Work, a prognosis factor for upper extremity musculoskeletal disorders?

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Washington University School of Medicine
Digital Commons@Becker
OHS Faculty PublicationsOccupational Health and Safety
1-1-2009
Work, a prognosis factor for upper extremity
musculoskeletal disorders
Alexis Descatha
Université Versailles-Saint Quentin
Yves Roquelaure
University of Angers, Angers,
Jean Francois Chastang
Université Versailles-Saint Quentin
Bradley A. Evanoff
Washington University School of Medicine in St. Louis
D. Cyr
Université Versailles-Saint Quentin
See next page for additional authors
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Recommended Citation
Descatha, Alexis; Roquelaure, Yves; Chastang, Jean Francois; Evanoff, Bradley A.; Cyr, D.; and Leclerc, Annette, "Work, a prognosis
factor for upper extremity musculoskeletal disorders".Occupational and Environmental Medicine, 66, 5, 351-352. 2009.

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Authors
Alexis Descatha, Yves Roquelaure, Jean Francois Chastang, Bradley A. Evanoff, D. Cyr, and Annette Leclerc
This article is available at Digital Commons@Becker:http://digitalcommons.wustl.edu/ohs_facpubs/7

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doi: 10.1136/oem.2008.042630
2009 66: 351-352 Occup Environ Med

A Descatha, Y Roquelaure, J-F Chastang, et al.
musculoskeletal disorders?
Work, a prognosis factor for upper extremity

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LETTER
Work, a prognosis factor for
upper extremity musculoskeletal
disorders?
Upper extremity musculoskeletal (UEMS)
disorders are a significant problem in indus-
trialcountries.1Thereisstrongevidenceforan
association between biomechanical exposures
and UEMS disorders.2–4However, little is
known about the occupational factors asso-
ciated with recovery from these disorders.5–7
To determine if occupational factors were
associated with outcome in workers with
UEMS symptoms or disorders, we used data
from a repetitive task survey performed in
1993–1994 and again in 1996–1997. The
design has been described in earlier publica-
tions.8 9Each worker had a standardised
medical examination at baseline and again
in 1996–1997. The self-administered ques-
tionnaire filled out at baseline included data
on personal variables, a psychological vari-
able, postures and biomechanical constraints
at work (self-assessed, but checked with the
occupational physician), psychosocial work
factors, and baseline severity of the disorder.
Workers were also asked in 1996–1997 about
changes in work tasks in the 3-year follow-
up period.
Only workers with symptoms or UEMS
disorders in 1993–1994 are considered here.
Three categories of outcome in 1996–1997
were defined: no symptoms and no UEMS
disorders, UEMS symptoms and no disorder,
and one or more UEMS disorders diagnosed.
We analysed the 1993–1994 factors asso-
ciated with outcomes (neither symptom nor
disorder in 1996–1997 versus symptoms only
and versus disorders), using multinomial
non-ordinal logistic regression. Factors were
included in the model if they reached a
p level of 0.20 in bivariate analyses. If some
prognosis factors were too strongly corre-
lated, only the most appropriate one was
included.
Of the initial 700 workers, 598 were
followed completely during the 3-year period
(85.4%). At baseline, 464 of them had UEMS
symptoms or disorders and were included in
this analysis (77.6% of the 598 workers).
Most hadadisorder
lence=70.4%) and only 43 had symptoms
in isolation. No difference in outcome was
found between those who reported their job
had changed in the last 3 years (n=114) and
those who declared that it had not (n=350,
p.0.05). Factors associated with the 3-year
outcome in multivariate analyses were age,
‘‘work with force’’, and pain intensity
(adjusted for gender, the presence of a
psychosomatic or depressive problem and
the presence of UEMS disorder diagnosed in
1993–1994; table 1), with a stronger associa-
tion for disorders than for symptoms only.
This study is one of the first to jointly
consider the occupational, personal and pain
factors associated with a prognosis of UEMS
symptoms or disorders, in a worker popula-
tion performing highly repetitive tasks.
Despite several limitations (no information
on events during the years between exam-
ination, losses to follow-up, subjective self-
assessment of risk factors, definition of
(n=421,preva-
UEMS disorders based on clinical examina-
tion), these results were consistent with the
few existing studies on prognosis: older age
isknown to berelatedto a poor prognosis,10–12
as are pain intensity and duration at base-
line,5 7 12–14and the presence of disorders at
baseline.10 15The role of occupational factors
in prognosis is still debated: some investiga-
tors have found that physical work factors
arenot associated
whereas others have reported that they
are.5 7 17Job control and satisfaction at work
were not associated with outcome in our
study.
In conclusion, we found that work with
force was associated with a poorer prog-
nosis, as were age and pain intensity at
baseline.Furtherstudies,
needed to clarify the role of personal and
work-related factors in determining the
prognosis of UEMS disorders in working
populations.
withprognosis,11 16
however,are
A Descatha,1,2Y Roquelaure,3J-F Chastang,1
B Evanoff,4D Cyr,1A Leclerc1
1INSERM, U687, Villejuif, F-94807, France and Universite ´
Versailles-Saint Quentin (UVSQ), Faculte ´ de Me ´decine Paris-
Ile-de-France-Ouest, Guyancourt, F-78280, France;2UVSQ-
AP-HP, Poincare ´ University Hospital, Occupational Health
Department, Garches, F-92380, France;3Laboratory of
Ergonomics and Occupational Health, University of Angers,
Angers, F-49000, France;4Division of General Medical
Sciences, Washington University School of Medicine, St.
Louis, MO 63110, USA
Correspondence to: Alexis Descatha, Unite ´ de pathologie
professionnelle, CHU Poincare ´, 104 bd R. Poincare ´, 92380
Garches, France; alexis.descatha@rpc.aphp.fr
Acknowledgements: We are grateful to the members of
the Study Group on Repetitive Work who were involved in
this survey, as well as to the occupational physicians who
collected the data and carried out the physical examinations.
We thank Lawrence J Fine for his contribution to the
preparation of the questionnaire in 1992.
Accepted 9 September 2008
Occup Environ Med 2009;66:351–352.
doi:10.1136/oem.2008.042630
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Table 1
and the baseline variables*
Multivariate analysis based on multinomial logistic model between the 3-year outcome
Presence of UEMS symptoms
alone in 1996–1997 (n=43),
OR (95% CI)
Presence of at least one UEMS
disorder in 1996–1997
(n=421), OR (95% CI)
Gender
Men
Women
Age
,30 years
30–45 years
.45 years
Presence of psychosomatic or
depressive problems
No
Yes
‘‘Work with force’’
No
Yes
Pain intensity in 1993–1994
No strong pain
Strong and unbearable pain
UEMS disorder in 1993–94
No
Yes
1
0.68 (0.27 to 1.72)
1
1.52 (0.80 to 2.86)
1
1.35 (0.48 to 3.82)
1.45 (0.37 to 5.67)
1
2.86 (1.42 to 5.73)
3.31 (1.32 to 8.29)
1
1.47 (0.27 to 7.95)
1
3.02 (0.89 to 10.23)
1
1.92 (0.78 to 4.76)
1
2.31 (1.27 to 4.21)
1
2.70 (1.05 to 5.00)
1
2.76 (1.52 to 6.91)
1
0.53 (0.17 to 1.63)
1
2.09 (0.89 to 4.93)
UEMS, upper extremity musculoskeletal.
The multiple UEMS disorders and duration of pain highly associated with pain intensity, were not included in the model.
*The reference was workers with no symptoms and no UEMS disorders in 1996–1997.
PostScript
Occup Environ Med May 2009 Vol 66 No 5351
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PostScript
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