had had a rotationplasty had a mean functional score, according to the system of the Musculoskeletal Tumor Society, of 24 points, and the patients who had had an endoprosthetic replacement had a mean score of 25 points. This difference was not found to be significant, with the numbers available (p = 0.47). Only one patient who had had a rotationplasty used an assistive device when walking long distances, whereas six patients who had had an endoprosthetic replacement used an assistive device. This difference was significant (p<0.001). The quality-of-life questionnaire revealed that the patients who had had a rotationplasty could participate in hobbies such as carpentry and sports as well as in other daily activities to a significantly greater degree than those who had had an endoprosthetic replacement (p = 0.001). Restriction in daily activities due to pain was significantly less common in the group that had had a rotationplasty than it was in the group that had had an endoprosthetic replacement (p = 0.047). CONCLUSIONS: Rotationplasty was not associated with any disadvantages with regard to function or quality of life in comparison with endoprosthetic replacement. It is possible that the psychosocial outcome is influenced by the fact that patients who have a rotationplasty know that additional operative intervention is not usually necessary. Despite good functional and quality-of-life results, the cosmetic appearance may be the most serious disadvantage of rotationplasty. The decision to perform this procedure must be made on a case-by-case basis.

Adolescent↗
PubMed2004

Patient factors associated with duration of certified sickness absence and transition to long-term incapacity.

BACKGROUND: Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM: To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING: Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN: Prospective data collection and audit of sickness certificate details. METHOD: GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS: Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis changed during a sickness episode. Risk factors for longer-term incapacity included increasing age, social deprivation, mild and severe mental disorder, neoplasm, and congenital illness. For mild mental disorder claimants, age, addiction, and deprivation were risk factors for relatively longer incapacity. For musculoskeletal problems, the development of chronic incapacity was significantly related to the nature of the problem. Back pain claimants were likely to return to work sooner than those with other musculoskeletal problems. CONCLUSIONS: In addition to the presenting diagnosis, a range of factors is associated with the development of chronic incapacity for work, including age and social deprivation. GPs should consider these when negotiating sickness certification with patients.

Acute Disease↗
PubMed2002

Central hyperexcitability in chronic musculoskeletal pain: a conceptual breakthrough with multiple clinical implications.

Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

Animals↗
PubMed2006

A study of the effects of isokinetic pre-employment physical capability screening in the reduction of musculoskeletal disorders in a labor intensive work environment.

OBJECTIVES: This study investigated the effects of pre-employment physical ability screening using isokinetic dynamometry in injury development, specific to musculoskeletal disorders (MSDs) of the knees, shoulders and back among workers in physically demanding jobs. METHODS: New hires (n=503) from a large US employer's 105 industrial yards were screened to match the physical demands of their prospective jobs and tracked for up to 33 months. Results were compared to a control group of 1423 workers. RESULTS: There were significant reductions in the frequency and severity of musculoskeletal disorder injuries in the screened employee population. Non-screened applicants were 2.38 times more likely to experience a MSD-related overexertion injury specific to the knees, shoulders and back than screened hires (OR=2.3759; p=0.0001), and incurred 4.33 times higher cost of claims (p=0.0003). Covariates of age, pay type, race and job classification were markedly different between screened and unscreened hires. Among the screened cohort, only the more physically demanding job classifications were significant with field material handlers 7.1 times more likely to experience a non-MSD than less physically demanding workers (OR=7.1036; p=0.0063). CONCLUSIONS: Objective isokinetic pre-employment screening may significantly reduce injuries in physically demanding jobs. Employees having been effectively matched to the physical demands of their jobs may be at significantly lesser risk of injury and disability from both musculoskeletal and non-musculoskeletal disorders.

Adult↗
PubMed1996

Roles of kringle domain-containing serine proteases in epithelial-mesenchymal transitions during embryonic development.

Transformation of an epithelial sheet into a migrating mesenchymal cell population implies the destruction of the basal lamina underlying the epithelium, and the subsequent localized digestion of the extracellular matrix by the migrating cells. Proteases are involved in these processes. Among them, molecules containing both a serine protease domain and at least one kringle domain have been identified as possible important effectors. Interestingly, related proteins containing an inactive serine protease domain also seem to play a role, suggesting that the function of these molecules in epithelial-mesenchymal transformation is not confined to proteolytic digestion of cell attachments. Instead, these molecules act through specific tyrosine kinase receptors in the membrane of the responding cells. In this review, we summarize data implicating this family of molecules in various epithelial-mesenchymal transitions during embryonic development. Our major focus of attention are: hepatocyte growth factor/scatter factor (HGF/SF), its tyrosine kinase receptor proto-oncogene c-met, and the related peptide factor HGF-like/macrophage-stimulating protein (HGF1/MSP), whose receptor is the Ron tyrosine kinase. c-met and Ron also have another close homolog in the chick, called Sea, whose ligand remains unknown. Interestingly, HGF/SF is activated by other plasminogen-related molecules which, apart from a specific activator, include the protease urokinase. HGF/SF, c-met and HGF/MSP are expressed in dynamic ways during early embryonic development, correlating with regions undergoing epithelial/mesenchymal transformations. Moreover, several assays are now starting to reveal great pleiotropism of function during development, including both the loss and the acquisition of epithelial morphology according to the cell type and assay used, as well as angiogenesis, kidney tubule morphogenesis, cell motility, the maintenance of competence for neural induction and some aspects of the later development of the musculoskeletal and nervous systems.

Animals↗
PubMed1997

Work organization is significantly associated with upper extremities musculoskeletal disorders among employees engaged in interactive computer-telephone tasks of an international bank subsidiary in São Paulo, Brazil.

This study was designed to verify the risk factors for developing upper extremities musculoskeletal disorders (UEMD) among workers engaged in customer service tasks performed by telephone at a private banking corporation in São Paulo, Brazil. The monthly incidence of UEMD in hands and/or wrists in this group was studied retrospectively from January 1993 to June 1995. The statistical analysis was done by using multiple linear regression with the monthly incidence of UEMD considered as dependent variable in models controlled for age, seniority, mean daily regular worktime and overtime per operator, time pressure at work, rest/work schedule, management status, personnel training on postural and muscle stretching, and ergonomic hazards. The variables associated with UEMD were the following: time pressure at work (coefficient = 0.049; p = 0.008) and rest/work schedule (coefficient = -0.047; p = 0.02). The results indicate that working conditions are significantly associated with UEMD, and changes in the working schedule may decrease the incidence of this problem in workers assigned to tasks related to the interactive use of computer-accessible databases during telephone contacts.

Adult↗
PubMed1999

Transient neurological symptoms after spinal anaesthesia with hyperbaric 5% lidocaine or general anaesthesia.

Transient neurotoxicity of concentrated local anaesthetics has been thought to be the main reason for transient neurological symptoms after spinal anaesthesia. Profound musculoligamental relaxation by high doses of local anaesthetics may contribute to the development of postoperative musculoskeletal pain. In order to evaluate the role of the loss of strength of the supportive structures of the spine in the development of transient neurological symptoms, 60 patients (ASA I-II) undergoing minor orthopaedic, varicose vein or inguinal hernia operations were allocated randomly to receive spinal anaesthesia with hyperbaric lidocaine 50 mg ml-1 (85-100 mg) or balanced general anaesthesia with neuromuscular block. Patients were interviewed 24 h later and after 1 week they returned a written questionnaire. Transient neurological symptoms, consisting of pain in the buttocks or pain radiating symmetrically to the lower extremities, occurred in eight patients (27%) receiving spinal anaesthesia and in one patient (3%) receiving general anaesthesia (P < 0.05). We conclude that a transient neurotoxic effect of hyperbaric lidocaine 50 mg ml-1 is probably the main reason for transient neurological symptoms after spinal anaesthesia but musculoligamental relaxation may contribute to the development of low back or leg pain after both anaesthetic techniques.

Adult↗
PubMed2005

Musculoskeletal pain associated with the use of computer systems in Nigeria.

INTRODUCTION: Computer related musculoskeletal disorders affect millions of computer users yearly in developed nations as reported in the literature. With proliferation of computer systems in the developing nations, the associated musculoskeletal pain has yet to be investigated. This serves as impetus for this study. METHODS: A structured questionnaire was used to obtain information from computer users across six federal university campuses in Nigeria. The questionnaire contained two sections of 35 items each. The questions requested the respondents to provide information on age, sex, years of computer usage, hour spent on computer per week, associated musculoskeletal pain, pain severity and knowledge of preventive measures. 1041 questionnaires were analyzed using descriptive statistics. RESULT: Low back pain and neck pain were found to be the highest pain complaint with 74% and 73% respectively. 67% of the respondents complained of wrist pain, followed by finger pain (65%), shoulder pain 63% and general body pain 61%. The knee and foot pains were the least reported complaints with 26% and 25% respectively. In terms of pain severity, low back pain, finger pain, neck pain and shoulder pain are rated to be moderate, while all other joints were said to be of mild pain. DISCUSSION: The results of this study indicated that low back pain, neck pain and upper limbs are the common disorders complaints among the users. The cause of the pain may be attributed to bad ergonomics among the users.

Adult↗
PubMed2003

Disturbance of pro-inflammatory cytokines in post-traumatic psychopathology.

BACKGROUND: Post-traumatic psychopathology (PTP) is important to the orthopaedic surgeon as it may complicate the recovery from musculoskeletal injury. PTP is associated with a disturbance of the hypothalamic-pituitary-adrenal axis, and may lead to impaired healing. We have investigated the relationship between PTP and pro-inflammatory markers of the metabolic response to trauma. MATERIALS AND METHODS: A prospective cohort study of 82 patients with musculoskeletal injuries, correlating development of psychopathology (measured by general health questionnaire) and pro-inflammatory markers (CRP, IL-6, sIL-6r, TNF-alpha) two and six months after their injury. RESULTS: Psychological disturbance was found in 39% of patients at two months and 18% at six months. This disturbance was associated with significantly increased levels of IL-6 at two months and of sIL-6r and TNF-alpha at six months. CRP levels were not related to the development of PTP. CONCLUSIONS: The relationship between PTP and disturbances of pro-inflammatory markers needs further exploration, but may explain in part the impaired functional recovery when musculoskeletal trauma is complicated by psychological disturbance.

Accidents, Traffic↗
PubMed2003

Establishment of tendon-derived cell lines exhibiting pluripotent mesenchymal stem cell-like property.

Development of the musculoskeletal system requires coordinated formation of distinct types of tissues, including bone, cartilage, muscle, and tendon. Compared to muscle, cartilage, and bone, cellular and molecular bases of tendon development have not been well understood due to the lack of tendon cell lines. The purpose of this study was to establish and characterize tendon cell lines. Three clonal tendon cell lines (TT-E4, TT-G11, and TT-D6) were established using transgenic mice harboring a temperature-sensitive mutant of SV40 large T antigen. Proliferation of these cells was significantly enhanced by treatment with bFGF and TGF-beta but not BMP2. Tendon phenotype-related genes such as those encoding scleraxis, Six1, EphA4, COMP, and type I collagen were expressed in these tendon cell clones. In addition to tendon phenotype-related genes, expression of osteopontin and Cbfal was observed. These clonal cell lines formed hard fibrous connective tissue when implanted onto chorioallantoic membrane in ovo. Furthermore, these cells also formed tendon-like tissues when they were implanted into defects made in patella tendon in mice. As these tendon cell lines also produced fibrocartilaginous tissues in tendon defect implantation experiments, mesenchymal stem cell properties were examined. Interestingly, these cells expressed genes related to osteogenic, chondrogenic, and adipogenic lineages at low levels when examined by RT-PCR. TT-G11 and TT-E4 cells differentiated into either osteoblasts or adipocytes, respectively, when they were cultured in cognate differentiation medium. These observations indicated that the established tendon cell line possesses mesenchymal stem cell-like properties, suggesting the existence of mesenchymal stem cell in tendon tissue.

Adipocytes↗
PubMed2004

Preventing disability from occupational musculoskeletal injuries in an urban, acute and tertiary care hospital: results from a prevention and early active return-to-work safely program.

OBJECTIVE: Healthcare workers are at high risk for musculoskeletal injuries. A program was developed to decrease the incidence of musculoskeletal injuries and the duration of associated time loss. METHODS: A program combining primary prevention and on-site early intervention was implemented at a large, urban hospital. Incidence rates were compared using Poisson regression. Cox regression was used to analyze the time to return to regular duties. RESULTS: Although there was no reduction in incidence, the program was effective in returning injured employees to work more promptly for registered nurses and health science professionals (therapists, technicians), although not for facility support staff. CONCLUSIONS: Overall savings in time loss and compensation payments were realized. However, better integration of prevention and follow-up efforts are needed, and greater attention to the sociopolitical environment is required to improve outcomes for facility support staff.

Absenteeism↗