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PubMed2007

Developing the stage of change approach for the reduction of work-related musculoskeletal disorders.

Musculoskeletal disorders remain the most prevalent form of occupational ill health, prompting examination of why attempts to manage the problem have been less successful than perhaps hoped. With a view to improving the efficacy of such interventions, this study examined the applicability of the stage of change approach to the workplace. Tools were developed to assess individual and organizational stage of change towards reducing the risks of musculoskeletal disorders. The tools were tested in a range of occupational sectors, and demonstrated high levels of validity and reliability. Implications for the application of the model in the workplace for improving intervention effectiveness are discussed.

Behavioral Medicine↗
PubMed2002

Evaluation of an upper extremity student-role functioning scale using item response theory.

Millions of workers suffer from upper extremity (musculoskeletal) disorders. Many of these workers are predisposed to upper extremity musculoskeletal disorders because of early exposure to ergonomic risks as students. Computer usage for four or more hours remains the greatest risk for upper extremity musculoskeletal disorders for workers and students alike. Developing preventative methods to reduce student exposure, and thus protect future workers from upper extremity musculoskeletal disorders later in life, requires an appropriate measure for upper extremity musculoskeletal disorder prevalence and related limitations for student functioning. Item response theory analysis was used to evaluate and further develop a upper extremity functioning scale for the student role.

Adult↗
PubMed1998

Smoking and musculoskeletal disorders in the metal industry: a prospective study.

OBJECTIVES: To obtain longitudinal information of the relation between smoking and musculoskeletal disorders in an industrial setting. METHODS: The associations of lifetime tobacco exposure (pack-years), current smoking status, and stopping smoking with back and limb disorders were studied in a cohort of white collar and blue collar employees in a metal industry. Measurements were made three times at 5 year intervals. Two thirds of an initial sample of 902 took part in both re-examinations. Musculoskeletal morbidity was measured as the abundance of symptoms during the past year and as clinical findings assessed by a physiotherapist (upper decile score/score difference = index category). Logistic regression and a generalised estimating equation were used, allowing for sociodemographic variables, physical workload, body mass index, exercise activity, and mental distress. RESULTS: By comparison with never smokers, exposure of 10-< 20 pack-years, the odds ratio (OR) (95% confidence interval (95% CI) of the 10 year change in neck-shoulder symptoms was 3.1 (1.4 to 6.8), in low back symptoms 2.4 (1.1 to 5.1), in upper limb symptoms 1.9 (NS), and in lower limb symptoms 3.4 (1.5 to 7.8). The highest exposure category of > or = 20 pack-years was associated with the change in upper limb findings 2.9 (1.4 to 6.2) and lower limb findings 2.9 (1.2 to 7.2). Those who continued to smoke through the follow up period had a higher increase in clinical findings 2.5 (1.1 to 5.9) than never smokers. There was a dose-response in the association of smoking intensity with future musculoskeletal symptoms. Also, those who stopped smoking during the follow up had a higher increase in symptoms 4.4 (2.0 to 9.9) and findings 3.5 (1.4 to 8.8) than never smokers. CONCLUSION: Smoking seems to predict the development in the occurrence of musculoskeletal symptoms and signs. Stopping smoking is associated with high morbidity.

Adult↗
PubMed2002

Drugs in development: bisphosphonates and metalloproteinase inhibitors.

The destruction of bone and cartilage is characteristic of the progression of musculoskeletal diseases. The present review discusses the developments made with two different classes of drugs, the bisphosphonates and matrix metalloproteinase inhibitors. Bisphosphonates have proven to be an effective and safe treatment for the prevention of bone loss, especially in osteoporotic disease, and may have a role in the treatment of arthritic diseases. The development of matrix metalloproteinase inhibitors and their role as potential therapies are also discussed, especially in the light of the disappointing human trials data so far published.

Animals↗
PubMed1999

Reproducibility of a self-report questionnaire for upper extremity musculoskeletal disorder risk factors.

A self-report questionnaire was developed to evaluate the potential for assessment of possible risk factors for musculoskeletal disorders. Visual-analog and categorical scales were designed to represent responses relating to primary work as well as a second job and hobbies or non-work activities. 71 tree nursery workers completed the scales twice in consecutive weeks. Agreement between means of the two questionnaire administrations was 0.80 or higher for all scales. Intraclass correlation coefficients ranged between 0.59 and 0.69 for the primary job hand/wrist responses and between 0.49 and 0.82 for non-work/hobby neck and upper arm scales. These results show potential for future application of similar scales in industry or temporary and seasonal work to evaluate exposure to upper extremity risk factors.

Adult↗
PubMed1999

Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness.

BACKGROUND: A short questionnaire on functional status was designed for use in community-based outcome studies and in the management of individual patients who have musculoskeletal disease. As most musculoskeletal care is delivered in community practices, short, validated instruments are necessary to perform clinical studies on the effectiveness of treatment in this setting. METHODS: A forty-six-item questionnaire was created as an extension of the work to develop the longer, 101-item Musculoskeletal Function Assessment (MFA) questionnaire. The Short Musculoskeletal Function Assessment (SMFA) questionnaire consists of the dysfunction index, which has thirty-four items for the assessment of patient function, and the bother index, which has twelve items for the assessment of how much patients are bothered by functional problems. The SMFA questionnaire was evaluated for reliability, validity, and responsiveness in a population of 420 patients who had a musculoskeletal disease or injury. RESULTS: The SMFA questionnaire demonstrated excellent internal consistency and stability, with most values greater than 0.90. Content validity for the dysfunction and bother indexes was supported with very little skew (less than 1.00), few ceiling effects (less than 5 percent), and no floor effects. Convergent validity was supported with significant correlations between the SMFA dysfunction and bother indexes and the physicians' ratings of patient function (for example, activities of daily living, recreational and leisure activities, and emotional function [rho > or = 0.40]) and standard clinical measures (for example, grip strength and walking speed [r > or = 0.401). Convergent and discriminant construct validity of the SMFA indexes were demonstrated (p < 0.01) in comparisons with clinical, demographic, Short Form-36 (SF-36), and life-change data. The responsiveness of the SMFA questionnaire to change over time was demonstrated with standardized response means ranging from moderate (0.76) to large (-1.14) for patients who had changes in health status. CONCLUSIONS: The SMFA questionnaire may be used for clinical assessments of the impact of treatment in groups of patients who have musculoskeletal disease or injury. It also may be used in clinical settings to provide reliable and valid assessments of the health status of an individual patient.

Adolescent↗
PubMed1997

The scientific basis for making guidelines and standards to prevent work-related musculoskeletal disorders.

Regulations concerning the work environment, tools, and the performance of work are at their best based on scientific evidence. Existing European directives, European and North American standards, and recent guidelines with the potential to prevent musculoskeletal disorders, are either qualitative or semiquantitative. The exception is the NIOSH lifting guide, which is highly quantitative. Of the European directives and standards, few have been developed with the primary goal of preventing musculoskeletal disorders, whereas one North American standard and another suggestion for a standard have this specific aim. In a review of epidemiological studies on low-back, neck, shoulder, and upper extremity disorders, several physical load factors were identified as risk factors for the disorders. Many of these factors have been repeatedly identified, and for different types of outcomes of an anatomical area (e.g. pain, disc herniation, disc degeneration of the low-back or neck). However, quantitative exposure-response relationships between physical load factors and disorders based on field studies are largely unknown. Experimental studies have provided a multitude of potentially useful data. It is concluded that both well-designed epidemiological studies with quantitative assessments of physical work load and valid measurements of musculoskeletal disorders, and experimental studies are needed for the future development of regulation. To determine the role of experimental studies in regulation, it should be known to what extent fatigue and other short-term responses are precursors of disorders. Regulation should be directed especially towards factors that are likely to be causative for musculoskeletal disorders. Examples of such factors are sudden overload in manual handling activities, heavy physical work involving manual handling tasks, and vibration from tools. Guidelines that are acceptable and feasible can and should be developed. The effects of such guidelines on the occurrence of musculoskeletal disorders should be investigated.

Ergonomics↗
PubMed2000

The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb.

OBJECTIVES: Following a consensus statement from a multidisciplinary UK workshop, a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb. The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting. METHOD: 43 consecutive referrals to a soft tissue rheumatism clinic (group 1) and 45 subjects with one of a list of specific upper limb disorders (including shoulder capsulitis, rotator cuff tendinitis, lateral epicondylitis and tenosynovitis) (group 2), were recruited from hospital rheumatology and orthopaedic outpatient clinics. All 88 subjects were examined by a research nurse (blinded to diagnosis), and everyone from group 1 was independently examined by a rheumatologist. Between observer agreement was assessed among subjects from group 1 by calculating Cohen's kappa for dichotomous physical signs, and mean differences with limits of agreement for measured ranges of joint movement. To assess the validity of the examination, a pre-defined algorithm was applied to the nurse's examination findings in patients from both groups, and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic's independent diagnosis as the reference standard. RESULTS: The between observer repeatability of physical signs varied from good to excellent, with kappa coefficients of 0.66 to 1.00 for most categorical observations, and mean absolute differences of 1.4 degrees -11.9 degrees for measurements of shoulder movement. The sensitivity of the schedule in comparison with the reference standard varied between diagnoses from 58%-100%, while the specificities ranged from 84%-100%. The nurse and the clinic physician generally agreed in their diagnoses, but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis, whereas the clinic physician did not. CONCLUSION: The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting. Examination can feasibly be delegated to a trained nurse, and the protocol has the benefit of face and construct validity as well as consensus backing. Its performance in the community, where disease is less clear cut, merits separate evaluation, and further refinement is needed to discriminate between discrete pathologies at the shoulder.

Adult↗
PubMed1999

Teaching a screening musculoskeletal examination: a randomized, controlled trial of different instructional methods.

PURPOSE: To develop and test a program to teach a rapid screening musculoskeletal examination. METHOD: In 1995, 191 medical and physician assistant students were randomized to four intervention groups: written materials only (n = 47), written materials and videotape (n = 46), written materials and small-group sessions facilitated by fourth-year medical students (n = 55), and all three methods (n = 43). Assessments, in the form of a written test and standardized patient examinations, were conducted before the interventions (n = 40 randomly selected students), seven to ten days and again three months after the interventions (n = all 191 students), and 16 months after the interventions (n = 103 students). RESULTS: While the four intervention groups' written test scores were approximately equal, their scores on the standardized patient examination differed significantly. The students taught in small groups demonstrated significantly superior examination skills compared with the students taught with written material or videotape at seven to ten days and retained this relative superiority after three and 16 months (p < .0001). CONCLUSION: Small-group instruction with hands-on supervised practice is superior to more passive instructional methods for teaching musculoskeletal examination skills and can be successfully delivered by trained senior medical student facilitators with minimal direct expenditure of faculty time.

Analysis of Variance↗
PubMed2005

Consumer-driven health care: building partnerships in research.

Over the past four decades, there has been a widespread movement to increase the involvement of patients and the public in health care. Strategies to effectively foster consumer participation are occurring within all research activities from research priority setting to utilization. One of the ten principles of the Cochrane Collaboration is to 'enable wide participation', and this includes consumers. The Cochrane Musculoskeletal Group (CMSG) is a review group of 50 within the Collaboration that has been working to increase consumer participation since its inception in 1993. Based in Canada, the CMSG has embraced the concept of knowledge translation as advocated by the Canadian Institutes of Health Research. The emphasis in knowledge translation is on interactions or partnerships between researchers and users to facilitate the use of relevant research in decision making. While the CMSG recognizes the importance of reaching all users, much of its work has focused on developing relationships with people with musculoskeletal diseases to enhance consumer participation in research. The CMSG has built a network of consumer members who guide research priorities, peer review systematic reviews and also promote and facilitate consumer-appropriate knowledge dissemination. Consumers were recruited through links with other arthritis organizations and the recruitment continues. Specific roles were established for the consumer team and responsibilities of the CMSG staff developed. The continuing development of a diversified team of consumer participants enables the CMSG to produce and promote access to high quality relevant systematic reviews and summaries of those reviews to the consumer.

Biomedical Research↗
PubMed2003

Technology use and psychosocial factors in the self-reporting of musculoskeletal disorder symptoms in call center workers.

PROBLEM: Evidence exists to suggest that working with computer terminals and keyboards is associated with the development and exacerbation of a range of musculoskeletal disorders (MSDs). Research has suggested that psychosocial factors may be of more importance than computer use factors in the development of MSDs in the computing workplace. METHOD: A questionnaire-based study was undertaken to test this hypothesis in a sample of 67 call center workers. A Spearman's rho was performed on the data, as well as chi(2) tests on the individual variables. RESULTS: It was found that overall, computer use factors were significantly associated with self-reporting of MSD symptoms, whereas psychosocial factors had no such association. However, certain individual psychosocial factors emerged as having a significant association with MSD symptoms. DISCUSSION: The findings suggest that specific areas of call center work have associations with poor worker health and possible long-term MSD problems. These areas appear to be workload and particular management-worker relations, rather than computer use. SUMMARY: This suggests that the relationship among computer use, psychosocial factors, and MSD is a complex area that would benefit from more research. IMPACT ON INDUSTRY: This study raises issues about the importance of psychosocial and organizational factors and employee welfare in the call center working environment.

Adult↗
PubMed2000

[Musculoskeletal tissue engineering with resorbable polymers].

Musculoskeletal tissues can present congenital or acquired defects as a result of disease, accidental trauma or iatrogenous causes. This loss of bony substance is traditionally treated by the replacement of bony tissue (grafts or flaps), or by synthetic materials. Each of these methods of treatment, however, entails its specific disadvantages, limitations and complications. The recent approach for treatment of musculoskeletal defects has been the development of the growing of neotissues derived from autogenous cells, and artificial biodegradable matrixes. This method assumed the name "tissue engineering" in the late 1980s. Tissue Engineering, or TE, has employed advances made in the area of cellular culture, intercellular matrix biology, and also, in the area of biomaterial science. TE is an multi-disciplinary approach. Musculoskeletal TE, although in its preliminary stages, should allow access to treatments of the future.

Biocompatible Materials↗
PubMed1994

Asplenia syndrome: insight into embryology through an analysis of cardiac and extracardiac anomalies.

Asplenia syndrome is characterized by complex congenital heart defects, asplenia and abdominal heterotaxy. Recent interest in the syndrome has been increased by new knowledge arising from animal models and by continuing improvements in surgical outcome in childhood. To further elucidate the embryologic timing and mechanisms of the asplenia syndrome, 32 necropsy cases were reviewed and 487 published autopsy cases were reanalyzed at the hospital. The most common congenital heart defects were atrial septal defects, common atrioventricular canals and conotruncal anomalies. With use of current information on the timing of normal development, it was hypothesized that most defects originate at Streeter Horizon XIII; patients averaged 3.2 Horizon XIII defects, more than at any other stage. Distribution was unimodal. Extracardiac anomalies also exhibited a developmental spectrum. Because the normal spleen develops by Horizon XIII, asplenia, the sine qua non of the syndrome, originates then or earlier. Abnormal pulmonary lobation occurred in 80% of cases, with right isomerism occurring most often; pulmonary branching asymmetry also originates at or before Horizon XIII. Abdominal heterotaxy occurred in 72% of cases, but the timing of origin is unclear. Anomalies of other systems, including genitourinary, musculoskeletal, endocrine, and nervous systems, develop later (typically XV to XXIII); specific anomalies were less frequent, although much more prevalent than in the general population. It is concluded that asplenia syndrome is a focal developmental disturbance in laterality which occurs primarily at Horizon XIII.

Abnormalities, Multiple↗
PubMed2002

Work is a risk factor for adolescent musculoskeletal pain.

The study objectives were to determine the incidence of musculoskeletal pain in a cohort of adolescents and whether work is a risk factor for its development. 502 students in the seventh to ninth grades responded to a questionnaire at three times over a 12-month period, addressing musculoskeletal health and lifestyle factors. Annual incidence of musculoskeletal pain was 38%. Adolescents who worked developed pain more than those who did not work (adjusted odds ratio (OR): 1.62, 95% confidence interval (CI): 0.96, 2.76). Those who worked in white-collar jobs were at a higher risk of developing pain than those in blue-collar jobs or childcare. The conclusion that work is associated with musculoskeletal pain development in adolescents implies that implementation of prevention strategies in the workplace should include adolescents who work.

Adolescent↗
PubMed1993

Modelling the population health impact of musculoskeletal diseases: arthritis.

OBJECTIVE: A model adjusting for reductions in quality and quantity of life was developed to estimate the population health impact of musculoskeletal diseases. METHODS: Using arthritis as the prototype, prevalence, mortality, and severity data from a variety of sources were combined to model a hypothetical cohort of 1,000 individuals through life. Quality adjusted life years and population health expectancy were calculated for those with arthritis and compared to the general population. RESULTS: Without adjusting for quality of life, a cohort of 1,000 women and 1,000 men at age 15 years could expect 65,010 and 58,735 life years, respectively. Adjusting for quality of life, women with arthritis could expect 61,719 life years, and men 57,123 life years. The unadjusted population health expectancy was 65.0 for girls and 58.7 for boys (at age 15 years). Adjusting for quality of life, the population health expectancies were 61.7 and 57.1, years for women and men, respectively. CONCLUSION: Using this model, the typical adult woman with arthritis can expect to lose 3.3 healthy years of life, and a man, 1.6 healthy years of life. Overall, the model provided a general methodology for determining the population health impact of musculoskeletal diseases. In addition, it is hoped that the methodology will stimulate further research into this area, raise awareness about the uses and limitations of currently available data, and provide a useful model for monitoring the impact of interventions.

Adolescent↗
PubMed1985

Musculoskeletal applications of three-dimensional surface reconstructions.

We have applied computer programs originally developed for craniofacial surgical planning and evaluation to complex musculoskeletal problems. These computer programs reformat ordinary CT scans into black and white images of the three-dimensional osseous surfaces found in the scanned volume. These reformatted three-dimensional CT scan images increase the utility of CT scan examinations of complex osseous structures, such as the wrist, spine, hip, knee, and shoulder. The software, which operates on an unmodified commercially available CT scanner, can produce high-quality surface reconstructions from CT scan slices without operator intervention. No special knowledge of the principles used in the reconstruction methods is needed to successfully use the programs.

Adolescent↗
PubMed1993

A method for continuous monitoring of the ground reaction force during daily activity.

Theoretical models and experimental studies of bone remodeling have identified peak cyclic force levels (or cyclic tissue strain energy density), number of daily loading cycles, and load (strain) rate as possible contributors to the bone modeling and remodeling stimulus. To test our theoretical model and further investigate the influence of mechanical forces on bone density, we have focused on the calcaneus as a model site loaded by calcaneal surface tractions which are predominantly determined by the magnitude of the external ground reaction force (GRF). During daily activity the body is subjected to a random external loading history supplied primarily by the GRF consisting of body weight (BW) plus inertial forces (related to intensity of activity) accelerating the body center of mass. We have hypothesized that monitoring the vertical component of the GRF (GRFz) may provide a useful method of quantifying activity level in order to investigate the influence of mechanical forces on muscle and bone. GRF loading histories among individuals are known to vary greatly in peak force levels and daily cycles and we suggest these differences may be reflected in differences in lower limb musculoskeletal properties. We report here development of instrumentation to monitor the vertical component of the ground reaction force during normal daily activity.

Biomechanical Phenomena↗
PubMed2005

Bone-targeting macromolecular therapeutics.

Musculoskeletal diseases such as osteoporosis are recognized as major public health problems worldwide. Many novel therapeutic agents have been identified for the treatment of these diseases. However, the majority of them are not specific to hard tissue, resulting significant toxicity. Bone-targeting drug delivery systems based on water-soluble polymers can specifically direct candidate drugs to bone thereby reducing side effects due to non-specific tissue interactions. Incorporation of a targeting moiety, a drug release mechanism, drug selection and optimization of the polymer carrier are all essential elements in the development of bone-targeting macromolecular therapeutics. Successful clinical application of this approach can significantly contribute to the development of treatments for many musculoskeletal diseases.

Animals↗