E S Nahit

Mechanical and psychosocial factors predict new onset shoulder pain: a prospective cohort study of newly employed workers

Aim: To test the hypothesis that work related mechanical and psychosocial factors predict new onset shoulder pain in newly employed workers. Methods: Two year prospective study of newly employed workers from 12 diverse occupational settings. At baseline, 1081 subjects provided information on work related mechanical and psychosocial risk factors, and current pain status. Results: In all, 803 (74%) subjects were free from shoulder pain at baseline. Of those, 638 (79%) responded at 12 months and 476 (88%) at 24 months. New onset shoulder pain was reported by 93 (15%) and 73 (15%) subjects respectively. An increased risk of symptom onset was found in subjects reporting mechanical exposures involving heavy weights including lifting with one or two hands, carrying on one shoulder, lifting at or above shoulder level, and pushing or pulling. Working with hands above shoulder level was also predictive of new onset shoulder pain. Of the psychosocial factors examined, the strongest predictor was monotonous work. Those individuals with any other previous pain also had an increased risk of new onset shoulder pain at follow up. In multivariate analysis, lifting heavy weights with one or two hands, pushing or pulling heavy weights, working with hands above shoulder level, and monotonous work were independently associated with new onset shoulder pain. Conclusions: This study supports the hypothesised relation between mechanical risk factors and shoulder pain. In general, work related psychosocial factors were modestly associated with new onset shoulder pain. However, monotonous work was a strong risk factor for new onset shoulder pain.

Effects of psychosocial and individual psychological factors on the onset of musculoskeletal pain: common and site-specific effects.

Objective: To determine whether adverse psychosocial and individual psychological factors increase the risk of pain across regional sites. Methods: A prospective study was conducted of newly employed workers from 12 diverse occupational groups. Near to the beginning of subjects’ employment, details of work related psychosocial factors and individual psychological distress were obtained by means of a self completed questionnaire. Questionnaire follow up after 12 months provided data on these same exposures and ascertained pain at any of four anatomical sites: the low back, shoulder, wrist/forearm, and knee. Results: Of the original 1081 subjects, 829 (77%) provided full details at the one year follow up. Psychosocial work demands and high levels of individual psychological distress were found to have a common effect across sites. Psychological distress was associated with a doubling of the risk of reported pain (odds ratio = 2.1, 95% confidence interval 1.6 to 2.7), while aspects of job demand, poor support from colleagues, and work dissatisfaction were all associated with increased odds of reported pain onset of between 1.4 and 1.7. These effects were almost all common across the four regional pain sites. Conclusions: In cohorts of newly employed workers, certain work related psychosocial factors and individual psychological distress are associated with the subsequent reporting of musculoskeletal pain, and generally this effect is common across anatomical sites.

Short term influence of mechanical factors on regional musculoskeletal pain: a study of new workers from 12 occupational groups.

OBJECTIVES To determine the influence of short term exposure to mechanical factors on regional musculoskeletal pain. METHODS Full time newly employed workers were recruited from 12 occupational groups and information collected by questionnaire. Subjects indicated on a blank body manikin any low back, shoulder, wrist or forearm or both, or knee pain which had occurred during the past month and had lasted more than 1 day. Data were also collected with a previously validated questionnaire on working postures, manual handling activities, and repetitive movements of the upper limb. The relations between mechanical factors and each area of pain were calculated as odds ratios (ORs) with 95% confidence intervals (95% CIs). Adjustment was made for age and sex. RESULTS 1081 subjects (median age 23; interquartile range 20–27) were recruited to the study (a participation rate of 91%). 261 (24%) reported low back pain, 221 (20%) shoulder pain, 93 (9%) wrist or forearm pain, and 222 (21%) knee pain. Several specific manual handling activities were found to be associated with low back, shoulder, and knee pain. Carrying weights of more than 50 lbs (23 kg) on one shoulder was the factor which was most strongly associated with low back pain (OR 2.4 (95% CI 1.5 to 3.8)), shoulder pain (OR 3.1 (95% CI 1.9 to 4.8)), and knee pain (OR 3.5 (95% CI 2.2 to 5.5)), whereas forearm pain was most strongly associated with repetitive movements of the wrists (OR 1.8 (95% CI 1.04 to 3.1)). By contrast very few postures were associated with regional pain, although bending forwards in an uncomfortable position for at least 15 minutes was associated with shoulder pain (OR 1.6 (95% CI 1.2 to 2.2)) and kneeling for at least 15 minutes was associated with knee pain (OR 1.8 (95% CI 1.2 to 2.6)). Exposure to mechanical factors was most strongly associated with pain at multiple sites rather than with pains in individual regions. CONCLUSIONS Even among workers with only short term exposure to mechanical factors, musculoskeletal pain is increased.

Interobserver reliability in measuring flexion, internal rotation, and external rotation of the hip using a plurimeter.

OBJECTIVE: To determine reliability of the measurement of hip movements (flexion, internal rotation, and external rotation) between medical practitioners. METHODS: Six clinicians carried out measurements of hip movements on each of six patients with osteoarthritis of one hip, using a specifically designed plurimeter. RESULTS: There was no evidence of any systematic difference between medical practitioners in the measurement of hip flexion, internal rotation, or external rotation. The degree of agreement was greatest for hip flexion. CONCLUSIONS: This study has shown that measurement of range of movement at the hip is repeatable between practitioners using a simple plurimeter and may represent an examination that is suitable for monitoring progress and treatment.

The occurrence of falls among patients with a new episode of hip pain

OBJECTIVES To establish the risk of falling among those who consult their general practitioner with a new episode of hip pain and to discover if risk is altered by age and according to whether, at presentation, signs of osteoarthritis are present on radiography. METHODS A case-control study was conducted. Cases were all patients who presented with a new episode of hip pain to participating general practices throughout the United Kingdom. All cases had a pelvic radiograph taken on recruitment to the study. Three controls were matched for sex, age, and general practice to each case. A questionnaire was sent by post to all cases and controls. The risk of having fallen in the past 12 months among cases and controls was compared. RESULTS The study included 111 cases presenting with hip pain and 229 controls who had not consulted with hip pain in the previous 12 months. Women (odds ratio = 3.6, 95% CI 1.9, 6.7) but not men (odds ratio = 0.8, 95% CI 0.3, 2.3) reported an increased risk of falling in the previous 12 months. Similar results were obtained when the previous four months were considered. For all cases, hip pain predated any reported falls. The increased risk in women was found particularly for those aged less than 70. Risk of falling was not altered by the presence of radiological changes of osteoarthritis. CONCLUSIONS Hip pain, which may be a symptom of osteoarthritis of the hip, increases the risk of falling. This finding has implications for the advice offered by general practitioners to patients who consult with early hip pain.

Predicting the onset of knee pain: results from a 2-year prospective study of new workers

Objective: To determine the relative contribution of work-related mechanical (injury) factors and psychosocial factors to the onset of a new episode of knee pain, in a cohort of newly employed workers. Methods: A prospective cohort study of newly employed workers from 12 diverse occupational settings in England (The New Workers Study). 859 newly employed workers, free of knee pain, were identified. Information about occupational mechanical factors (manual handling and postural activities), the occupational physical environment, and psychological and psychosocial factors was collected by self-completion questionnaires. Participants were followed up after 12 and 24 months to identify cases of knee pain onset. Generalised estimating equations were used to estimate the risk of new-onset knee pain, with respect to the exposures previously measured. Results: In total, over the 2-year follow-up period, 108 cases of new-onset knee pain were observed. Mechanical load, postural factors, psychological distress and work-place psychosocial factors all influenced the risk of new-onset knee pain over the 2-year follow-up period. On multivariate analysis, two factors remained independently predictive of knee pain onset: lifting or carrying heavy weights in one hand, and the level of general psychological distress. Conclusion: In addition to mechanical (injury) factors, psychological factors are important risk factors for knee pain onset as shown in a population of young newly employed workers.

Estimating Intervention Effects in a Complex Multi-Level Smoking Prevention Study

This paper illustrates how to estimate cumulative and non-cumulative treatment effects in a complex school-based smoking intervention study. The Instrumental Variable method is used to tackle non-compliance and measurement error for a range of treatment exposure measures (binary, ordinal and continuous) in the presence of clustering and dropout. The results are compared to more routine analyses. The empirical findings from this study provide little encouragement for believing that poorly resourced school-based interventions can bring about substantial long-lasting reductions in smoking behaviour but that novel components such as a computer game might have some short-term effect.

Smoking behaviour in year 8 pupils: baseline characterisics of the UK ESFA longitudinal study

Abstract The vast majority of adult smokers take up the habit during adolescence and most continue to smoke for the rest of their lives. In order to reduce the prevalence of this highly health-compromising behaviour those factors which are associated with smoking in early adolescence need to be determined so that appropriate action can be taken. The study was part of the European Smoking Prevention Framework Approach (ESFA) project in which six European countries participated. In England 6626 young people (49.3% male, aged 12–13 years) from 42 schools were surveyed. Information was collected by means of a self-completed questionnaire. Nearly 14 per cent of the young people (884, 13.7%) were current smokers (smoke at least sometimes), with 5.4 per cent smoking at least once per week. Beliefs about smoking, social norms (friends think that the young person should smoke), social modelling (best friend, brother, sister smokes), perceived behaviour of others (young person estimates that at least half of friends or people the young person knows smoke), pressure from others (mother, sister, advertisements and friends) and leisure time activities (hanging out on the street with friends, going to house or rave parties) were all found to be independently associated with current smoking behaviour. In a separate gender specific analysis, few differences were observed between boys and girls at this age. The findings from this study suggest that smoking prevention and cessation activities need to be targeted not only at the individual child but also the wider community including the family. This cohort of young people will now be followed up over a period of three years, with half of the cohort being exposed to multi-level interventions.

Generalised estimating equations and low back pain

We read with interest the article by Hoogendoorn et al who examined the use of different approaches to analysing data from their prospective cohort study of work related exposures and the future onset of low back pain.1 Exposures and outcomes are time dependent factors as they are subject to change over time. The strength of the relation depends on the assumptions of time dependence (or independence) of exposures and outcomes. The effects of these assumptions can be investigated by adopting different modelling approaches to studies that have collected repeated measures of exposure and outcome data over time. Hoogendoorn et al have adopted such an approach in their study of work related risk factors for low back pain.1 Information on work related physical and psychosocial factors and low back pain outcome was collected at baseline and in three annual follow ups. They showed an increased risk of low back pain for work related mechanical factors, when using two different generalised estimating equation (GEE) models compared to the standard logistic regression approach.1 Conversely, for work related psychosocial factors the association with low back pain was weaker when the GEE method was employed. Such an approach is enlightening and we agree that it is important to explore such analytical techniques in the investigation of work related risk factors and musculoskeletal symptoms. Therefore further exploitation of this method of analysis seems appropriate. We have recently conducted a …