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Prevalence of multisite musculoskeletal symptoms: A French cross-sectional working population-based study

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Background The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population. Methods This study was performed on surveillance data of the cross-sectional survey (2002–2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire. Results The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb). Conclusions The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS.
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R E S E A R C H A R T I C L E Open Access
Prevalence of multisite musculoskeletal
symptoms: a French cross-sectional working
population-based study
Elsa Parot-Schinkel
1,2*
, Alexis Descatha
3
, Catherine Ha
4
, Audrey Petit
1,2
, Annette Leclerc
3
and Yves Roquelaure
1,2
Abstract
Background: The musculoskeletal disorders in working population represent one of the most worrying work-
related health issues at the present time and although the very great majority of available data on the subject focus
on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence
of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence
and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.
Methods: This study was performed on surveillance data of the cross-sectional survey (20022005) conducted by a
network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old).
Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-
administrated standardized NORDIC questionnaire.
Results: The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean
age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with
95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS
(lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women.
Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least
30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the
upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the
three anatomical regions (upper limb, axial region and lower limb).
Conclusions: The frequency and extent of multisite MS reported by workers are considerable. Further research
must be conducted in this field in order to provide a better understanding of the characteristics and determinants
of these multisite MS.
Background
All over the world, musculoskeletal disorders (MSDs)
are responsible for considerable human, social and
work-related burdens in terms of pain, distress at work,
disability and quality of life. This major health issue has
been recognized by the United Nations and the World
Health Organization, which approved The Bone and
Joint Decade 20002010 [1]. MSDs in working popula-
tion are the leading cause of morbidity and work
disability in the European Union [2,3] and represent one
of the most worrying work-related health issues at the
present time. According to Eurostat [4], the Statistical
Office of the European Communities, MSDs are the
most widespread and most costly work-related health
problem in Europe, affecting about 45 million workers.
A better understanding of the mechanisms responsible
for the onset and progression of these disorders consti-
tutes a major public health challenge in order to im-
prove the prevention, management and prognosis of
these disorders. For many years, research has therefore
been largely devoted to risk factors and prognostic fac-
tors of MSDs demonstrating, regardless of the site
* Correspondence: elparot@chu-angers.fr
1
LUNAM Université, Université dAngers, Laboratoire dergonomie et
dépidémiologie en santé au travail (LEEST), 49045, Angers, France
2
CHU dAngers, 49933, Angers, France
Full list of author information is available at the end of the article
© 2012 Parot-Schinkel et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Parot-Schinkel et al. BMC Musculoskeletal Disorders 2012, 13:122
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studied, an increased risk related to cumulative bio-
mechanical, psychosocial and organizational stresses.
The very great majority of the available data (descrip-
tive, aetiological and prognostic) focus on MSDs defined
by anatomical site. Recent studies support a more global
approach to musculoskeletal disorders analysing the ex-
tent of musculoskeletal symptoms (MS) and especially
the number of symptomatic anatomical sites rather than
a particular site, either in the general population [5-17]
or in the working population [18-24]. The results of
these studies indicate the moderate prevalence of symp-
toms strictly confined to a specific anatomical site (esti-
mated prevalence of 15 to 30% depending on the study)
and the predominance of multisite MS (prevalence in
the general population about 1/3 and 2/3 in the working
population).
This characterization of MS based on the number of
symptomatic sites regardless of the anatomical sites
appears to be particularly suitable to study widespread
pain according the American College of Rheumatology
definition (WSP) [25,26]. However, this appears to be in-
sufficient to describe less widespread multisite MS, as
Picavet et al. clearly described that although involvement
of several sites in the same region was very common, in-
volvement of several sites located in distinct regions was
also common [15]. It would be reasonable to suppose
that when four anatomical sites are affected, the patho-
physiology and prognosis may vary according to their re-
gional distribution (symptoms affecting a single
anatomical region or extending to more than one re-
gion). Croft challenged the conventional approach to
MS defined by anatomical site by proposing a new and
more relevant definition taking into account the extent
of MS by region [27].
Although several teams have started to describe the
profiles of these multisite MS [15,16,20,24] or 2-by-2
combinations corresponding to these multisite MS
[18,19,21,24,28-31], very few studies on multisite MS
and their corresponding profiles have been published.
Many of these studies were also conducted on very spe-
cific populations [18,20,23,24,32,33] and/or small sample
sizes [18,20,23,24,32].
The objective of this study, based on surveillance data
in a large regional workforce, was to describe the preva-
lence and characteristics of multisite MS in a large
population of workers.
Methods
Study design and population
The study was based on surveillance data collected by a
network of occupational physicians (OPs) in the working
population of the Loire Valley region (Central West
France) [34]. The Pays de la Loire study was approved
by both appropriate national committees : the Comité
consultatif sur le traitement de linformation en matière
de recherché dans le domaine de la santé (CCTIRS n°01-
215) and the Commission nationale de linformatique et
des libertés (CNIL n°901 273).
The economic structure of this region (5% of the
French working population) is diversified and similar to
that of most French regions [35].
All French workers, including temporary and part-
time workers, undergo a mandatory annual health exam-
ination by an OP in charge of the medical surveillance
of a group of companies. Eighty-three OPs out of 460
(18% participation), representative of the regions OPs,
participated in the study. Each OP was trained by the
investigators to randomly include workers undergoing a
mandatory regularly-scheduled health examination be-
tween April 2002 and April 2005. The inclusion process
followed a two-stage sampling procedure: first, the re-
search team chose 1545 half-days of scheduled exami-
nations for each OP. Next, using random sampling
tables, each OP selected 1 out of 10 workers from the
schedule on the half-days of worker examinations con-
sidered. Among the regularly-scheduled health examin-
ation which had thus been selected (approximately 2.2%
of the workers under surveillance by the 83 OPs), fewer
than 10% of the selected workers were excluded (no
shows, refusals, already included).
Data
Data analysed in this article were collected by a ques-
tionnaire filled in by the workers during their annual
visit. In particular, this questionnaire collected informa-
tion on sociodemographic characteristics and on the
presence and sites of MS. The presence and sites of MS
were documented by a French version of the NORDIC
questionnaire [36] including a mannequin with the ana-
tomical sites considered, the standardized scale routinely
used by occupational physicians for the detection of MS
[37].
The following anatomical sites were studied: neck,
shoulder/arm, elbow/forearm, hand/wrist, upper back,
lower back, hip/thigh, knee/lower leg and ankle/foot.
Two definitions of MS were used in this article:
presence of symptoms during the past 12 months by
site;
presence of symptoms lasting at least 30 days
(prolonged) during the past 12 months by site.
For bilateral anatomical sites, MS were classed as
present if they were reported on either or both sides of
the body.
In results presented by anatomical region (axial, upper
limb and lower limb), the neck was considered to be
part of the upper limb. The presence of MS in an
Parot-Schinkel et al. BMC Musculoskeletal Disorders 2012, 13:122 Page 2 of 11
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anatomical region for at least 30 days corresponded to
presence in at least one site within the region for at least
30 days.
Multisite MS are defined by the presence of symptoms
affecting more than one anatomical site on 9 studied
sites.
Statistical analysis
Classical statistical analyses were performed using SPSS
software (v15; SPSS Inc., Chicago, IL, USA). All analyses
were performed separately in men and women. The stat-
istical unit was the individual, prevalence rates were cal-
culated by dividing the number of subjects reporting
symptoms (unilateral or bilateral) for the site of interest
over the total number of responding subjects together
with the 95% confidence intervals. Categorical data were
compared with the Chi-square test or Fisher's exact test
and a Mantel-Haenszel extension of the chi-square test
for trend was used to test a linear trend. The limit of sig-
nificance was 0.05.
Results
The study population comprised 3,710 workers (2,162
men (58%), 1,548 women (42%), mean age: 38.4, SD:
10.4 years) out of 184,600 (2.0% sample) workers exam-
ined by the 83 OPs. Subjects mainly worked in service
industries (59%), meat and manufacturing industries
(34%), and more rarely in the construction (6%) and
agriculture (1.5%) sectors. Men were mainly skilled and
unskilled blue collar workers (56%), in intermediate
occupations and technicians (25%), and managers and
professionals (10%). Most women were low-grade white
collar workers (52%), skilled and unskilled blue collar
workers (24%), and in intermediate occupations and
technicians (19%). Most workers, regardless of gender,
presented a long service in the current job: more than
ten years in 56% of cases, more than two years in 84% of
cases and more than one year in 94% of cases.
Prevalence of musculoskeletal symptoms (MS)
A total of 3,109 workers reported at least one MS affect-
ing the limbs and/or spine during the past 12 months
(1,811 men and 1,298 women). The corresponding
prevalence rates were 83.8% with 95% confidence inter-
val of [82.8-85.3] for men and 83.9% [82.0-85.7] for
women.
At least one MS lasting at least 30 days during the past
12 months was reported by 1,287 workers (710 men and
577 women) with a prevalence of 32.8% [30.9-34.8] for
men and 37.3% [34.9-39.7] for women (p = 0.005).
Prevalences of MS in the nine anatomical sites during
the past 12 months are summarized in Table 1. The
most frequent site was the lower back with MS reported
by 59.3% [57.2-61.3] of men and 54.0% [51.5-56.5] of
women (p = 0.0015) and with MS lasting at least 30 days
reported by 16.6% [15.4-17.8] of all workers.
The other most frequent sites of MS were the neck,
shoulder and wrist in men and women, the upper back
in women and the knee or lower leg in men with signifi-
cant differences (for MS over the past 12 months and
MS lasting at least 30 days over the past 12 months) be-
tween the two sexes (with the exception of the knee or
lower leg) (Table 1).
Prevalence of multisite MS
Two-thirds of workers reported the presence of MS in-
volving more than one anatomical site (Table 2): 63.2%
[61.1-65.2] of men and 68.3% [66.0-70.7] of women
(p = 0.001).
Slightly less than one third of workers reported MS in-
volving four or more anatomical sites (27.3% of men and
34.0% of women), and 10% reported MS involving six or
more sites (8.2% of men and 12.7% of women).
Slightly less than 20% of workers reported MS lasting
at least 30 days in more than one anatomical site
(Table 3): 17.1% [15.5-18.7] of men and 22.4% [20.3-24.4]
of women (p <0.0001) and 6.3% of workers reported MS
lasting at least 30 days in four or more anatomical sites
(4.9% of men and 8.3% of women), while 4.5% of women
reported MS lasting at least 30 days in five or more ana-
tomical sites (versus 2.0% of men).
The prevalence of MS affecting two to four anatomical
sites was three to twelve times more common than
prevalence of MS affecting only one site in workers who
reported musculoskeletal symptoms at a given anatom-
ical site whatever it is (Figure 1).
More than 80% of MS lasting at least 30 days involving
the upper back, hip, neck and elbow were associated
with other MS (multisite MS). MS lasting at least 30 days
involving the knee or lower leg, lower back and ankles
were more frequently isolated (1/4 to 1/3 of cases).
The prevalence of multisite MS increased slightly but
significantly with increasing age (test for linear trend:
p = 0.001 for the men and p <0.0001 for the women,
Table 2). For the prevalence of multisite MS lasting at
least 30 days, we see a significant increase with in-
creasing age: slight for the men (test for linear trend:
p<0.0001, Table 3) but more marked for the women
(test for linear trend: p <0.0001, Table 3).
For the women, the prevalence of multisite MS was
associated with the occupational category (p = 0.006,
Table 2), we see a prevalence more raised for skilled and
unskilled workers versus associate professionals and
technicians.
The prevalence of multisite MS lasting at least 30 days
was associated with the occupational category for the
men and women (Table 3) with, for the men, a slightly
lower prevalence for the managers and professionals
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Table 1 Prevalence (%) and 95% confidence intervals (CI) of musculoskeletal symptoms during the past 12 months
among men and women
Symptoms: n (%) CI Men (N = 2,162) Women (N= 1,548)
Musculoskeletal symptoms:
Neck symptoms** 725 (33.5) 31.5-35.5 747 (48.3) 45.8-50.7
Shoulder or upper arm symptoms* 735 (34.0) 32.0-36.0 601 (38.8) 36.4-41.3
Elbow or forearm symptoms 371 (17.2) 15.6-18.7 261 (16.9) 15.0-18.7
Wrist or hand symptoms** 468 (21.6) 19.9-23.4 463 (29.9) 27.6-32.2
Upper back symptoms** 451 (20.9) 19.1-22.6 503 (32.5) 30.2-34.8
Low back symptoms* 1281 (59.3) 57.2-61.3 836 (54.0) 51.5-56.5
Hip or thigh symptoms 360 (16.7) 15.1-18.2 278 (18.0) 16.0-19.9
Knee or lower leg symptoms 611 (28.3) 26.4-30.2 410 (26.5) 24.3-28.7
Ankle or foot symptoms 339 (15.7) 14.1-17.2 230 (14.9) 13.1-16.6
Musculoskeletal symptoms lasting at least 30 days:
Neck symptoms** 142 (6.6) 5.5-7.6 185 (12.0) 10.3-13.6
Shoulder or upper arm symptoms** 197 (9.1) 7.9-10.3 202 (13.0) 11.4-14.7
Elbow or forearm symptoms 128 (5.9) 4.9-6.9 112 (7.2) 5.9-8.5
Wrist or hand symptoms** 130 (6.0) 5.0-7.0 154 (9.9) 8.5-11.4
Upper back symptoms** 121 (5.6) 4.6-6.6 174 (11.2) 9.7-12.8
Low back symptoms 352 (16.3) 14.7-17.8 264 (17.1) 15.2-18.9
Hip or thigh symptoms 102 (4.7) 3.8-5.6 91 (5.9) 4.7-7.1
Knee or lower leg symptoms 189 (8.7) 7.6-9.9 146 (9.4) 8.0-10.9
Ankle or foot symptoms 109 (5.0) 4.1-6.0 89 (5.7) 4.6-6.9
Significant differences between men and women: * p <0.01, ** p <0.0001.
Table 2 Prevalence (%) and 95% confidence intervals (CI) of multisite musculoskeletal symptoms (MS) during the past
12 months among men and women
Multisite MS: n (%) CI Men (N = 2,162) Women (N = 1,548)
By genre* 1366 (63.2) 61.1-65.2 1058 (68.3) 66.0-70.7
By age group (test for linear trend)
}{
16-29 years 296 (57.6) 53.3-61.9 228 (63.2) 58.2-68.1
30-39 years 413 (63.5) 59.8-67.2 268 (62.5) 57.9-67.1
40-49 years 393 (64.2) 60.4-68.0 358 (73.5) 69.6-77.4
50-63 years 259 (68.3) 63.7-73.0 204 (75.6) 70.4-80.7
By occupational category
Managers and professionals 134 (63.8) 57.3-70.3 52 (66.7) 56.2-77.1
Associate professionals/technicians 337 (62.4) 58.3-66.5 195 (67.5) 62.1-72.9
Employees 113 (60.1) 53.1-67.1 523 (65.5) 62.2-68.8
Skilled and unskilled workers 773 (63.9) 61.2-66.6 285 (75.6) 71.3-79.9
By economic activity
Service industries 664 (61.6) 58.7-64.5 726 (66.4) 63.6-69.2
Meat and manufacturing industries 559 (65.1) 61.9-68.3 293 (73.1) 68.7-77.4
Construction 123 (65.1) 58.3-71.9 16 (64.0) 45.2-82.8
Agriculture 19 (61.3) 44.1-78.4 19 (76.0) 59.3-92.7
Significant differences between men and women: * p <0.01, ** p <0.0001.
Significant differences among men:
}
p<0.01,
}}
p<0.0001.
Significant differences among women:
p<0.01,
{
p<0.0001.
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(p = 0.013) and, for the women, a higher prevalence for
skilled and unskilled workers (p = 0.052). Furthermore,
for the women, we also observe a significant association
between prevalence of multisite MS lasting at least
30 days and the activity sector with a higher prevalence
for the meat and manufacturing industries versus the
service industries (p = 0.026, Table 3).
MS by anatomical region
The anatomical regions most frequently involved were
the axial and upper limb regions with a prevalence of
MS lasting at least 30 days over the past 12 months of
18 to 23% (Table 4).
About one quarter of subjects (Table 5) reported the
presence of MS involving a single anatomical region dur-
ing the past 12 months (25.7% of men and 21.9% of
women), usually involving axial regions in men (45.4% of
symptoms localized to one region) and the upper limb
in women (54.3% of symptoms localized to one region).
One-third of subjects (31.3% of men and 34.2% of
women) reported the presence of MS involving two ana-
tomical regions during the past 12 months (axial and
upper limb for 2/3 of them) and 27.2% reported disor-
ders involving the three anatomical regions studied:
axial, upper limb and lower limb.
Nine to 12% of subjects reported the presence of MS
in two anatomical regions for at least 30 days (Table 6)
with a predominance of symptoms affecting the axial
and upper limb regions (51.3% of symptoms localized to
two regions).
More than 90% of multisite MS concerned two or three
anatomical regions (91.9% for men and 90.6% for women).
Almost 80% of multisite MS lasting at least 30 days
involved two or three anatomical regions (77.0% for men
and 77.7% for women).
Discussion
Main results
This study presented analyses of the prevalence of multi-
site MS over a 12-month period in a general population
of workers and described both the type and extent of
other associated MS.
The main results of this study are:
The frequency and extent of multisite MS were
considerable in this population (2/3 with multisite
MS with more than 90% of these multisite MS
involving more than one anatomical region);
Although multisite MS were significantly more
frequent in women (68.3%), they were also very
frequent in men (63.2%);
The prevalence of multisite MS lasting more than
30 days was very high (17.1% men and 22.4% of
women) and these symptoms were widespread (80%
of these multisite MS involved more than one
anatomical region).
Table 3 Prevalence (%) and 95% confidence intervals (CI) of multisite musculoskeletal symptoms (MS) lasting at least
30 days during the past 12 months among men and women
Multisite MS: n (%) CI Men (N = 2,162) Women (N = 1,548)
By genre** 370 (17.1) 15.5-18.7 346 (22.4) 20.3-24.4
By age group (test for linear trend)
}}{
16-29 years 48 (9.3) 6.8-11.9 43 (11.9) 8.6-15.3
30-39 years 97 (14.9) 12.2-17.7 72 (16.8) 13.2-20.3
40-49 years 130 (21.2) 18.0-24.5 132 (27.1) 23.2-31.1
50-63 years 93 (24.5) 20.2-28.9 99 (36.7) 30.9-42.4
By occupational category
}
Managers and professionals 22 (10.5) 6.3-14.6 19 (24.4) 14.8-33.9
Associate professionals/technicians 86 (15.9) 12.8-19.0 54 (18.7) 14.2-23.2
Employees 30 (16.0) 10.7-21.2 170 (21.3) 18.5-24.1
Skilled and unskilled workers 232 (19.2) 17.0-21.4 102 (27.1) 22.6-31.5
By economic activity
Service industries 170 (15.8) 13.6-17.9 228 (20.9) 18.5-23.3
Meat and manufacturing industries 160 (18.6) 16.0-21.2 108 (27.0) 22.6-31.3
Construction 34 (18.0) 12.5-23.5 2 (8.0) 1.0-26.0
#
Agriculture 5 (16.1) 3.2-29.1 6 (24.0) 7.3-40.7
Significant differences between men and women: * p <0.01, ** p <0.0001.
Significant differences among men:
}
p<0.01,
}}
p<0.0001.
Significant differences among women:
p<0.01,
{
p<0.0001.
#
Estimation of CI with Fishers exact method (np or nq <5).
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Methodological considerations
One of the strong points of this study is the large sample
size (3,710 workers) and the representativity of the study
population. The fact that all workers in France, including
part-time or temporary workers, are submitted to an an-
nual health check-up by an occupational physician in
charge of the medical surveillance of a group of com-
panies confirms that the recruitment of this study, based
on a network of occupational physicians, is relevant to
study the target population although farmers and self-
employed workers, rarely followed by occupational phy-
sicians, would be underrepresented in this study. The
representativity of the study sample compared to the
population of the region and to the French population
Table 4 Prevalence (%) and 95% confidence intervals (CI)
of musculoskeletal symptoms in various anatomical
regions during the past 12 months among men and
women
Symptoms: n (%) CI Men (N = 2,162) Women (N = 1,548)
Musculoskeletal symptoms:
Axial 1395 (64.5) 62.5-66.5 996 (64.3) 62.0-66.7
Upper limb (with neck) 1310 (60.6) 58.5-62.7 1067 (68.9) 66.6-71.2
Lower limb 942 (43.6) 41.5-45.7 623 (40.2) 37.8-42.7
Musculoskeletal symptoms lasting at least 30 days:
Axial 383 (17.7) 16.1-19.3 335 (21.6) 19.6-23.7
Upper limb (with neck) 378 (17.5) 15.9-19.1 362 (23.4) 21.3-25.5
Lower limb 322 (14.9) 13.4-16.4 229 (14.8) 13.0-16.6
Table 5 Numbers of anatomical regions with
musculoskeletal symptoms during the past 12 months
among men and women
Symptoms: n (%) CI Men (N = 2,162) Women (N = 1,548)
No region: 351 (16.2) 14.7-17.8 250 (16.1) 14.3-18.0
One region: 555 (25.7) 23.8-27.5 339 (21.9) 19.8-24.0
Axial 252 (11.7) 10.3-13.0 121 (7.8) 6.5-9.2
Upper limb (with neck) 211 (9.8) 8.5-11.0 184 (11.9) 10.3-13.5
Lower limb 92 (4.3) 3.4-5.1 34 (2.2) 1.5-2.9
Two regions: 676 (31.3) 29.3-33.2 530 (34.2) 31.9-36.6
Axial and upper limb 406 (18.8) 17.1-20.4 370 (23.9) 21.8-26.0
Axial and lower limb 157 (7.3) 6.2-8.4 76 (4.9) 3.8-6.0
Upper and lower limb 113 (5.2) 4.3-6.2 84 (5.4) 4.3-6.6
Three regions: 580 (26.8) 25.0-28.7 429 (27.7) 25.5-29.9
A
K
H
LB
UB
W
E
S
N
0 20406080100
A
A
K
H
LB
UB
W
E
S
N
020406080100
B
Distribution (%)
Symptoms in 1 site
Symptoms in 2-4 sites
Symptoms in 5 sites or more sites
Figure 1 Distribution of musculoskeletal symptoms lasting at least 30 days according to the number of symptoms. These figures
represent the distribution of musculoskeletal symptoms lasting at least 30 days during the past 12 months according to the number of declared
symptoms among men (figure A) and women (figure B): Neck symptoms (N), Shoulder or upper arm symptoms (S), Elbow or forearm symptoms
(E), Wrist or hand symptoms (W), Upper back symptoms (UB), Low back symptoms (LB), Hip or thigh symptoms (H), Knee or lower leg symptoms
(K), Ankle or foot symptoms (A).
Parot-Schinkel et al. BMC Musculoskeletal Disorders 2012, 13:122 Page 6 of 11
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has already been detailed in a previous article [34]: Com-
parison of their socio-economic status with the last
available French census (1999, http://www.insee.fr), the
distribution of occupations showed no major differences
for either gender with the regional workforce, except for
the few occupations not surveyed by OPs (e.g., shop-
keepers and self-employed workers).
The use of a self-administered questionnaire intro-
duces a reporting bias inherent to this type of data col-
lection leading probably to an over-estimation of recent
and more serious musculoskeletal symptoms [38]. Fur-
thermore, some individuals might have a tendency to re-
port any symptoms, whereas others not report similar
symptoms [39]. However, we have collected no informa-
tion on the personality traits which could influence
reporting patterns of symptoms. The standardized Nordic
questionnaire [38] or derived questionnaires are com-
monly used in epidemiological studies on musculoskeletal
disorders in the workplace or in the general population.
The sensitivity and repeatability of this questionnaire are
good and this questionnaire is likely to have a high utility
in screening and surveillance [40-46]. The French version
of this questionnaire [47] has a good sensitivity (100%)
and moderate specificity (51%) in comparison with the
physical examination of the upper limbs, according to the
study of Descatha and al [48].
Lastly, this cross-sectional study cannot provide any
information about the chronology and course of the
symptoms described.
Prevalence of MS
Estimated prevalences of MS reported in the literature
vary considerably from one study to another, as they are
highly dependent on the definition of musculoskeletal
symptoms (types of symptoms, duration of symptoms
and exposure period considered), the populations inter-
viewed and the context of the study.
However, the results of this study are fairly concordant
with those reported in the literature and the general
knowledge on this subject. The prevalence of MS
observed in this study (about 84%) is similar to the
prevalence of 87% reported in several similar studies
[11,13,20].
The results concerning the prevalence of MS by ana-
tomical site over a 12-month period are also globally
consistent with published data.
In a review of the literature [49], the prevalence of low
back symptoms over a 12-month period was between 39
and 67%. The prevalence of 57% observed in the present
study was therefore perfectly consistent with this range,
as well as the estimations published in other studies
[15,21,23,24]. The prevalence of MS of the upper back
(26%) is also concordant with data of the literature (pre-
valences ranging from 6 to 33% [15,22,24]), as are the
prevalences of MS of the elbow (17%, 6 to 21% in the lit-
erature [15,22-24]), hand (25%, 8 to 38% in the literature
[15,18,22-24]) and hip (17%, 6 to 32% in the literature
[15,22,24]).
Published data on the prevalence of MS over a 12-month
period in other sites are more heterogeneous [15,18,
19,22-24]. However, the estimated prevalences reported
in the present study are consistent with published
data, but are situated in the low range for the ankles
or feet (15% in our study and 7 to 27% in the litera-
ture) and in the high range for the neck (40% in our
study and 17 to 48% in the literature), shoulder (36%
in our study and 19 to 39% in the literature) and
knee or lower leg (28% in our study and 11 to 26%
in the literature).
Prevalence of multisite MS
The multisite MS described in this study were slightly
more frequent and more extensive than those reported
in the general population (50% of multisite MS and only
20.6% with MS in 4 or more sites) in the study by
Picavet et al. [15]. When we compare the prevalence of
multisite MS by sex and age group, we observe in our
study in working population that the prevalences were on
average twice as high that those observed in the study of
Picavet in general population. In contrast, Kamaleri [11-14]
reported more frequent and more extensive multisite MS
in a general population cohort (75.4% of multisite MS and
37.5% with MS in 5 or more sites). However, Kamaleri
et al. studied an additional anatomical site, the head, for
which more than 30% of the population reported symp-
toms. This can probably explain the higher prevalence
reported by Kamaleri and al. This anatomical site was not
taken into account in this study, as head symptoms do not
constitute a work-related MS.
High prevalences of multisite musculoskeletal pain are
commonly found in many countries, but the precise
Table 6 Numbers of anatomical regions of
musculoskeletal symptoms lasting at least 30 days
during the past 12 months among men and women
Symptoms: n (%) CI Men (N = 2,162) Women (N = 1,548)
No region: 1452 (67.2) 65.2-69.1 971 (62.7) 60.3-65.1
One region: 425 (19.7) 18.0-21.3 308 (19.9) 17.9-21.9
Axial 148 (6.8) 5.8-7.9 101 (6.5) 5.3-7.8
Upper limb (with neck) 149 (6.9) 5.8-8.0 140 (9.0) 7.6-10.5
Lower limb 128 (5.9) 4.9-6.9 67 (4.3) 3.3-5.3
Two regions: 197 (9.1) 7.9-10.3 189 (12.2) 10.6-13.8
Axial and upper limb 91 (4.2) 3.4-5.1 107 (6.9) 5.6-8.2
Axial and lower limb 56 (2.6) 1.9-3.3 47 (3.0) 2.2-3.9
Upper and lower limb 50 (2.3) 1.7-2.9 35 (2.3) 1.5-3.0
Three regions: 88 (4.1) 3.2-4.9 80 (5.2) 4.1-6.3
Parot-Schinkel et al. BMC Musculoskeletal Disorders 2012, 13:122 Page 7 of 11
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comparison of prevalences of musculoskeletal pain in
France and other high income countries is difficult due
to the variability of the methods used. However, the
results of the World Mental Health Surveys (WMHS) of
multiple pains (2 or more sites with pain problems
among the following 4 ones: back/neck pain, headaches,
arthritis, other pain) in the general population are glo-
bally comparable for France and other countries [50].
These results are not comparable because the health
problems taken into account by both studies are not
strictly identical. Despite this limit, this result of the
WMHS illustrate that the problem of the painful symp-
toms is globally comparable in the French population
than in other high income countries.
Our data concerning the number of anatomical sites
of MS differ from those reported by some studies con-
ducted in working populations [18,20,23], as these stud-
ies targeted specific populations and only considered a
limited number of sites (4 to 7 sites).
Yeung [24] reported similar frequencies of multisite
MS in men workers (63.4%) to those reported in this
study (63.9% for men workers), but, as in the study by
Kamaleri, these symptoms were more widespread (22.7%
with MS in 5 or more sites).
Although Haukka [20] only studied pain experienced
during the past three months, he reported similar preva-
lence of MS (73% among female kitchen workers versus
75.6% for female workers in this study) and similar re-
gional distribution of MS to that observed in this study.
Prevalence of MS lasting at least 30 days
The estimated prevalences of MS lasting at least 30 days
presented in this study are concordant with published
data [18,51,52] and clearly confirm the importance of
these subacute or chronic symptoms.
Multisite MS lasting at least 30 days among nurses,
office workers and postal clerks in Crete were more fre-
quent (1/3 versus, in our study, 15.8% for men and
20.9% for women in the service industries), but less
widespread (only 4% with MS lasting at least 30 days in
4 or more sites), in the study by Solidaki [23].
In our study, MS lasting at least 30 days involving
the knee or lower leg and lower back were often iso-
lated. Conversely, MS lasting at least 30 days involving
the upper back, hip and elbow, relatively uncommon
in our study, were usually associated with other MS.
This observation underlines that multisite MS do not
necessarily correspond to the most frequent MS and
suggests the existence of anatomical associations spe-
cific to multisite MS.
Comparison between men and women
In this study, as in several previously published studies
[21,23,33,53], 12-month prevalences were significantly
higher in women for MS of the neck (+15%) and wrist
(+8%). Twelve-month prevalences were also significantly
higher in women than men for MS of the upper back
(+11%) and shoulder (+5%), but were significantly lower
for the lower back (5%).
Significant differences, relatively moderate (4 to 6%),
were also observed for MS lasting at least 30 days (with
the exception of the lower back).
These findings are consistent with the observed differ-
ences in the prevalence of multisite MS: multisite MS
were significantly more frequent in women (+5%), in
agreement with the literature. This could reflect not only
a higher tendency in women than men to report pain at
multiple sites [54], but also a higher burden of disease
among women [55]. The sites mostly frequently involved
in women (neck, shoulder, wrist and upper back) also
corresponded to the sites most frequently associated
with others MS (i.e. multisite MS). On the other hand,
MS of the lower back, less frequent in women, often
corresponded to localized MS.
Nevertheless, multisite MS were also reported by a
considerable proportion of men, including widespread
MS (MS involving 5 or more sites).
Recent studies have specifically investigated differences
between men and women [56,57]. Messing et al. demon-
strated that gender was an independent risk factor for
neck and lower limb pain even after adjustment for all
of the identified personal and work-related risk factors.
The proposed explanations for the impact of gender
included different exposures and working conditions
(even within the same type of job), an interaction be-
tween gender and personal factors, as well as biological
and psychological differences. Silverstein et al. also
reported higher prevalence rates of declared MS in
women, but few differences in terms of diagnosed mus-
culoskeletal disorders. Furthermore, in this last study, in-
dependent personal risk factors associated with MS of
the wrist were more advanced age, presence of comor-
bidities and a high body mass index for women, while
only more advanced age was an independent risk factor
for men.
Perspectives
Several studies have demonstrated a poorer state of
health [11,30,58] associated with these multisite MS, es-
pecially in terms of sleep [11,58], comorbidities (other
MS or vascular diseases) [59], functional capacity
[12,15,17,58,60] and quality of life [30,60], and a poorer
occupational prognosis [14,22,61,62]. The risk associated
with these multisite symptoms increases with the num-
ber of sites affected, even after adjustment for the other
identified risk factors [11-14,22].
The presence of regional or widespread MS has also
been reported to be significantly correlated with excess
Parot-Schinkel et al. BMC Musculoskeletal Disorders 2012, 13:122 Page 8 of 11
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mortality compared to subjects not experiencing MS,
with an excess mortality of about 20% for regional pain
(excess cancer mortality) and 30% for WSP (excess can-
cer and cardiovascular mortality), after adjustment for
age, gender and ethnic group [63].
In this study, the presence of multisite MS was asso-
ciated with the female gender and advanced age. How-
ever, the whole working population was concerned since
the prevalence of the multisite MS lasting at least 30 days
for the younger age group was not negligible (9% in men
and 12% in women). The prevalence of multisite symp-
toms was little influenced by occupational categories
and activity sector. So, these results do not allow the
identification of specific risk groups to target future
interventions of prevention.
Conclusions
This study confirms the importance of multisite MS, in-
cluding symptoms lasting at least 30 days. In view of the
poor prognosis associated with these multisite MS, fur-
ther research must be conducted on this subject in order
to more clearly identify the various profiles of multisite
MS and their determinants.
Competing interests
None of the authors has any conflicts of interest to declare.
Authors' contributions
Parot-Schinkel performed the analyses, participated to data interpretation,
wrote the main part of the first version of the manuscript and made
revisions after comments from the other authors. Descatha participated to
data interpretation, to writing the first version of the manuscript and to
comment the different versions of the manuscript. Ha and Leclerc
participated to design the study, to data interpretation, and to comment the
manuscript. Petit participated to data interpretation and to comment the
different versions of the manuscript. Roquelaure designed and conducted
the study, participated to data interpretation, and to comment the
manuscript.
All authors read and approved the final manuscript
Authorsinformation
The authors are members of research units in occupational health and A
Descatha, Y Roquelaure and A Leclerc are members of the Musculoskeletal
Committee of the International Commission of Occupational Health (ICOH),
and the French Language Research group on MSD.
Acknowledgements
The authors are grateful to the occupational physicians involved in the
sentinel network: Doctors Abonnat, Banon, Bardet, Becquemie, Bertin,
Bertrand, Bidron, Biton, Bizouarne, Boisse, Bonamy, Bonneau, Bouguer-
Diquelou, Bourrut-Lacouture, Breton, Caillon, Cesbron, Chisacof, Chotard,
Compain, Coquin-Georgeac, Cordes, Couet, Coutand, Danielou, Darcy,
Davenas, De Lansalut, De Lescure, Diquelou, Dopsent, Dufrenne-Benetti,
Dupas, Evano, Fache, Fontaine, Frampas-Chotard, Guillier, Guillimin, Harinte,
Harrigan, Hervio, Hirigoyen, Jahan, Jube, Kalfon, Labraga, Laine-Colin,
Laventure, Le Clerc, Le Dizet, Lechevalier, Ledenvic, Leroux, Leroy-Maguer,
Levrard, Levy, Logeay, Lucas, Mallet, Martin-Laurent, Mazoyer, Meritet, Michel,
Migne-Cousseau, Moisan, Page, Patillot, Pinaud, Pineau, Pizzalla, Plessis,
Plouhinec, Raffray, Robin-Riom, Roussel, Russu, Saboureault, Schlindwein,
Soulard, Thomson, Treillard and Tripodi. The Pays de la Loire study was
supported by The French Institute for Public Health Surveillance. We thank
Anthony Saul who provided traduction services for this article.
Author details
1
LUNAM Université, Université dAngers, Laboratoire dergonomie et
dépidémiologie en santé au travail (LEEST), 49045, Angers, France.
2
CHU
dAngers, 49933, Angers, France.
3
Université de Versailles St-Quentin, UMRS
1018, Centre for Research in Epidemiology and Population Health,
Population-Based Epidemiological Cohorts Research Platform, 94807, Villejuif,
France.
4
Département santé travail, Institut de veille sanitaire, 94415,
Saint-Maurice, France.
Received: 10 August 2011 Accepted: 29 June 2012
Published: 20 July 2012
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doi:10.1186/1471-2474-13-122
Cite this article as: Parot-Schinkel et al.:Prevalence of multisite
musculoskeletal symptoms: a French cross-sectional working
population-based study. BMC Musculoskeletal Disorders 2012 13:122.
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... In other words, the majority of the available studies have evaluated site-specific MSDs. Nevertheless, some recent studies have focused on a multisite investigation of MSDs in the working population [8][9][10][11][12] and the general population [13][14][15][16], suggesting a moderate prevalence of symptoms strictly restricted to a specific anatomical site (estimated prevalence of 15-30% in different studies) and a notable prevalence of multisite symptoms (estimated to be one-third and two-thirds in the general and working populations, respectively). Furthermore, although the involvement of several sites in the same region has been very common, the involvement of several sites located in separate regions has also been reported [13]. ...
... Recent studies have emphasized a multisite investigation of MSDs in the working and general populations [8,11]. In one study on French industrial workers based on descriptive data, two-thirds of the workers reported musculoskeletal symptoms in more than one anatomical site in the last year and the anatomical sites that involved more simultaneously were the neck, upper back, elbows and hips [8]. ...
... Recent studies have emphasized a multisite investigation of MSDs in the working and general populations [8,11]. In one study on French industrial workers based on descriptive data, two-thirds of the workers reported musculoskeletal symptoms in more than one anatomical site in the last year and the anatomical sites that involved more simultaneously were the neck, upper back, elbows and hips [8]. In one study among Greek workers of different job groups, pain at multiple anatomical sites was commonly reported, and the number of anatomical sites involving musculoskeletal symptoms was suggested as a measure for describing the severity of the impairment [11]. ...
Article
Background: The present study aimed to define specific patterns of multisite MSDs of office employees and to examine how derived patterns are related to the ergonomic chair design. Methods: in this cross-sectional study of 254 office employees, major patterns of MSDs were extracted using latent class analysis and investigated its association with the ergonomic chair design. Results: Four major patterns of MSDs were extracted using latent class analysis. Class 1 (12.1%) was characterized by individuals with high probabilities of MSDs in the neck, shoulders, back, and wrists. Class 2 (36.6%) was marked by individuals with near-zero probabilities of MSDs across all sites. Class 3 (14.1%) included high probabilities of complaints in the back, hips, and knees. Class 4 (38.2%) accounted for those with high probabilities of MSDs across all sites. Considering class 2 as the reference, there was an inverse significant association between seat comfort and membership to class 3 (OR=0.94, 95%CI [0.89-0.99]) and class 4 (OR=0.94, 95%CI [0.91-0.98]) and a significant inverse relationship between body support and membership to class 4 (OR=0.95, 95%CI [0.92-0.99]). Conclusion: MSDs can be summarized with latent class-derived patterns among the office workers. Ergonomic chair design was significantly associated with the type of MSDs patterns.
... After removal of duplicates, 5744 articles were screened at title/ abstract level and a total of 658 articles were screened at carried forward for full-text screening. Finally, 19 articles were considered eligible for this systematic review [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. ...
... The risk of bias assessment is shown in Table 2. In the overall rating, 14 articles were judged to have a low risk of bias [29-35, 38-43, 46], three articles a moderate risk of bias [28,36,37], and two articles a high risk of bias [44,45]. Overall, the internal validity was judged to be slightly better than the external validity, also, when the articles with an overall high risk of bias were excluded. ...
Article
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Background Co-occurring musculoskeletal pain is common among people with persistent low back pain (LBP) and associated with more negative consequences than LBP alone. The distribution and prevalence of musculoskeletal pain co-occurring with persistent LBP has not been systematically described, which hence was the aim of this review. Methods Literature searches were performed in MEDLINE, Embase, CINAHL and Scopus. We considered observational studies from clinical settings or based on cohorts of the general or working populations involving adults 18 years or older with persistent LBP (≥4 wks) and co-occurring musculoskeletal pain for eligibility. Study selection, data extraction and risk of bias assessment were carried out by independent reviewers. Results are presented according to study population, distribution and location(s) of co-occurring pain. Results Nineteen studies out of 5744 unique records met the inclusion criteria. Studies were from high-income countries in Europe, USA and Japan. A total of 34,492 people with persistent LBP were included in our evidence synthesis. Methods for assessing and categorizing co-occurring pain varied considerably between studies, but based on the available data from observational studies, we identified three main categories of co-occurring pain – these were axial pain (18 to 58%), extremity pain (6 to 50%), and multi-site musculoskeletal pain (10 to 89%). Persistent LBP with co-occurring pain was reported more often by females than males, and co-occurring pain was reported more often in patients with more disability. Conclusions People with persistent LBP often report co-occurring neck pain, extremity pain or multi-site pain. Assessment of co-occurring pain alongside persistent LBP vary considerable between studies and there is a need for harmonisation of measurement methods to advance our understanding of how pain in different body regions occur alongside persistent LBP. Systematic review registration PROSPERO CRD42017068807 .
... 17 A crosssectional investigation to depict prevalence and attributes of musculoskeletal symptoms in an extensive French working population using a Nordic questionnaire showed that the prevalence of the musculoskeletal disorder in women were 83.8%. 18 A study done on vegetable vendors concluded that the prevalence of low back pain in vendors is high. 19 A bulletin released by WHO states that low back pain is associated with working bad postures such as bending forward heavily with one's trunk, bending and twisting simultaneously with one's trunk, a bent and twisted posture for long periods, and making repetitive movements with the trunk. ...
... 10 Results were similar for the other occupational categories. Parot-Schinkel et al reported significantly higher prevalence rates for women than for men in the categories of managers/professionals (66.7% vs 63.8%), associated professionals/technicians (67.5% vs 62.4%), and skilled and unskilled workers (75.6% vs 63.9%), 20 showing that female workers were at higher risk of WMSDs than male workers. Therefore, gender differences should be considered in WMSD prevention. ...
Article
Full-text available
Objectives Occupational characteristics in the food and beverage service industry (FBSI) have been found to be associated with musculoskeletal disorders (MSDs). This study aimed to examine gender and site‐specific incident risks of MSDs among FBSI workers in Taiwan using a national population‐based database. Methods We conducted a 15‐year population‐based cohort study among 224 506 FBSI workers in Taiwan using data from five large nationwide databases to estimate direct standardized incidence ratios (SIRs) for identifying specific MSDs related to overexertion and repetitiveness during work. Overall, MSDs risks were also investigated by gender, sub‐industrial categories, and certificate types. Results We found SIRs for overall MSDs for male and female workers of 1.706 (95% CI, 1.688‐1.724) and 2.198 (95% CI, 2.177‐2.219), respectively. Our findings indicate significantly increased WMSD risk for both men and women, including median/ulnar nerve disorders (ICD‐9 354.0‐354.2); spondylosis and allied disorders (ICD‐9 721); intervertebral disc disorders (ICD‐9 722); disorders of the back (ICD‐9 724); peripheral enthesopathies and allied syndromes (ICD‐9 726); synovium, tendon, and bursa disorders (ICD‐9 727); and soft tissues of the peripheral system disorders (ICD‐9 729). Food stall workers and workers with Chinese cuisine or baking licenses were at higher risk among sub‐industrial categories and certificate types. Conclusion This large‐scale study revealed that FBSI workers were at higher risk for several MSDs than the general population. This information could help prioritize MSD problems and identify a high‐risk population. Relevant policy and ergonomic improvements and interventions could be implemented for health promotion in this industry.
... Our results are congruent with the literature regarding the musculoskeletal disorders which have been shown as comorbid conditions strongly linked to chronic LBP, whatever the populations studied, the musculoskeletal conditions considered and the methodological characteristics of the studies (10)(11)(12)17,18,22). This is congruent also with pathophysiological hypotheses and findings related to multisite pain (23). Our results tend to suggest that the association may be stronger with non-specific musculoskeletal pain such as those considered in the somatoform cluster (thoracic back complaints, muscle pain), rather than with more specific musculoskeletal diagnoses, at least during the 2 years following the beginning of the episodes. ...
... Most cited References (Can, Atalay, & Eraslan, 2015;Chiasson, Imbeau, Aubry, & Delisle, 2012;Das, Ghosh, & Gangopadhyay, n.d.;Faaberg, Kehrli, Lager, Guo, & Han, 2010;Hignett & McAtamney, 2000;Kumar, Baliga, & Kumar, 2013;Motamedzade, Ashuri, Golmohammadi, & Mahjub, 2011;Mukhopadhyay & Srivastava, 2010;Rafeemanesh, Jafari, Kashani, & Rahimpour, 2013) LANDEWEERD, & DROST, 1995;Somnath Gangopadhyay, Das, Das, & Ghoshal, 2005;Somnath Gangopadhyay, Das, Das, Ghoshal, & Ghosh, 2010;Karhu, Härkönen, Sorvali, & Vepsäläinen, 1981;Karhu, Kansi, & Kuorinka, 1977;Kee & Karwowski, 2007;Kivi & Mattila, 1991;Lee & Han, 2013;Louhevaara, 1999;Nevala-Puranen, Kallionpää, & Ojanen, 1996 & Gangopadhyay, 2015;Gallis, 2006;S. Gangopadhyay, Ghosh, Das, Ghoshal, & Das, 2010;Glover, McGregor, Sullivan, & Hague, 2005;Gummesson et al., 2006;Hussain, 2004;Kolstrup, 2012;Kumar et al., 2013;Lin et al., 2012;Mehrdad, Morshedizadeh, & Dennerlein, 2012;Palmer, 1996;Parot-Schinkel et al., 2012;Ratzon, Yaros, Mizlik, & Kanner, 2000;Singh & Chokhandre, 2015) ...
Chapter
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The purpose of this study is to review the literature on possible ergonomic methods to evaluate in a service station, this methods are known as the Rapid Entire Body Assessment (REBA), the Ovako Working Posture Analysis System (OWAS) and the Nordic Questionnaire, which were determined given that they recognize musculoskeletal disorders and corporal affectations in all the limbs of the worker. In this sense, a bibliometric and systematic analysis of the literature was carried out where the study variables, most representative authors, frequency of key words and geographic concentration were determined.
... It was possible to select the right or left side of the body, and each body region was flagged (head, cervical, dorsal, lumbar, shoulder, arm, elbow, forearm, wrist, hand, hip, thigh, knee, leg, ankle, foot). Due to the heterogeneity and often multisite pain of the reported musculoskeletal symptoms in these settings 28) , in case there was more than one complaint the selection was to be based only on the highest intensity symptom. ...
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This study followed assembly line workers during 7 months, comprising a 4-wk season holidays. The main purposes were to determine the potential effect of working time on the presence and intensity of upper limb musculoskeletal symptoms, as to verify the effect of 4 wk of job interruption in the upper limb musculoskeletal symptoms presence and intensity. Data was collected during 6 moments. Generalized estimating equations analyses were used. For the effect estimates, odds ratio with corresponding 95% confidence intervals were reported for each outcome/model. The upper limb musculoskeletal symptoms showed a significant increase (p=0.001), especially after the 4 wk off. In all data collection points there was a significant positive association between the upper limb musculoskeletal symptoms and general health status (p<0.001). Considering symptoms’ intensity, significant relations were found (p<0.001). Work time had a negative effect on the work-related upper limb musculoskeletal symptoms over 7 months (OR 0.909, 95% CI 0.861–0.960, p=0.001). For the intensity of upper limb symptoms, the effect of time was also statistical significant (OR 0.115, 95% CI 1.031–1.220, p=0.008). A 4-wk job interruption did not show an immediately positive effect on upper limb musculoskeletal symptoms presence.
Chapter
Over the years the human factors are becoming increasingly decisive in the organization of the manufacturing industry production process. In this article we are overviewing how ergonomics are integrated in the complete job-scheduling optimization process; we are specifically focusing on the collection of ergonomic data. A large variety of tools and methods have been developed to assess physical and psychosocial risks in a working environment. In this article we review the principal methods described in the literature, labelled under three main categories: observational, self-evaluation and direct measurement. This large diversity of evaluation methods is directly linked with the flexibility required by health experts to analyze precisely various situations in the field. Most of the ergonomic-based job scheduling applications reviewed are using a different method which makes it difficult to compare directly the efficiency of the subsequent optimization.
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Objectives To investigate whether behaviour change techniques (BCTs) can influence adherence to home exercise in people with upper extremity musculoskeletal disorders (UEMD). Design A systematic review of randomised control trials, non‐randomised control trials, case–control studies and cohort studies. Results were presented narratively. Participants were those with UEMD. The intervention was any home exercise programme, alongside a BCT designed to increase exercise adherence. Any duration of intervention was accepted. The main outcome sought was adherence to home exercise. A systematic search was performed on four online databases. Grey literature was searched. Results The search resulted in 28,755 titles. 77 full‐text articles were assessed for eligibility. Six studies were included in the qualitative synthesis. Four studies had Some Concern of Bias, whilst two studies had High Risk of Bias. Three studies found statistically significant differences in exercise adherence (p < 0.05) between the Intervention group and Control group. The BCT ‘Social Support (unspecified)’ was used within all studies that found significant differences in adherence levels at outcome. However, multiple BCTs were received by the Intervention groups within all studies, making it impossible to identify the effects of any single BCT upon adherence levels. Conclusion Social support may be relevant in patients' adherence levels to HEPs. However, confidence in the results is uncertain given the small number of studies found, and their High RoB. Future studies should validate their measurement and definition of adherence, as well as the number of BCTs they use, to provide reproducible evidence.
Chapter
Globalization and technological development have imposed a great challenge in the search for business competitiveness. This research studies the business, competitive or generic strategies that favored or disadvantaged the achievement of a sustained competitive advantage in the period 2013 to 2015 in medium and large companies of the Bucaramanga Metropolitan Area (AMB), for which we worked with a sample of 213 of the 685 companies under study, for a margin of error of 5% and a confidence level of 90%. To select the companies that achieved a sustained competitive advantage, those that exceeded the Dupont profitability of their respective national economic subsector in the three years of study were identified. The test of difference of proportions using the t-student distribution with the Minitab-v17® software, allows to conclude at 10% of significance that implementing the differentiation and approach or niche business strategies favored the achievement of a sustained competitive advantage in the companies and period under study. These results allow efforts to be focused by the local government and the business sector towards the improvement of regional competitiveness.
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Background: In Spain, as in many countries, women report poorer general health and more daily activity limitations due to health reasons when compared with men. This study aims to examine whether these poorer indicators are due to a greater prevalence of health problems and to identify the types of problems that contribute most to gender inequalities. Methods: Cross-sectional study on the population aged >15 years and residing in Spain, with data from the 2006 National Health Survey (n = 29139). The sex prevalence ratios (PR) of poor self-rated health and chronic limitation of activity are sequentially adjusted by age and the presence of 27 chronic conditions by means of robust Poisson regression. Results: At equal number of disorders, women reported equal or even better health than men. The excess of poor health in women (age-adjusted PR and 95% CI: self-rated health = 1.36, 1.29-1.41; chronic limitation = 1.25, 1.18-1.32) disappeared when adjusting for the number of chronic diseases (self-rated health = 1.00, 0.96-1.04; chronic limitation = 0.90, 0.85-0.96). Musculoskeletal, mental and other pain disorders accounted for most of the association. The results were consistent in different strata of age, social class, and type of country of birth. Conclusion: These results suggest that the poorer self-rated health of women is a reflection of the higher burden of disease they suffer. A health system responsive to gender inequalities should increase its efforts in addressing and resolving musculoskeletal, mental and other pain disorders, usually less considered in favour of disorders with greater impact on mortality.
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This population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking. A cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18-74 years) in a county (Ostergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary. The participation rate was 76.7% (n = 7637); the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90-94%) and depending on definition of WSP the prevalence varied between 4.8-7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor - together with age 50-64 years, low annual income, and non-Nordic citizen - for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population. This study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status.
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To test the hypothesis that cultural factors such as health beliefs and expectations have an important influence on common musculoskeletal symptoms and associated disability, we compared prevalence rates in groups of workers carrying out similar physical activities in different cultural settings. We conducted a cross-sectional survey at factories and offices in Mumbai, India and in the UK. A questionnaire about symptoms, disability and risk factors was administered at interview to six occupational groups: three groups of office workers who regularly used computer keyboards (165 Indian, 67 UK of Indian subcontinental origin and 172 UK white), and three groups of workers carrying out repetitive manual tasks with the hands or arms (178 Indian, 73 UK of Indian subcontinental origin and 159 UK white). Modified Cox regression was used to calculate hazard ratios (HRs) for the prevalence of symptoms and disability by occupational group, adjusted for differences in sex, age, mental health and job satisfaction. Reported occupational activities were similar in the three groups of office workers (frequent use of keyboards) and in the three groups of manual workers (frequent movements of the wrist or fingers, bending of the elbow, work with the hands above shoulder height and work with the neck twisted). In comparison with the Indian manual workers, the prevalence of back, neck and arm pain was substantially higher in all of the other five occupational groups. The difference was greatest for arm pain lasting >30 days in the past year in UK white manual workers (HR 17.8, 95% CI 5.4-59.1) and UK manual workers of Indian subcontinental origin (HR 20.5, 95% CI 5.7-73.1). Office workers in India had lower rates of pain in the wrist and hand than office workers in the UK. Only 1% of the Indian manual workers and 16% of the Indian office workers had ever heard of 'RSI' or similar terms, as compared with 80% of the UK workers. Our findings support the hypothesized impact of cultural factors on common musculoskeletal complaints. Current controls on hazardous physical activities in the workplace may not have the benefits that would be predicted from observational epidemiology.
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Regional musculoskeletal pain such as back or shoulder pain are commonly reported symptoms in the community. The extent of consultation to primary care with such problems is unknown as a variety of labels may be used to record such consultations. The objective was to classify musculoskeletal morbidity codes used in routine primary care by body region, and to determine the annual consultation prevalence of regional musculoskeletal problems. Musculoskeletal codes within the Read morbidity Code system were identified and grouped by relevant body region by four GPs. Consultations with these codes were then extracted from the recorded consultations at twelve general practices contributing to a general practice consultation database (CiPCA). Annual consultation prevalence per 10,000 registered persons for the year 2006 was determined, stratified by age and gender, for problems in individual regions and for problems affecting multiple regions. 5,908 musculoskeletal codes were grouped into regions. One in seven of all recorded consultations were for a musculoskeletal problem. The back was the most common individual region recorded (591 people consulting per 10,000 registered persons), followed by the knee (324/10,000). In children, the foot was the most common region. Different age and gender trends were apparent across body regions although women generally had higher consultation rates. The annual consultation-based prevalence for problems encompassing more than one region was 556 people consulting per 10,000 registered persons and increased in older people and in females. There is an extensive and varied regional musculoskeletal workload in primary care. Musculoskeletal problems are a major constituent of general practice. The output from this study can be used as a resource for planning future studies.
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Objective: To assess the prevalence of musculoskeletal symptoms among the major ethnic minority populations of Greater Manchester. Method: The study group was a community sample of 2117 adults from the Indian, Pakistani, Bangladeshi, and African Caribbean communities. Questionnaires administered by post and by an interviewer were used to assess the presence of any musculoskeletal pain, pain in specific joints, and the level of physical function. Ethnicity was self assigned. The results were compared with those from a recent study in the local white population using the same methodology. Results: Overall response rate was 75% among the south Asian (Indian, Pakistani, and Bangladeshi community and 47% among the African Caribbean community. The profile of musculoskeletal pain among the ethnic minority groups differed from that in the white population. Although musculoskeletal symptoms were slightly more prevalent among people from ethnic minority groups than among the white population, pain in multiple sites was considerably more common among ethnic minorities. Conclusions: The finding that musculoskeletal pain is more widespread among ethnic minority communities in the UK has not previously been reported. This may reflect social, cultural, and psychological differences. The cause of the differences in the profile of pain and the health needs that follow need further investigation.
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Background Few studies have demonstrated the consequences of having back pain and the mechanisms underlying decisions to seek medical care. This study aimed to assess the prevalence of back pain and other musculoskeletal complaints and to identify factors that determine specific type of care-seeking due to back pain among scaffolders.MethodsA cross-sectional study was conducted among 323 scaffolders. A questionnaire was used to collect data on musculoskeletal complaints and type of medical care sought. Logistic regression analysis was performed to study the risk factors for care-seeking for LBP, estimating Prevalence Ratios (PR) as a measure of association.ResultsThe prevalence of musculoskeletal complaints was high. Severe back pain was reported by 28% of the scaffolders, LBP with sciatic pain by 23%, with sickness absence by 21%, with disability by 21%, and chronic back pain by 14%. Back pain was often accompanied by complaints of neck, shoulder, or knee. A general practitioner was sought by 44% of the workers with LBP, a physiotherapist by 22%, an occupational physician by 20%, and a specialist by 11%. The nature and severity of back pain seemed to determine the decision to visit the GP. Irradiating pain and sickness absence were the strongest predictors for seeking medical care and being referred to a specialist or physiotherapist.Conclusion The particular definition of back pain and the selection process of workers with LBP may partly determine the findings on work-related risk factors and health care utilization. Am. J. Ind. Med. 40:275–281, 2001. © 2001 Wiley-Liss, Inc.
Article
Chronic widespread pain (CWP) due to musculoskeletal conditions is a major social burden. The case definition of CWP relies on pain, chronicity (more than 3 months' duration) and widespread distribution (both sides of the body including the axial skeleton). Health Interview Survey (HIS) and Health Examination Survey (HES) have been used to assess the frequency of CWP in the general population. Unfortunately, both techniques are poorly standardised, which hampers comparison of data pertaining to different populations and countries. A major effort in the European Union (EU) is the development of common strategies to investigate musculoskeletal pain through HIS. Issues to be addressed include: (1) loss of daily life functions due to pain; (2) pain duration and rhythm; (3) affected sites; and (4) type of pain. We know that musculoskeletal pain affects between 13.5% and 47% of the general population, with CWP prevalence varying between 11.4% and 24%. Risk factors for musculoskeletal pain include age, gender, smoking, low education, low physical activity, poor social interaction, low family income, depression, anxiety and sleep disorders, as well as performing manual work, being a recent immigrant, non-Caucasian and widowed, separated or divorced.