Jens Peder Haahr

Reduction of pain-related disability in working populations : A randomized intervention study of the effects of an educational booklet addressing psychosocial risk factors and screening workplaces for physical health hazards

Study Design. Cluster randomized controlled trial with 6 and 8 quarters of follow-up. Objective. To test the effects of giving evidence-based information addressing psychosocial risk factors for pain-related disability and of screening workplaces for physical health hazards at work on reducing new episodes and duration of pain-related and general absence taking. Summary of Background Data. The “flag strategy” for handling low back pain problems is recommended in many Western countries but, so far, randomized intervention studies addressing psychosocial risk factors for disability related to low back pain show mixed results. Methods. We followed employees from 39 different work sites in western Denmark, who had received interventions consisting of either a carefully prepared booklet providing evidence-based information on common musculoskeletal pain problems alone or in combination with systematic workplace screening for physical work hazards. Absence due to pain for at least 7 days and the cumulative numbers of absence days were the main outcome measures. General absence taking was analyzed, too. Company registrations of sickness absence in combination with self-report on the cause of a given absence spell was used to inform absence spells. Results. A total of 3808 of 4006 eligible employees provided information. Among 1063 participants in the control arm, 1458 in the information arm, and 1287 in the information and workplace screening arm, 4.6%, 6.9%, and 4.6%, respectively, experienced pain-related absence, and 27.8%, 27.2%, and 24.0%, respectively, experienced general absence taking during follow-up. No positive effect on the risk of the 2 measures of absence or on the cumulative duration of absence among cases was seen. Conclusion. Results did not support population-based interventions addressing psychosocial risk factors for pain-related disability alone or in combination with workplace screening as effective in reducing the risk of pain-related absence taking or the duration of absence.

Responsiveness and Minimal Clinically Important Change: A Comparison Between 2 Shoulder Outcome Measures

Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after arthroscopic decompression surgery for subacromial impingement syndrome. The assessment at baseline and at 3 months included the OSS, the CS, and the European Quality of Life-5 Dimensions-3 Level (EQ-5D-3L) index. Responsiveness was assessed as follows: by correlation analysis between the change scores of the OSS, CS, and EQ-5D-3L index, and the Patient Global Impression of Change (PGIC) scale; by receiver-operating-characteristic (ROC) curve analysis using the PGIC scale as an external anchor; and by effect-size statistics. Results At 3 months, a follow-up assessment of 112 patients (89%) was conducted. The change scores of the CS and the OSS were more strongly correlated with the external anchor (PGIC scale) than the change score of the EQ-5D-3L index. The areas under the ROC curves exceeded 0.80 for both shoulder scores, with no significant differences between them, and comparable effect-size estimates were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery.

The significance of health anxiety and somatization in care-seeking for back and upper extremity pain

BACKGROUND Patients with musculoskeletal pain account for a large number of consultations in primary care. Improving our understanding of factors that make patients seek care could be of interest in decision making and prevention in the health care system. OBJECTIVES Our objectives were to examine if health anxiety, somatization and fear-avoidance beliefs were of importance for care-seeking with either back pain or upper extremity pain and to look at possible differences between the two groups. METHODS This is a prospective study with a baseline questionnaire and 18 months follow-up. Using the International Classification for Primary Care (ICPC), we identified care-seekers with either back pain or upper extremity pain among the potential patients of eight GPs. For analysis, we used Cox proportional hazards regression analysis. Analysis was stratified by gender. RESULTS We found that previous regional pain was a strong predictor of care-seeking. Somatization was associated with seeking care for back pain. Health anxiety was a predictor among women suffering from back pain. Only previous pain was a predictor of care-seeking for upper extremity pain. CONCLUSION The study implies that prevention of back pain and upper extremity pain requires different strategies and that gender and health anxieties should be taken into account.

Cross-cultural adaption and measurement properties of the Danish version of the Shoulder Pain and Disability Index

Objective: To cross-culturally adapt the Danish version of the Shoulder Pain and Disability Index and to evaluate its measurement properties in terms of reliability and known-group validity. Design: Test–retest study. Setting: Outpatient Clinic of the Department of Orthopaedic Surgery, Regional Hospital Herning, Denmark. Subjects: Consecutive shoulder patients referred to an outpatient clinic. Methods: The Shoulder Pain and Disability Index was translated from English into Danish according to international guidelines. The questionnaire was posted to patients one to two weeks before their scheduled clinical examination and repeated on the day of the examination. Results: A total of 65 patients with a variety of shoulder diagnoses were included in the study. No significant differences were found in scores between the first and the second questionnaire. The minimal detectable change was estimated to 19.4 points, and the intraclass correlation coefficient was 0.88 (95% confidence interval 0.83 to 0.94). Internal consistency measured by Cronbach’s alpha was 0.94. The questionnaire was found to discriminate well between currently working and non-working patients. Conclusion: The Shoulder Pain and Disability Index provides a sensitive and reliable tool to assess pain and disability in Danish-speaking orthopaedic shoulder patients.

Impact of work, health and health beliefs on new episodes of pain-related and general absence-taking

Objectives: To evaluate the impact of physical and psychosocial workloads, and self-reported health aspects and health beliefs, on the risk of new episodes of pain-related and general sickness absence. Methods: This was a cohort study with 2 years of follow-up of 3583 employed participants, 18—64 years of age. A questionnaire was used to obtain information about workloads, physical and mental health, fear avoidance and other health beliefs. Sickness absence data were collected from company reports, supplemented by self-report of the health problem to which absence was attributed, and by linkage to a central register of state-funded income loss compensation. Results: Sickness absence of at least 14 days and pain-related absence of at least 7 days was experienced by 24.9% and 5.2%, respectively, while 14.2% received state-funded income loss compensation. Physical work demands, working in the public sector, pain intensity, care-seeking behaviour, female gender and compensated sickness absence in the year prior to follow-up were the most important predictors of new episodes of sickness absence. Pain-related absence was associated with the same variables and also with high body mass index, but effect sizes differed. Psychosocial workloads, health anxiety and fear avoidance beliefs were unrelated to any of the absence measures used. Conclusion: Risk factors for general absence and for pain-related absence in unselected working populations are similar but of different effect sizes. A potential primary prevention area could be the provision of accommodating workplaces for employees with pain problems. The mechanisms behind the influence of care-seeking behaviour warrant further research.

Details on the association between heavy lifting and low back pain

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Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial

Background Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. Objective The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. Design A multicenter randomized controlled trial was conducted. Setting The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. Patients One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. Intervention A standardized exercise program consisting of physical therapist–supervised individual training sessions and home training was used. Outcome Measures The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. Results At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=−0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. Limitations The nature of the exercise intervention did not allow blinding of patients and care providers. Conclusion The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care.

0183 Face validity and inter-rater agreement between expert assessments of occupational mechanical exposures in a lower body job exposure matrix

Objectives We constructed a lower body job exposure matrix (JEM) based on five experts’ assessments of occupational mechanical exposures. The aim of this study was to evaluate the face validity of the rankings of the job groups and the inter-rater agreement between the experts’ rankings. Method The JEM cross tabulates the mean of five experts’ assessments of daily duration (hours/day) of standing/walking, kneeling/squatting, and whole-body vibration as well as total load lifted (kg/day), and frequency of lifting loads weighing ≥20 kg (times/day) in 121 job groups comprising occupational titles with expected homogeneous exposure patterns. The JEM covers 689 occupational titles, which were considered more than minimally exposed, out of 2227 in the Danish version of the International Standard Classification of Occupations. Weighted kappa statistics were used to evaluate inter-rater agreement on rankings of the job groups for four of these exposures. Two external experts checked the face validity of the rankings of the experts’ mean values. Results The experts’ ratings showed fair to moderate agreement (mean weighted kappa values between 0.36 and 0.49). The external experts agreed on 586 of the 605 rankings. Conclusions Experts agreed on rankings of the job groups, and rankings based on mean values had good face validity. However, further validation is warranted based on technical measurements or observations. The lower body JEM, which provides exposure estimates free of recall bias, has been applicable in exposure response studies of hip and knee osteoarthritis, inguinal hernia repair, varicose veins, and lumbar disc disorders.