Caitriona Cunningham

Prevalence of Musculoskeletal Disorders Among Farmers: A Systematic Review

OBJECTIVE To determine the prevalence of musculoskeletal disorders (MSDs) among farmers and to establish the most common regional MSDs reported. METHODS Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using keywords for MSDs and farmers. Pooled estimates of prevalence with 95% confidence intervals were calculated for overall MSD prevalence and the most common regional MSDs reported. RESULTS Twenty-four studies fulfilled the inclusion criteria and were incorporated into this review. From these studies, life-time prevalence of any form of MSD among farmers was 90.6% while 1-year MSD prevalence was 76.9% (95% CI 69.8-82.7). The majority of studies focused on spinal MSDs with low back pain (LBP) the most frequently investigated. Life-time LBP prevalence was 75% (95% CI 67-81.5) while 1-year LBP prevalence was 47.8% (95% CI 40.2-55.5). The next most common regional MSDs reported were upper (range 3.6-71.4%) and lower extremities (range 10.4-41%). CONCLUSIONS The systematic review identified the prevalence of MSDs by body region in farmers and established that LBP was the most common MSD, followed by upper and then lower extremity MSDs. Reported trends suggest that the prevalence of MSDs in farmers is greater than in non-farmer populations. Case-definition uniformity among MSD researchers is warranted. More studies are needed regarding upper and lower extremity MSDs, gender, workplace, and task context of MSDs.

Musculoskeletal disorders among Irish farmers

BACKGROUND Farming is an occupation that predisposes individuals to health problems including musculoskeletal disorders (MSDs). There is limited research regarding MSDs among farmers especially in Ireland. AIMS To establish the prevalence of MSDs, identify the most commonly affected body regions and to explore what factors may influence the development of the most common MSDs among farmers in Ireland. METHODS A questionnaire survey of Irish farmers was conducted. The study sample comprised 600 farmers (100 farmers from each of the six main farm enterprise systems in Ireland). RESULTS Of the 600 farmers, 56% had experienced a MSD in the previous year. The most commonly experienced MSDs were back pain (37%) and neck/shoulder pain (25%). Other MSDs experienced in the previous year included knee pain (9%), hand-wrist-elbow pain (9%), ankle/foot pain (9%) and hip pain (8%). Overall, MSDs were more common in farmers working longer hours (P < 0.05). Back pain was more prevalent in full-time farmers (P < 0.05), while prevalence of hip pain was greater in farmers who were older (P < 0.01), full time (P < 0.05), farming for longer (P < 0.01) and working for longer hours (P < 0.01). Farm enterprise was not a factor in influencing the development of MSDs. CONCLUSIONS These findings suggest that the number of hours worked by farmers, rather than enterprise specific tasks render farmers more susceptible to MSDs. Further investigation is needed to explore risk factors in the development of MSDs.

Risk factors for musculoskeletal disorders among farm owners and farm workers: A systematic review†

BACKGROUND A systematic review was undertaken to establish risk factors for the development of musculoskeletal disorders (MSDs) among farmers. METHODS Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using a battery of key words for MSDs and farmers. The studies methods quality was assessed using a standardized checklist. RESULTS Thirty-three studies fulfilled the inclusion criteria. The median method score was 65% of the maximum attainable score, resulting in 15 studies of higher methodological. Risks were categorized into: Work characteristics (n = 11), personal characteristics (n = 5), and psychosocial factors (n = 5). Spinal MSD risk factors include exposure to working in tree crops, vibration, postural load, being an owner operator, age, education beyond high school, suffering from asthma or depression, having <8 hr nightly sleep, bad quality sleep, and geographic location. Upper extremity MSD risk factors include being an owner operator, dust with pig workers, numbness and coldness in younger milkers and numbness in milkers >43 years, age, and body height in dairy farmers. Lower extremity MSD risk factors include, duration of farming ≥10 years, working >5 hr daily in animal barns, milking >40 cows, years as a dairy farmer, farm work, age, body mass, and female gender. CONCLUSIONS In exploring risk factors the spine was the most researched body region, followed by lower and upper extremity. Given the variance between studies, it is recommended that future studies focus on specific types of farmers and should explore specific exposures for specific body parts using standardized case definitions.

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland

OBJECTIVE To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland. DESIGN Cross-sectional survey of primary care physiotherapists. METHOD Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data. RESULTS A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapists role, and patients lack of interest in changing their unhealthy behaviour. CONCLUSION The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors.

Low back pain among Irish farmers

BACKGROUND Despite farming being regarded as a high-risk activity for low back pain (LBP), little LBP research exists for this work sector. AIMS To establish LBP prevalence, beliefs regarding LBP, perceived LBP risk factors, related health service utilization, awareness and participation in manual-handling training among farmers in Ireland. METHODS A cross-sectional questionnaire survey was distributed to 200 farmers in Ireland via five Irish veterinary practices. Data were entered onto the Statistical package for the Social Sciences (version 12.0.1) and analysed using descriptive statistics while qualitative data were coded and analysed for common themes. RESULTS The response rate was 52% (n = 104). Lifetime, annual and point prevalence of LBP was 74% (n = 77), 54% (n = 56) and 27% (n = 28), respectively. Of respondents with a history of LBP, 72% (n = 55) stated that farming had contributed to their problem. Sixty-three per cent (n = 31) identified lifting as a contributory factor to their LBP. The majority of respondents (86%, n = 66) with LBP sought some form of treatment, with 73% (n = 56) of these having attended a general practitioner (GP). Few respondents (13%, n = 14) had ever attended a manual-handling course. CONCLUSIONS A high prevalence of LBP was found among farmers, with lifting being reported as the major contributing factor. GPs were the most commonly utilized healthcare practitioner for LBP. Farmers do not commonly attend manual-handling courses with many noting they were not widely accessible or adequately publicized. There is a need for high-quality studies to examine the effectiveness of different interventions to prevent LBP among the Irish farming population.

Management of the extrahepatic symptoms of chronic hepatitis C: feasibility of a randomized controlled trial of exercise

ObjectiveThe aim of this study was to explore the feasibility and the efficacy of a physiotherapy-led exercise program in changing the health status of a sample of patients with chronic hepatitis C. DesignA single-blind randomized controlled trial was conducted in a sample of patients with iatrogenically acquired hepatitis C in Ireland. Twenty-two participants were recruited and randomly assigned to exercise (n = 10) and control (n = 12) groups. Both groups received a generic exercise advice leaflet, and the exercise group attended 12 exercise sessions for 6 wks. A battery of physical performance measures and patient-reported outcome measures were assessed at baseline and 6 wks, with 1-yr follow-up of the self-reported measures. ResultsSignificant group by time interactions during the 6-wk period were found for pain (F1,20 = 5.15, P = 0.034), grip strength (F1,20 = 5.94, P = 0.024), aerobic capacity (F1,20 = 5.73, P = 0.024), and depression (F1,20 = 6.16, P = 0.022), with the exercise group showing greater positive change. The exercise group also had superior gains in the 36-Item Short-Form Health Survey vitality and social function scores (P < 0.05). The short-term gains were not sustained at 1 yr. ConclusionsThis pilot study shows the feasibility of exercise in hepatitis C management, improving physical fitness, psychologic function, and quality-of-life without worsening symptoms in the short term.

Work‐related musculoskeletal disorders among Irish farm operators

BACKGROUND To establish prevalence, risk factors, and impact of work-related musculoskeletal disorders (WMSDs) among farmers in Ireland. METHODS In summer 2009, a questionnaire was appended to the Teagasc (Irish Agricultural and Food Development Authority) National Farm Survey (n = 1,110) to obtain data on the prevalence, risk factors and impact of WMSDs amongst farm operators in Ireland. Data were collected by trained recorders and analyzed using chi-square tests, t-tests, Mann-Whitneys U-tests and logistic regression models. RESULTS The prevalence of WMSDs in the previous year was 9.4% (n = 103), with the most commonly affected body region being the low back 31% (n = 32). Nearly 60% (n = 57) of farmers reported missing at least a full days work as a consequence of their WMSD. Personal factors evaluated using binary regression analysis, were found not to influence whether or not a farmer experienced a WMSD. However, work-related factors such as larger European Size Units (ESUs, OR: 1.007, CI: 1.002-1.012), greater number of hectares farmed (OR: 2.501, CI: 1.208-4.920), higher income (OR: 1.859, CI: 1.088-3.177), dairy enterprise (OR: 1.734, CI: 1.081-2.781), and working on a full-time farm (OR: 2.156, CI: 1.399-3.321) increased the likelihood of experiencing a WMSD. Working on a full-time farm was the only factor found to independently predict WMSDs in the multiple regression analyses. CONCLUSIONS This study suggests that the prevalence of WMSDs can be reduced by the application of improved farm management practices. A more detailed examination of the risk factors associated with WMSDs is required to establish causality and develop effective interventions.

Working Backs Project—implementing low back pain guidelines

BACKGROUND The St Vincents Working Backs Project (WBP) represents a strategy for the implementation of the UK Faculty of Occupational Medicine guidelines for the management of low back pain (LBP) in the workplace (Carter J, Birrell L. Occupational Health Guidelines for the Management of Low Back Pain at Work-Principal Recommendations. London: Faculty of Occupational Medicine, 2000). AIM To evaluate the efficacy of the St Vincents WBP. METHODS Questionnaire survey of staff and managers before and after the WBP intervention together with review of Occupational Health Department (OHD) data. The intervention included changes to LBP management pathways and protocols, combined with a guideline-based health promotion campaign. Outcomes included WBP awareness, LBP-related sickness absenteeism, staff back beliefs, intended management of LBP and manager attitudes towards LBP and it management. RESULTS Following the WBP intervention, 85% (n=46) of managers and 57% (n=124) of staff reported having heard of the WBP. LBP-related sickness absenteeism in the previous year had not decreased significantly (95% confidence interval: -0.03 to 0.06). Among staff, a mean improvement of 1.8 had occurred on the Back Beliefs Questionnaire score. More staff (36%) reported that they would try to stay active (P<0.05) with LBP and would choose to attend the OHD if they required treatment. More managers demonstrated guideline-consistent attitudes. CONCLUSIONS Following the WBP, staff and manager attitudes and beliefs towards LBP and its management were more consistent with the LBP guidelines although LBP-related sickness absenteeism did not decrease significantly. Future occupational guideline implementation strategy studies are required which should include a control worksite and rely on pre- and post-intervention organizational data.

The lived experience of low back pain among Irish farmers: case studies.

ABSTRACT Low back pain (LBP) is the most commonly reported musculoskeletal disorder (MSD) among farmers. There is limited researching regarding the lived experience of LBP among farmers. Video interviews were conducted with three dairy farmers who reported having a significant episode of LBP. The interview data were transcribed and analyzed, and results were presented in relation to the constructs explored. The farmers experienced their first significant episode of LBP in their late 20s or early 30s and all attributed their LBP to farm work or a farm-related incident. Hours worked per day ranged from 9 to 13 hours. Tasks identified by farmers that they were unable to do due to LBP included physical work, working with sheep, building work, and “certain jobs.” Work changes made due to LBP included getting help, slowing down, avoiding strenuous work, carrying smaller loads, mechanizing the farm, using the tractor more, and wearing a back belt for certain jobs. Each farmer had his own way of preventing or managing his LBP, including a mix of active self-management and passive coping strategies such as swimming, using ice, spinal manipulation, and taking medication. The farmers were unable to quantify how much their LBP had cost them directly or indirectly. The case studies illustrate farmers engaging in ongoing work despite significant pain. All of the farmers have adapted at work and engaged in self-management strategies to reduce the occurrence of LBP. Given the rich data produced by these case studies, future case studies are recommended to gain greater insights into farmers’ experiences concerning LBP.

Patient-reported outcome measures in advanced musculoskeletal physiotherapy practice: a systematic review

OBJECTIVE Advanced practice physiotherapists (APPs), also known as extended scope physiotherapists, provide a new model of service delivery for musculoskeletal (MSK) disorders. Research to date has largely focused on health service efficiencies, with less emphasis on patient outcomes. The present systematic review aimed to identify the patient-reported outcome measures (PROMs) being utilized by APPs. METHOD A wide search strategy was employed, including the PubMed, Embase, CINAHL, CENTRAL and PEDro databases, to identify studies relating to PROMs utilized by APPs in MSK healthcare settings. PROMs identified were classified into predetermined outcome domains, with additional contextual data extracted. RESULTS Of the initial 12,302 studies, 38 met the inclusion criteria. These involved APPs across different settings, utilizing 72 different PROMs and most commonly capturing: Patient Satisfaction, Quality of Life (QoL), Functional Status, and Pain; and, less frequently: Global Status (i.e. overall improvement), Psychological Well-Being, Work ability, and Healthcare Consumption and Costs. The quality of the PROMs varied greatly, with Satisfaction most commonly measured utilizing non-standardized locally-devised tools; the EuroQol five-dimensions questionnaire (EuroQoL-5D) and 36-Item Short-Form (SF-36) cited most frequently to capture QoL; and the Visual Analogue Scale (VAS) to capture Pain. No key measure was identified to capture Functional Status, with 15 different tools utilized. CONCLUSION APPs utilized a multiplicity of PROMs across a range of MSK disorders. The present review will act as an important resource, informing the selection of outcomes for MSK disorders, with a view to greater standardization of outcome measurement in MSK clinical practice, service evaluation and research.