Evert Zinzen

Implications of an adjustable bed height during standard nursing tasks on spinal motion, perceived exertion and muscular activity

Manual handling is a source of occupational stress, particularly for nursing personnel. High levels of biomechanical strain are associated with lifting and transferring patients, especially when the tasks are performed in flexed and twisted positions that induce an increased risk of functional and musculoskeletal problems. The use of adjustable beds in nursing practice has been suggested as a means of influencing working postures and reducing the muscular demands on nurses. The purpose of this study was to investigate the effects on spinal motion, muscular activity and perceived exertion when nurses had the opportunity to adjust bed height. The measures recorded during the conduct of standardized patient handling tasks were the changes in posture (inclination) and in shape (sagittal bending, side bending, axial rotation). Muscular activity was measured using surface electromyography. Perceived exertion was rated using the 15-graded Borg scale. The range of motion was not influenced by the adjustment of bed height, but rather a shift of the time duration histogram was noticed in the direction of the erect, safer position. The time spent in the safe zone of spinal motion near the erect position was significantly increased and was significantly decreased in the potential health-hazardous zones of spinal motion in the extreme positions. No differences in muscular activity or in perceived exertion were found between the two bed height conditions for any of the muscle groups. It was concluded that the quality of spinal motion is enhanced when the opportunity of adjusting the bed height is offered.

Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome

A systematic review was undertaken to examine whether patients with chronic fatigue syndrome (CFS) differ from healthy sedentary controls in physiological exercise capacity, physical activity level and muscle strength. From the available literature, it can be concluded that patients with CFS perform less physical activity during daily life, and have less peak isometric muscle strength compared to healthy sedentary control subjects. Conflicting data in relation to physiological exercise capacity of patients with CFS have been reported, but the weighted available evidence points towards a reduced physiological exercise capacity in CFS. Future studies should use a wash-out period for medication use, blinded assessments, a priori power calculation and a sedentary control group comparable for age, gender, body weight, body length and current physical activity level.

Post-mortem limitations of body composition analysis by computed tomography

Few of the indirect methods for measuring body composition have every been validated against direct human cadaver evidence. Computed tomography (CT), like NMR, has proved to be an important diagnostic tool and they appear to be the techniques of the future for body composition studies. The purpose of the present study (Cadaver Analysis Study III), undertaken at the Vrije Universiteit Brussel in a joint venture with the University of Göteborg, Sweden, was to validate tomographic measurements of volumes and areas from different tissues using data from CT-scanning of unembalmed deep-frozen cadavers and data collected by dissection of the same cadavers. Six Belgian adults were extensively measured and dissected. The body was divided into several slices for comparison of the CT image with photography of the same slice and comparison of tissue-volumes per segment for the whole body. Due to post-mortem changes and the frozen state of the cadavers, the CT measurements were greatly affected by artefacts disturbing adipose tissue (AT) and muscle area determinations. Only the bone area measurements were similar between the two techniques. However, when the volumes (per segment) of the same tissues were considered, no apparent difference was found between CT and dissection data for the muscle volume.

Association between cognitive performance, physical fitness, and physical activity level in women with chronic fatigue syndrome.

Limited scientific evidence suggests that physical activity is directly related to cognitive performance in patients with chronic fatigue syndrome (CFS). To date, no other study has examined the direct relationship between cognitive performance and physical fitness in these patients. This study examined whether cognitive performance and physical fitness are associated in female patients with CFS and investigated the association between cognitive performance and physical activity level (PAL) in the same study sample. We hypothesized that patients who performed better on cognitive tasks would show increased PALs and better performance on physical tests. The study included 31 women with CFS and 13 healthy inactive women. Participants first completed three cognitive tests. Afterward, they undertook a test to determine their maximal handgrip strength, performed a bicycle ergometer test, and were provided with an activity monitor. In patients with CFS, lower peak oxygen uptake and peak heart rate were associated with slower psychomotor speed (p < 0.05). Maximal handgrip strength was correlated with working memory performance (p < 0.05). Both choice and simple reaction time were lower in patients with CFS relative to healthy controls (p < 0.05 and p < 0.001, respectively). In conclusion, physical fitness, but not PAL, is associated with cognitive performance in female patients with CFS.

Work and Family Support Systems and the Prevalence of Lower Back Problems in a South African Steel Industry

IntroductionBack complaints are a common in society. MethodsAn analytical cross-sectional epidemiological study was carried out among 366 steel plant workers to examine the prevalence and association between lower back problems (LBP) and family and workplace related psychosocial risk factors.ResultsUsing inclusive and stringent definitions for LBP, point prevalence was 35.8% and 15.3%, respectively. Logistic regression analyses indicated significant adjusted odd ratios (OR) for negative perceptions of workplace support (2.32; CI 1.09–4.92), unexpected events (2.58; CI 1.19–5.59) and working under time pressures and deadlines (2.83; CI 1.24–6.48). A significant protective association was found for control over the order and pace of working tasks (OR 0.30; CI 0.14–0.63). A significant univariate association was further found between LBP and negative perceptions of family (1.97; CI 1.06–3.68) support.ConclusionThese findings suggest that workers who feel more in control on the job and who have good family and workplace support systems in tact are less likely to experience LBP. Supervisors are therefore encouraged to develop appropriate support and organizational systems which may be an inexpensive, but potentially beneficial, means of reducing worker stress and LBP.

Fear-avoidance beliefs and pain coping strategies in relation to lower back problems in a South African steel industry.

The objective was to determine the association between the prevalence of lower back problems (LBP), fear‐avoidance beliefs and pain coping strategies using an analytical cross‐sectional epidemiological study among a group of 366 workers in a South African stainless steel industry. Outcome (LBP) was defined using a questionnaire and a functional rating index. Exposure to psychosocial risk was determined using the Fear‐Avoidance Beliefs (FABQ) and Coping Strategies (CSQ) questionnaires. Multivariate logistic regression analyses for LBP indicated the following significant risk factors: work‐related fear‐avoidance beliefs (OR 3.40; 95% CI 2.20‐5.25), catastrophizing (1.31; 1.01‐1.7) and pain coping self statements (1.47; 1.16‐1.87). Significant protective associations were found for increased activity levels (OR 0.57; 95% CI 0.42‐0.78). These findings have utility in preventative screening procedures to identify workers with such beliefs and coping strategies who are at risk for prolonged work restrictions.

Psychosocial Factors Related to Lower Back Problems in a South African Manganese Industry

The purpose of this study was to determine the association between the prevalence of lower back problems, fear-avoidance beliefs, and pain-coping strategies in using an analytical cross-sectional epidemiological study among a group of 109 workers in a South African manganese industry. Outcome (LBP) was defined using a guided questionnaire and functional rating indexes. Exposure to psychosocial risk was determined using the Fear-Avoidance Beliefs (FABQ) and Coping Strategies (CSQ) questionnaires. Using inclusive and stringent definitions for perceived LBP, point prevalence was 37.6 and 29.4%, respectively. Only 8 cases of LBP were, however, recorded officially over a 7-year period reflecting a tendency of underreporting. Multivariate logistic regression analyses indicated significant adjusted relative risk ratios (RR) for work-related fear-avoidance beliefs (RR 2.35; 95% CI 1.39–3.95) as a singular psychosocial risk while no specific coping strategy could be isolated. In conclusion, work hardening and a contented ethos of the manual laborers under study moderates the association between the prevalence and etiology of LBP.

Lower Back Problems and Work-Related Risks in a South African Manganese Factory

An analytical cross-sectional epidemiological study carried out among 109 manganese plant workers aimed to examine the prevalence and association between lower back problems (LBP) and occupational risk factors. Outcome was defined using a guided questionnaire and a functional rating index. Exposure to occupational risk factors was determined using self-reported questionnaires and workstation analyses. Multivariate logistic regression analyses indicated significant adjusted odds ratios (OR) for prolonged 90° trunk flexion (OR 2.16; CI 1.15–4.05); manual handling (1.89; 1.17–3.08); load carriage (1.54; 1.08–2.19); and lifting (4.61; 1.37–15.47). The findings illustrate regional and occupational specifics of risk for LBP, and indicate that self-selection or adaptation to task-specific demands could possibly lead to observations of ergonomically relevant risk factors, which do not necessarily yield statistically significant associations with LBP. The findings further support multi-modal preventative approaches.

Sleep characteristics, exercise capacity and physical activity in patients with chronic fatigue syndrome

Abstract Purpose: Unrefreshing sleep and lowered physical activity are commonly observed in chronic fatigue syndrome (CFS) patients, but how they might influence each other remains unexplored. Therefore, this study simultaneously examined the exercise capacity, sleep characteristics and physical activity in CFS patients. Methods: Handgrip strength and cycle exercise capacity were assessed in 42 female CFS patients and 24 inactive control subjects. During four consecutive days and nights, energy expenditure, activity and sleep–wake pattern were objectively registered using a Sensewear Armband. Results: Exercise capacity was significantly lower in CFS patients. In both groups VO2peak correlated with the time subjects were physically active. In CFS patients only, VO2peak correlated negatively with sleeping during the day whilst physical activity level and energy expenditure correlated negatively with sleep latency and lying awake at night. Conclusions: In the present study, CFS patients with higher VO2peak tend to sleep less over day. Occupation in physical activities was negatively associated with sleep latency and lying awake at night. Increased physical activity potentially has beneficial effects on sleep quality in CFS. However, a close monitoring of the effects of increasing physical activity is essential to avoid negative effects on the health status of patients. Implications for Rehabilitation Female patients with chronic fatigue syndrome (CFS) have normal sleep latency and sleep efficiency, but sleep more and spent more time in bed as compared to healthy inactive women. Female CFS patients have lower exercise capacity, and a lower physical activity level as compared to healthy inactive women. CFS patients appear to be more sensitive for sleep quality (sleep latency and lying awake at night), which is associated with a low physical activity level.

Will the use of different prevalence rates influence the development of a primary prevention programme for low-back problems?

To determine relations to low-back problems (LBP), different prevalence rates are used. The disadvantage of using different selection criteria is that studies are not comparable, except where they provide the same results. The present aim was to establish whether different prevalence selection criteria lead to different answers on a newly formed set of questionnaires. Since this set is new, reliability tests were performed (test-retest and calculations of Cronbachs Alpha, Cohens Kappa and the intraclass correlation). Results of the questionnaire should form the cornerstones of a primary prevention programme. Altogether 1783 nurses in four Flemish (Belgian) hospitals were questioned. Information was gathered on work circumstances, education, general health, psychosocial factors, leisure activities, family situation and musculoskeletal problems. Four different datasets with variables related to lifetime prevalence LBP, annual prevalence LBP, point prevalence LBP and a set with all related variables were constructed. The variables demonstrating a relation with LBP differed slightly depending on the kind of prevalence used (lifetime, annual, point). A factor analysis on each set of prevalence related data failed due to the lack of homogeneity of the variables. Fear avoidance, coping aspects and musculoskeletal problems in other regions then the lower back were, in all circumstances, the most discriminating variables. Their discriminating power, however, differed depending on the kind of prevalence used. The differences were too small to influence the construction of the prevention programme. It is concluded that in developing a primary prevention programme any of the prevalence rates can be used. The combination of the three types of prevalence rates studied provides the most complete and reliable image.