Audrey Petit

Prevalence of multisite musculoskeletal symptoms: a French cross-sectional working population-based study

BackgroundThe musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.MethodsThis study was performed on surveillance data of the cross-sectional survey (2002–2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire.ResultsThe study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb).ConclusionsThe frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS.

Psychosocial risk factors, interventions, and comorbidity in patients with non-specific low back pain in primary care: need for comprehensive and patient-centered care

Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients’ or HCPs’ overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.

Effectiveness of three treatment strategies on occupational limitations and quality of life for patients with non-specific chronic low back pain: Is a multidisciplinary approach the key feature to success: study protocol for a randomized controlled trial

BackgroundChronic low back pain (cLBP) is a significant public health problem, being the primary cause of work absenteeism, as well as affecting sufferers’ quality of life, in industrialized society. International guidelines recommend intensive multidisciplinary approaches for patients with cLBP. However, these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements. Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients. It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost. The aim of this study is to compare three programs with various levels of intensity and multidisciplinary.Methods/DesignThis paper describes the protocol for a prospective, randomized, controlled, clinical trial in working aged patients with cLBP. Three treatment strategies are compared: (1) intensive and multidisciplinary program conducted in a rehabilitation center; (2) less intensive outpatient program conducted by a private physiotherapist; (3) mixed strategy combining the same out program with a multidisciplinary intervention. The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program. The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs. The intervention part of the trial programs will take 5 weeks and observational follow-up will take 12 months. The sample size will be 180 participants (60 for each arm). The project has been approved by the Ethical Committee of Angers Hospital, France.DiscussionOn the hypothesis that a multidisciplinary approach is the key feature to programs success in reducing social and occupational impairment in cLBP patients, we suggest that it is possible to achieve the same results with less intensive strategies if a multidisciplinary approach is maintained.Trial registrationCurrent Controlled Trials NCT02030171.

Personal, Biomechanical, Organizational and Psychosocial Risk Factors for Neck Disorders in a Working Population

Personal, Biomechanical, Organizational and Psychosocial Risk Factors for Neck Disorders in a Working Population: Audrey PETIT, et al. LUNAM University, Laboratory of Ergonomics and Epidemiology in Occupational health, (LEEST), University of Angers, Faculty of Medicine, France—

Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta-Analysis.

In view of recent published studies, a meta‐analysis was undertaken on prospective studies in order to assess any association between lateral epicondylitis and physical exposure at work.

Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study.

To examine the incidence and risk factors for incident thoracic spine pain (TSP) in workers representative of a French regions working population.

French good practice guidelines for management of the risk of low back pain among workers exposed to manual material handling: Hierarchical strategy of risk assessment of work situations.

BACKGROUND Manual material handling remains a major cause of occupational accidents and diseases in various sectors and occupations. OBJECTIVE This paper summarizes the main recommendations of the good practice guidelines of the French Society of Occupational Medicine for the risk assessment for back disorders in workers exposed to manual handling of loads. METHODS The guidelines were written by a multidisciplinary working group of 24 experts, according to the Clinical Practice Guidelines method proposed by French National Health Authority, and reviewed by a multidisciplinary peer review committee of 50 experts. Recommendations were based on a large systematic review of the international literature carried out from 1990 to March 2012 and classified (Grade A, B, C or expert consensus) according to their level of evidence. RESULTS The main recommendations are a three-level hierarchical method of risk assessment based on participatory ergonomics and suggested assessment tools that can be used routinely by professionals of occupational health, workers themselves and their supervisors. CONCLUSION These French guidelines are intended for professionals of occupational health in charge of the prevention of low back disorders. The recommended methods are applicable to other countries than France.

Prevalence of thoracic spine pain in a surveillance network

BACKGROUND Back pain has long been identified as a major occupational health issue, but there are few prevalence studies on thoracic spine pain (TSP). The epidemiological surveillance of musculoskeletal disorders implemented in 2002 by the French Institute for Public Health Surveillance in the Pays de la Loire region provided the opportunity to study the prevalence of TSP in a large, representative sample of workers. AIMS To assess the prevalence of TSP across a week in a regional workforce according to age, occupational category and industry sector in men and women separately. METHODS A random sample of workers aged 20-59 years, representative of the regional workforce, was constituted between 2002 and 2005. Medical and occupational data were gathered by questionnaire. RESULTS The sample consisted of 3710 workers (58% men). The prevalence of TSP was higher in women (17%) than in men (9%). Lower grade male white-collar workers were more likely to report TSP (17%) than male workers in other occupational categories, whereas upper grade female white-collar and professional workers were more likely to report TSP. No significant difference in the prevalence of TSP was noted in either men or women according to industry sector. CONCLUSIONS Although TSP is less frequent than low back and neck pain, the results of this study indicate that 1 in 10 men and 1 in 5 women suffer from TSP.

Incidence of Chronic and Other Knee Pain in Relation to Occupational Risk Factors in a Large Working Population

OBJECTIVES The aim of this study was to estimate the incidence of chronic and other knee pain (KP) in relation to occupational and personal risk factors among workers representative of a general working population. METHODS Of 3710 workers in a French region included in a surveillance network for musculoskeletal disorders (2002-2005), 2332 completed a follow-up questionnaire in 2007-2009 (Cosali cohort). The questionnaires included questions on musculoskeletal symptoms, and personal and occupational exposure. Incident cases of KP in 2007-2009 (i.e. with KP at follow-up but not at baseline) were dichotomized into chronic KP (>30 days in the previous year) and other KP. Associations between incident KP and personal and occupational factors at baseline were studied separately according to sex using multinomial logistic regression. RESULTS Of the 1616 respondents without KP at baseline, 122 (7.5%) reported chronic KP and 243 (15.0%) reported other KP. The incidence rate of chronic KP was estimated at 19.6 per 1000 worker-years (95% CI: 16.3-23.5). After adjustment for age and body mass index, significant associations were found between incident chronic KP and handling loads >4kg [odds ratio (OR) 2.1 (1.2-3.6) for men, OR 2.3 (1.1-5.0) for women] and kneeling >2h a day for men [OR 1.8 (1.0-3.0)]. CONCLUSIONS This study highlights the high frequency of chronic KP in the working population and the role of occupational factors in its incidence, in particular those kneeling and handling loads.

Chronic low back pain, chronic disability at work, chronic management issues

Low-back pain (LBP) stands out as the leading musculoskeletal disorder because it is both highly prevalent and the disability with which people live for the greatest number of years (1, 2). Reaching a peak between the ages of 30–50 years, LBP affects a population at a time of career advancement (3, 4). Back pain is the most expensive disease in terms of indirect costs due to sickness absence and work disability. Indirect (or productivity) costs contribute 93% to total costs, illustrating the importance of the consequences of the disease for work performance (5, 6). On a personal level, low self-motivation and self-confidence make it harder to initiate the return-to-work (RTW) process, especially when problems at work are related to the reason for sick leave (7, 8). At the workplace level, colleagues take over the tasks of the worker on sick leave, work piles up, or another worker is hired to take over the tasks. Timely RTW is thus of great benefit for both injured workers and their employers. The majority of people who experience an episode of back pain recover quickly without residual functional loss, and most of these episodes never reach the consulting room (9). Overall, it is estimated that 60–70% of patients recover within 6 weeks, and 80–90% within 12 weeks. However, recovery after 12 weeks is slow and uncertain, and fewer than half of individuals disabled >12 months return to work. After two years of absence from work, the RTW rate is close to zero (10): the longer a worker is unable to work, the greater is the probability that he/she will not return to work. Chronic LBP is not just “the same as acute back pain lasting longer”, but the result of a complex interplay of physical, psychological, social, and occupational factors. The World Health Organization’s International Classification of Functioning Disability and Health (ICF) has recognized the influence of personal and workplace factors on activity and participation levels (11). If the cause of work disability is associated with workplace factors, then a return to an unchanged workplace (with or without appropriate treatment for the disorder) may be not successful and even lead to recurrent sick leave of longer duration (12, 13). Personal and workplace factors may become RTW barriers. Management of chronic LBP thus has to take into account potential psychological and workplace RTW barriers that might hinder recovery. Key workplace factors include heavy physical demands, the inability to modify work, job stress, an unsupportive workplace, job dissatisfaction, poor expectation of RTW, and fear of re-injury (14). Key psychological factors include depressed mood, social isolation, pain catastrophizing, fear-avoidance beliefs, and low self-efficacy for managing pain (15). The recommendations for management of chronic LBP highlight the multidimensional nature of the problem. For example, the European guidelines for the management of chronic non-specific LBP recommend assessment of domains including work-related factors, psychosocial distress, and depressive mood, and point out that no single intervention is likely to be effective due to the multidimensional nature of chronic LBP (16). International guidelines therefore recommend the use of supervised active exercises, multidisciplinary approaches, cognitive-behavioral therapies, and measures of social and professional order for patients with chronic LBP (16–19). A number of exercise intervention trials for LBP have specifically targeted affected workers with the aim of facilitating a return to usual work or improving work endurance. An extensive literature review of randomized clinical trials for work conditioning programs among injured workers concluded that these types of programs were effective in reducing sick days for workers with chronic LBP compared to usual measures only when they: (i) integrated cognitive-behavioral approaches with intensive physical training (aerobic capacity, muscle strength and endurance, coordination); (ii) were in some way work-related; and (iii) were provided and supervised by either a physiotherapist or a multidisciplinary team (20). Although physical exercise can still be considered a beneficial and also a safe strategy for chronic LBP, the exact mechanisms are not yet clear and may be related to improved aspects of physical fitness, improved mood, fears and behavior, decreased sensitization, or combinations of these different mechanisms. Literature analysis suggests that it may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning program effective (21). According to a French study carried out in 2010 by the epidemiological surveillance network for musculoskeletal disorders in the Pays de la Loire region [3 601 113 inhabitants in 2014], the number of employees with LBP is very high. Using the macro Calmar, developed in SAS (SAS Institute, Cary, NC, USA) by the French National Institute of Statistics and Economic Studies (INSEE), the data from this network were extrapolated to the regional population covered by the occupational medicine (excluding some special social systems not represented in the study) to determine the extent of the phenomenon at the regional level (22). Thus, we can estimate that >268 000 employees reported backache during the preceding seven days and more than half a million (316 552 men and 244 253 women) during the 12 months preceding the survey (ie, 59.3% of men and 55.0% of women). Considering that 2–7% of people with non-specific LBP are at risk of developing chronic pain and disability in due course (23), this would indicate 11 216–39 257 employees at risk of developing severe and durable work disability. Given these statistics – and considering the recommended types of programs for chronic LBP, on the one hand, and the total amount of patient provision by multidisciplinary teams of rehabilitation centres on the other – it is obvious that we cannot meet requirements. These costly and time-consuming intensive multidisciplinary programmes can thus only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements (16, 18, 24). A lighter program may be one alternative strategy to full-time hospital-based programs at the same stage of treatment, with valuable results in terms of disability and occupational outcome for patients suffering from chronic LBP (24–30). More is not always better (31). It is therefore important to define both what the determining components of management are to overcome activity restriction, including occupational status, and how to include more hospital-independent programs in our healthcare systems in order to treat a larger number of patients more effectively at a lower cost and be able to offer stratified management programs adjusted to the severity of individual situations (32).