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PubMed2003

The effects of job rotation on the risk of reporting low back pain.

Job rotation has been widely recommended as an administrative control to reduce the risk of developing work-related musculoskeletal disorders. However, evidence of its benefits are hard to find in the literature. The effect of job rotation on predictions for the risk of reporting low back pain was estimated using Low Back Pain Reporting (LBPR) and Time Weighted Average (TWA) approaches. Index scores calculated using the peak hand force, the peak L4/L5 shear force and the L4/L5 moment cumulated over the entire shift were used to estimate the effects of job rotation on the probability of reporting low back pain. Simulations of realistic rotations between two jobs showed that workers in low demand jobs who rotate into higher demand jobs experience a linear increase in reporting probability using the TWA approach. With the LBPR approach a step increase in reporting probability occurred because of the immediate exposure to the peak loading parameters associated with the more demanding job. With a 50-50 rotation the TWA and LBPR index scores increased by 39% and 57%, respectively. With the LBPR approach the redistribution of risk was not uniform with job rotation. The increase was greater for those who rotated into the demanding job compared to the reduction experienced by those who rotated out of the demanding job. The effects of job rotation are not easily estimated because of the complex effect that mixing jobs has on peak and cumulative tissue loading.

Adult↗
PubMed2003

Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review.

OBJECTIVE: To review randomized controlled trials evaluating the effectiveness of therapeutic exercise and orthopedic manual therapy for the treatment of impingement syndrome. DATA SOURCE: Reports up to October 2002 were located from MEDLINE, the Cochrane Database of Systematic Reviews, the Physiotherapy Evidence Database (PEDro), the TRIP database, and the Cumulative Index to Nursing & Allied Health Literature (CINAHL) using "shoulder" and "clinical trial"/"randomized controlled trial" as search terms. STUDY SELECTION: Studies were included if (1) they were a randomized controlled trial; (2) they were related to impingement syndrome, rotator cuff tendinitis, or bursitis; (3) one of the treatments included therapeutic exercise or manual therapy. DATA EXTRACTION: Two independent observers reviewed the methodological quality of the studies using an assessment tool developed by the Cochrane Musculoskeletal Injuries Group. Differences were resolved by consensus. DATA SYNTHESIS: Seven trials met our inclusion criteria. After consensus, the mean methodological score for all studies was 13.9 +/- 2.4 (of 24). Four studies of 7, including the 3 trials with the best methodological score (67%), suggested some benefit of therapeutic exercise or manual therapy compared with other treatments such as acromioplasty, placebo, or no intervention. CONCLUSIONS: There is limited evidence to support the efficacy of therapeutic exercise and manual therapy to treat impingement syndrome. More methodologically sound studies are needed to further evaluate these interventions.

Exercise Therapy↗
PubMed2006

The effects of periodontal instrument handle design on hand muscle load and pinch force.

BACKGROUND: In comparison with people in other occupations, dentists and dental hygienists are at increased risk of developing work-related musculoskeletal disorders, including carpal tunnel syndrome. An important risk factor in dental practice is forceful pinching, which occurs during dental scaling. Ergonomically designed dental instruments may help reduce the prevalence of MSDs among dental practitioners. METHODS: In the authors' study, 24 dentists and dental hygienists used 10 custom-designed dental scaling instruments with different handle diameters and weights to perform a simulated scaling task. The authors recorded the muscle activity of two extensors and two flexors in the forearm with electromyography, while thumb pinch force was measured by pressure sensors. RESULTS: Handle designs of periodontal instruments had significant (P < .05) effects on hand muscle load and pinch force during a manual scaling task. The instrument with a large diameter (10 millimeters) and a light weight (15 grams) required the least amount of muscle load and pinch force. There was a limit to the effect of handle diameter, with diameters larger than 10 mm having no additional benefit; however, the study did not identify a limit to the effect of reducing the weight of the instrument, and therefore instruments lighter than 15 g may require even less pinch force. CLINICAL IMPLICATIONS: The results from this study can guide dentists and dental hygienists in selection of dental scaling instruments.

Adult↗
PubMed1996

The interaction of wearing multifocal lenses with head posture and pain.

Chronic placement of the head anterior to the body's center of gravity can be a component in the development of neurovascular and musculoskeletal dysfunction. In order to evaluate and treat dysfunction and pain, physical therapists need to be aware of variables that can affect head position. The objectives of this study were to investigate the interaction between wearing multifocal lenses and head posture; to determine the interaction of forward head posture and upper quarter pain; and to determine the intratester reliability of a head posture gauge. Head posture and self-reported pain were collected on 25 randomly chosen multifocal lens wearers between the ages of 40 and 50 and compared with a similar group of nonmultifocal lens wearers. The mean forward head posture in the two groups were significantly different (t = 2.06, one-tailed, p = 0.023). Subjects wearing multifocal lenses had a greater degree of forward head posture when compared with nonmultifocal lens wearers. A one-way analysis of variance was used to compare forward head posture with pain. In this sample, mean forward head posture levels did not differ significantly according to level of pain (p = 0.15). Intratester reliability of the head posture gauge was demonstrated to be high through the use of the intraclass correlation coefficient (ICC = 0.99). Wearing multifocal lenses may influence a person to hold his/her head in a position more forward than the ideal postural alignment.

Adult↗
PubMed1994

Challenges for space medicine.

Since April 1961, when Yuri Gagarin first orbited the earth about 270 astronauts (predominantly males) have lived in space. More than 90 percent of these astronauts were natives of the USA and the ex-USSR. In this commentary, the challenges confronting the discipline of space medicine are reviewed. These include, (1) space sickness, (2) wasting of the musculoskeletal system and (3) developing a longterm life support system.

Aerospace Medicine↗
PubMed1996

Major ablative procedures in orthopaedic surgery.

In the presence of the notable progress in limb-sparing techniques afforded by the developments in microsurgery and musculoskeletal oncology, major ablative surgery of the extremities still remains a last-resort, yet powerful tool in managing patients with primary tumors in whom wide excision is not possible, as well as in cases with severe trauma to the limbs. During the last thirteen years, eight major ablative procedures were performed at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Seven out of the eight procedures were performed in patients with primary malignant tumors either because the anatomical location or multiple recurrences of the tumor did not allow removal by wide local excision or by amputation at a lower level. In one patient, the procedure was related to a severe, mangling trauma. Four illustrative cases of the eight major ablative procedures performed are reported to highlight the current indications of this rarely used, complex, and extensive surgery. The characteristic cases presented are: hemipelvectomy in a patient with chondrosarcoma of the pelvis, disarticulation of the hip in a patient with a malignant histiocytoma of the supracondylar area of the knee, forequarter amputation in a patient with a basal cell carcinoma of the axilla, and disarticulation of the shoulder in a patient with an incomplete nonviable amputation at the level of the shoulder girdle associated with severe damage to the brachial plexus and axillary artery. After a five to over a ten year follow-up, six of the eight patients who where subjected to major ablative procedures are doing well and are satisfactorily active. These cases reflect the dilemma that orthopaedic surgeons geons still face in selecting limb salvage or major ablative surgery in cases of aggressive malignant tumors to severe trauma.

Amputation, Surgical↗
PubMed1997

[Ultrasound fracture diagnosis--an experimental study].

Thanks to the increasing use of ultrasonography in the diagnostic evaluation of the musculoskeletal system, and the development of high-resolution ultrasonic transducers with ever better image quality, as well as the greater general trend towards non-invasive techniques, the use of ultrasonography in the diagnosis and follow-up of fractures would appear to make good sense. The aim of the present experimental study was, therefore, to identify the typical acoustic pattern of fractures and areas of bone impression and defects, while taking account of possible sources of error due to artefacts. Experiments were carried out on cadaver bones immersed in a water bath, using 7.5 and 10 MHz linear transducers. Depending on its size, the bony defect is represented by an interruption of the cortical echo, or a dorsal band of echoes limited to the fracture zone. Of interest is the fact that fractures and bony defects are not represented as such when the transducer is directed parallel to the line of the fracture or the impression area. Particular attention needs to be paid to the numerous artefacts occurring at the margins of the fracture. In summary, it may be noted that using resolution transducers under standardised experimental examination conditions, cortical interruptions of not less than 1 mm can be identified.

Artifacts↗
PubMed2006

The mind does matter: Psychological and physical recovery after musculoskeletal trauma.

BACKGROUND: Posttraumatic psychopathology (PTP) is important to the orthopedic surgeon because it appears to be much more common than might have been suspected and may complicate the recovery from musculoskeletal injury. We have investigated the relationship between physical and psychological recovery in victims of musculoskeletal trauma. METHODS: A prospective cohort of 200 patients with musculoskeletal injuries were studied, correlating development of psychopathology (measured by the General Health Questionnaire) and functional outcome (measured by Short Form-36, Sickness Impact Profile, and Musculoskeletal Function Assessment) 2 and 6 months after their injuries. RESULTS: Pre-existing psychological disturbance was found in 11% of our patients; this figure rose to 46% of patients at 2 months but fell to 22% at 6 months. The posttraumatic disturbance correlated strongly with impaired functional outcome as measured by all three outcomes measures (total and category scores) (p < 0.05). CONCLUSIONS: The strong correlation of PTP with impaired functional outcome after musculoskeletal trauma stresses that it is a significant problem. Further research is required to determine whether an approach that combines physical and psychological treatment can improve patient outcomes.

Adolescent↗
PubMed1999

Musculoskeletal manifestations in a population-based cohort of patients with giant cell arteritis.

OBJECTIVE: To define musculoskeletal manifestations occurring in a population-based cohort of patients with giant cell (temporal) arteritis (GCA). METHODS: The records of 128 patients with GCA diagnosed over a 42-year-period (1950-1991) in Olmsted County, MN, were reviewed for the presence and type of musculoskeletal manifestations, their relationship to the onset and course of GCA, and their response to treatment. RESULTS: Fifty-three patients (41%) developed polymyalgia rheumatica: 23 before, 17 concurrently with, and 13 after the diagnosis of GCA. Thirty patients (23%) developed 1 or more peripheral musculoskeletal manifestations. These included peripheral synovitis in 23 patients (6 of whom fulfilled criteria for rheumatoid arthritis), distal extremity swelling with pitting edema in 13, distal swelling without pitting in 5, tenosynovitis in 6, and carpal tunnel syndrome in 2. Fifty-seven episodes of peripheral manifestations occurred in the 30 patients at different times during the course of GCA. In most, the onset of PMR and peripheral manifestations was within 2 years of the diagnosis of GCA. CONCLUSION: Musculoskeletal symptoms in GCA are common and varied. Most appear linked temporally to the underlying GCA, indicating that the nature of this illness and its clinical expression are broader than often considered.

Aged↗
PubMedDate not supplied

The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America.

The goal of orthopaedic interventions is to improve the functional health of patients, particularly physical function. The American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America (POSNA) commissioned a work group to construct functional health outcomes scales for children and adolescents, focusing on musculoskeletal health. The work group developed scales assessing upper extremity function, transfers and mobility, physical function and sports, comfort (pain free), happiness and satisfaction, and expectations for treatment. Parent and adolescent self-report forms were developed and tested on 470 subjects aged 2-18 years. The POSNA scales demonstrated good reliability, construct validity, sensitivity to change over a 9-month period, and ability to outperform a standard instrument, the Child Health Questionnaire physical functioning scale. They were useful for a wide variety of ages and diagnoses. They appear to be ideally suited for orthopaedic surgeons to assess the functional health and efficacy of treatment of their patients at baseline and follow-up.

Activities of Daily Living↗
PubMed1997

A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine.

STUDY DESIGN: This study developed and independently applied a spine tumor classification system, referred to as the Weinstein-Boriani-Biagini system, in a retrospective analysis of a series of patients with spinal giant cell tumors from three institutions. OBJECTIVE: To evaluate factors of potential prognostic significance for recurrence of spinal giant cell tumors. SUMMARY OF BACKGROUND DATA: No prior reviews of patients treated with modern surgical techniques are available. METHODS: Charts and radiographs for 36 cases of spinal giant cell tumors were reviewed by an independent investigator. All patients had had recent clinical follow-up examinations. All patients were classified according to the Enneking system. A subgroup of 24 patients for whom preoperative computed tomography scans were available were classified using the Weinstein-Boriani-Biagini staging system. Outcome measures included pain, neurologic status, and tumor recurrence. RESULTS: Recurrence rates were substantially higher among patients treated with attempted surgical excision before referral to a tertiary care center (83% vs. 18%). There was a higher recurrence rate for tumors that involved the vertebral body and posterior elements in comparison with lesions residing in only anterior elements (24% vs. 0%). Tumors that had extra-osseous extension into the canal and into the paraspinous musculature had a higher recurrence rate than tumors either confined to the osseous compartment or with extension either into the spinal canal or externally into paraspinous planes, but not both (21% vs. 10%). CONCLUSIONS: These results indicate that the Weinstein-Boriani-Biagini system may prove useful in developing treatment algorithms and in assessing outcome for these rare and difficult lesions. At least in the case of giant cell tumors, the musculoskeletal tumor staging system as developed by Enneking for long bones suggests the ideal surgical margin and may provide information relevant to tumor recurrence rates. Additional aspects of tumor extent and location, however, may berelevant to primary tumor recurrence rates when the selesions occur in the spine.

Adolescent↗
PubMed2003

Derivation and identification of questions that act as predictors of abdominal pain of musculoskeletal origin.

OBJECTIVE: Although most causes of abdominal pain have a visceral origin, the musculoskeletal system must be considered when the cause is not obvious. This prospective study aimed to identify questions that would aid the diagnosis of patients with abdominal pain of musculoskeletal origin. DESIGN: Assessment of consecutive patients with abdominal pain recruited from gastroenterological outpatient clinics to develop diagnostic pointers to identify abdominal pain arising from musculoskeletal disorders. PARTICIPANTS: Subjects with benign abdominal pain, with or without a change in bowel habit, were recruited from gastroenterological clinics. Patients with inflammatory or neoplastic disease were excluded. SETTING: The study was conducted in the Physiotherapy Department, Addenbrooke's NHS Trust Hospital, Cambridge. MAIN OUTCOME MEASURES: A set of questions developed to indicate a musculoskeletal cause of a patient's abdominal symptoms. RESULTS The questions 'Does taking a deep breath aggravate your symptoms?' and 'Does twisting your back aggravate your symptoms?' had a significant positive indication of abdominal symptoms of musculoskeletal origin. The questions 'Has there been any change in bowel habit since onset of your symptoms?', 'Does eating foods aggravate your symptoms?' and 'Has there been any weight change since onset of symptoms?' had a significant negative indication for abdominal symptoms not of musculoskeletal origin. A combination of these questions gave 96% specificity and 67% sensitivity. CONCLUSION: These questions may help with the early identification of patients with abdominal pain of musculoskeletal origin and will be tested in further studies.

Abdominal Pain↗
PubMed2004

The pain disability questionnaire: a new psychometrically sound measure for chronic musculoskeletal disorders.

STUDY DESIGN: The Pain Disability Questionnaire (PDQ) is a psychometric evaluation study of a new measure of functional status. OBJECTIVE: To evaluate the psychometric properties of the PDQ and compare its validity and responsiveness to traditional measures of functional status, such as the Oswestry, Million (MVAS), and SF-36 instruments. SUMMARY OF BACKGROUND DATA: Measuring clinical outcomes is an essential element of any musculoskeletal treatment. The PDQ was developed for this purpose. It yields a total functional disability score ranging from 0 to 150. The focus, much like other health inventories, is primarily on disability and function. However, unlike most other measures, this instrument is designed for the full array of chronic disabling musculoskeletal disorders (CDMDs), rather than low back pain alone. Further, psychosocial variables, which recent studies have shown to play an integral role in the development and maintenance of chronic pain disability, formed an important core of the PDQ. METHODS: Four groups were used in this psychometric evaluation: an asymptomatic normative population (NP; n = 50), an acute musculoskeletal disorder population (AMD; n = 52), a chronic disabled musculoskeletal disorder population (CDMD; n = 230), and a heterogeneous pain population (HP; n = 114). The NP and AMD groups served as comparison samples for the CDMD and HP groups. Analyses of PDQ reliability, validity, and responsiveness were conducted. RESULTS: Test-retest reliability coefficients (ranging from 0.94 to 0.98) and a Cronbach's alpha coefficient of 0.96 for the PDQ were found to be of excellent quality. The responsiveness of the PDQ, as measured by Cohen's effect size statistic, ranged from 0.85 to 1.07, better than the Oswestry, MVAS, and SF-36. A high level of face validity was observed for the PDQ, as the CDMD population exhibited significantly higher pretreatment PDQ scores than a group of patients suffering from acute injuries. The construct-related validity of the PDQ was also found to be of excellent quality, as it correlated well to both the MVAS (0.65-0.81) and Oswestry (0.55-0.80). The PDQ consistently demonstrated stronger correlation coefficients to a wide variety of physical and psychosocial measures of human function, such as the SF-36, Beck Depression Inventory, Hamilton-D, State-Trait Anxiety Scale, and Pain Intensity VAS, than either the Oswestry or MVAS. A factor analysis of the PDQ revealed two factors: a Functional Status Component (FSC) and a Psychosocial Component (PC). Analyses proved each of these two components to be valid in assessing their theorized constructs. CONCLUSIONS: The present study represents a comprehensive psychometric evaluation of a new functional status measure for musculoskeletal conditions in general, and a CDMD population in particular. The psychometric properties of the PDQ are excellent, demonstrating strong reliability, responsiveness, and validity, relative to many other existing measures of functional status. The many weaknesses cited for some of the existing measures were taken into account in designing this instrument. Consequently, the characteristics commonly noted as weaknesses for these other measures (such as a restriction to only the low back pain population, and inconsistent responsiveness) can be cited as strengths of the PDQ. Its generalizability and utility for assessing orthopedic treatment progress and functional outcomes must now be evaluated in broader settings.

Acute Disease↗
PubMed1999

Model-based development of neuroprosthesis for paraplegic patients.

In paraplegic patients with upper motor neuron lesions the signal path from the central nervous system to the muscles is interrupted. Functional electrical stimulation applied to the lower motor neurons can replace the lacking signals. A so-called neuroprosthesis may be used to restore motor function in paraplegic patients on the basis of functional electrical stimulation. However, the control of multiple joints is difficult due to the complexity, nonlinearity, and time-variance of the system involved. Furthermore, effects such as muscle fatigue, spasticity, and limited force in the stimulated muscle further complicate the control task. Mathematical models of the human musculoskeletal system can support the development of neuroprosthesis. In this article a detailed overview of the existing work in the literature is given and two examples developed by the author are presented that give an insight into model-based development of neuroprosthesis for paraplegic patients. It is shown that modelling the musculoskeletal system can provide better understanding of muscular force production and movement coordination principles. Models can also be used to design and test stimulation patterns and feedback control strategies. Additionally, model components can be implemented in a controller to improve control performance. Eventually, the use of musculoskeletal models for neuroprosthesis design may help to avoid internal disturbances such as fatigue and optimize muscular force output. Furthermore, better controller quality can be obtained than in previous empirical approaches. In addition, the number of experimental tests to be performed with human subjects can be reduced. It is concluded that mathematical models play an increasing role in the development of reliable closed-loop controlled, lower extremity neuroprostheses.

Electric Stimulation Therapy↗
PubMed1984

Psychobiology of speech development: coemergence of language and a movement system.

Speech development in the child represents the coemergence of language and a movement system. This paper presents seven basic principles on which a theory of speech development should be formed. Briefly, these principles address developmental changes in musculoskeletal and neural anatomy, continuities in phonetic development, coordination of productive (motor) and perceptual capabilities, rhythmic or cyclic patterning of movement, changing units of phonologic contrast, and interaction of phonetic development with acquisition of a motor skill for speech. These basic principles are in harmony with an autoorganizational theory of language development in which the infant generates, maintains, and transforms patterns of order. Examples of developmental patterns are taken from the literature to illustrate the explanatory value of the autoorganizational theory.

Adult↗
PubMed2005

Effects of negatively sloped keyboard wedges on risk factors for upper extremity work-related musculoskeletal disorders and user performance.

Several changes to computer peripherals have been developed to reduce exposure to identified risk factors for musculoskeletal injury, notably in keyboard designs. Negative keyboard angles and their resulting effects on objective physiological measures, subjective measures and performance have been studied, although few angles have been investigated despite the benefits associated with their use. The objective of this study was to quantify the effects of negative keyboard angles on forearm muscle activity, wrist posture, key strike force, perceived discomfort and performance and to identify a negative keyboard angle or range of keyboard angles that minimizes exposure to risk factors for hand/wrist injuries. Ten experienced typists (four males and six females) participated in a laboratory study to compare keyboard angles ranging from 0 degrees to -30 degrees , at 10 degrees increments, and a keyboard with a 7 degrees slope, using a wedge designed for use with standard QWERTY keyboards. Repeatability of exposures was examined by requiring participants to complete two test sessions 1 week apart. Dependent variable data were collected during 10 min basic data entry tasks. Wrist posture data favoured negative keyboard angles of 0 degrees (horizontal) or greater, compared to a positive keyboard angle of 7 degrees , especially for the flexion/extension direction. In general, the percentage of wrist movements within a neutral zone and the percentages of wrist movements within +/-5 degrees and +/-10 degrees increased as keyboard angle became more negative. Electromyography results were mixed, with some variables supporting negative keyboard angles whilst other results favoured the standard keyboard configuration. Net typing speed supported the -10 degrees keyboard angle, whilst other negative typing angles were comparable, if not better than, with the standard keyboard. Therefore, angles ranging from 0 degrees to -30 degrees in general provide significant reductions in exposure to deviated wrist postures and muscle activity and comparable performance.

Adult↗