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

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

Prévalence des symptômes musculo-squelettiques multi-sites dans une population de travailleurs salariés

Objectif.– La prévalence des troubles musculo-squelettiques (TMS) d’origine professionnelle ne cessent d’augmenter et bien que la très grande majorité des données disponibles sur le sujet portent sur les TMS définis par localisation anatomique, un nombre croissant de travaux témoignent de la faible prévalence des symptômes isolés et bien délimités sur un site anatomique spécifique. L’objectif de ce travail est de décrire la prévalence et les caractéristiques des symptômes musculosquelettiques (SMS) multi-sites (MS) dans une large population de travailleurs salariés français. Méthode.– Cette étude a été réalisée à partir des données de surveillance de l’enquête transversale (2002–2005) du réseau de médecin du travail dans la population des travailleurs salariés de la région des Pays-de-la-Loire (20 à 59 ans). Les données sur les SMS ont été renseignées dans la salle d’attente des médecins du travail du réseau au moyen de l’auto-questionnaire standardisé NORDIC. Résultats.– La population de l’étude comprenait 3710 salariés (58 %, soit 2162 hommes et 42 %, soit 1548 femmes) de moyenne d’âge 38,4 ans (écart-type 10,4 ans). Les catégories professionnelles représentées étaient : « ouvriers qualifiés et non qualifiés » (56 %), « professions intermédiaires » (25 %) ou « cadres » (10 %) chez les hommes et « employées » (52 %), « ouvrières qualifiées et non qualifiées » (24 %) ou « professions intermédiaires » (19 %) chez les femmes. La prévalence des SMS au cours des 12 derniers mois était de 83,8 % avec un intervalle de confiance à 95 % de [82,8–85,3] pour les hommes et de 83,9 % [82,0–85,7] pour les femmes. La prévalence des SMS subaigus (d’au moins 30 jours) au cours des 12 derniers mois était de 32,8 % [30,9–34,8] pour les hommes et de 37,3 % [34,9–39,7] pour les femmes. Deux tiers des salariés déclaraient la présence de SMS sur deux sites anatomiques ou plus (SMS-MS) et environ 20 % déclaraient la présence de SMS d’au moins 30 jours sur deux sites anatomiques ou plus (SMS-MS). Les sites anatomiques les plus fréquemment associés à d’autres SMS étaient le haut du dos, la hanche, le coude et la nuque. La majorité de ces SMS-MS était étendue sur au moins deux des trois régions anatomiques (membre supérieur, région axiale et membre inférieur). Conclusion.– La fréquence et l’étendue des SMS-MS sont considérables chez les travailleurs. Il est indispensable d’approfondir nos connaissances dans ce domaine afin de mieux comprendre leurs caractéristiques et leurs déterminants

Practical application and clinical impact of the WHO histopathological criteria on bone marrow biopsy for the diagnosis of essential thrombocythemia versus prefibrotic primary myelofibrosis

Aims: To evaluate the feasibility of the histopathological diagnosis of prefibrotic–early primary myelofibrosis (PM) as described in the World Health Organization (WHO) classification and to evaluate the clinical implications of prefibrotic–early PM in a series of patients previously diagnosed as having essential thrombocythemia (ET) according to the Polycythemia Vera Study Group criteria. Methods and results: WHO criteria were applied to bone marrow biopsy specimens by two pathologists who then reclassified 127 cases as 102 ET (80.3%), 18 prefibrotic–early PM (14.2%) and seven fibrotic PM (5.5%). In 45 cases (35%), the final diagnosis was only reached by consensus. The megakaryocytic criteria that best discriminated between ET and prefibrotic–early PM were an increased nucleo–cytoplasmic ratio, presence of cloudlike nuclei, hyperchromatic-dysplastic nuclei, paratrabecular megakaryocytes and tight clusters. A histological score discriminated between ET (score ≤3) and PM (score ≥6), but 21 cases showed an intermediate ambiguous score. No significant differences were observed at diagnosis and at follow-up (median time 93 months) for thrombosis, major haemorrhage, laboratory data, transformation into overt myeloid metaplasia and survival. Conclusions: The distinction between ET and prefibrotic–early PM is impaired by subjectivity in pathological practice and is of questionable clinical relevance, at least when considering individual patients

Factors affecting return to work after carpal tunnel syndrome surgery in a large French cohort

OBJECTIVE: To evaluate occupational outcomes after surgical release of the median nerve in carpal tunnel syndrome (CTS).DESIGN: Retrospective study 12 to 24 months after surgery. SETTING: Hand centers (N=3) in 2 different areas. PARTICIPANTS: Patients who had undergone surgical release of the median nerve in 2002 to 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Duration of sick leave after surgery and associated factors were analyzed by using bivariate (log rank) and multivariate analyses of survival (Cox model). RESULTS: Questionnaires mailed in 2004 regarding medical condition (history and surgery), employment (occupational category codes in 1 digit), and compensation were returned (N=1248; 62%), with 253 men and 682 women stating they were employed at the time of surgery (N=935). Most were working at the time of the study (n=851; 91.0%). Median duration of sick leave before returning to work was 60 days. The main factors associated with adverse occupational outcome (long duration of sick leave) were simultaneous intervention for another upper-extremity musculoskeletal disorder, belief (by the patient) in an occupational cause, and "blue-collar worker" occupational category (the strongest determinant). CONCLUSION: This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients

Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees

BACKGROUND CONTEXT: Low back pain (LBP) is a major public health problem, with a considerable impact on workers. PURPOSE: To model the risk of LBP in the male general working population. STUDY DESIGN/SETTING: Repeated cross-sectional surveys in a wide occupational setting. PATIENT SAMPLE: A random sample of 2,161 men working in various occupations in a French region participated in a first survey in 2002, and 1,313 of these (60.8%) participated in a second survey in 2007. OUTCOME MEASURE: The self-reported prevalence of LBP during the previous week in the second survey. METHODS: Twenty-one biomechanical, organizational, psychosocial, and individual factors were assessed in the first survey. The association between these potential risk factors and the prevalence of later LBP (in the second survey) was studied, using multistep logistic regression models. RESULTS: Three hundred ninety-four men reported LBP in the second survey (prevalence 30.0%). The final multivariate model highlighted four risk factors: frequent bending (odds ratio [OR], 1.45, 95% confidence interval [CI], 1.07-1.97 for bending forward only; and OR, 2.13, 95% CI, 1.52-3.00 for bending both forward and sideways), driving industrial vehicles (OR, 1.35; 95% CI, 1.00-1.81), working more hours than officially planned (OR, 1.38; 95% CI, 1.05-1.81), and reported low support from supervisors (OR, 1.35; 95% CI, 1.02-1.79). CONCLUSIONS: These results emphasize that biomechanical factors remain worth considering, even when psychosocial factors are taken into account, and provide a significant contribution to preventive strategies

Facteurs associés à la lombalgie chez les hommes salariés des Pays de la Loire

Objectif : Les lombalgies ont des répercussions majeures sur le monde du travail. Un manque de données prospectives et représentatives de la diversité des emplois limite l’analyse des facteurs de risque chez les travailleurs. L’objectif de cette étude était d’estimer, à l’aide d’une modélisation, les facteurs associés à la lombalgie chez les salariés des Pays de la Loire.Méthodes : Un échantillon aléatoire de salariés a fait l’objet de deux enquêtes successives. La prévalence des lombalgies lors de la deuxième enquête a été modélisée, par régression logistique multi-étapes, à partir de facteurs de risque individuels et professionnels recueillis lors de la première enquête. Des analyses de sensibilité ont été réalisées. Les analyses ont été stratifiées par sexe ; seuls les résultats pour les hommes sont présentés. Résultats : Parmi les 3 710 participants à la première enquête, 2 332 ont répondu à la deuxième enquête, dont 1 313 hommes. La prévalence des lombalgies était de 30 % chez les hommes. Des douleurs du cou ou des membres supérieurs, se pencher fréquemment et travailler plus que prévu étaient les facteurs de risque principaux de lombalgie ultérieure. L’association observée entre un faible soutien de la hiérarchie et des lombalgies ultérieures devenait non significative dans une analyse restreinte aux salariés sans lombalgie lors de la première enquête. Conclusions : Le rôle des facteurs biomécaniques et organisationnels semble prédominant sur celui des facteurs psychosociaux. Celui des facteurs individuels est d’interprétation délicate. Quelques limites méthodologiques doivent être discutées, mais l’analyse simultanée de multiples facteurs dans une population diversifiée de travailleurs constitue un apport original et utile pour des actions de prévention

Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial.

STUDY DESIGN: Randomized parallel group comparative trial with a 1-year follow-up period. OBJECTIVE: To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up. SUMMARY OF BACKGROUND DATA: Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration. METHODS: A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847). RESULTS: In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group. CONCLUSION: Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs

Étude des facteurs associés au devenir professionnel après intervention chirurgicale pour un syndrome du canal carpien dans les Pays de la Loire

L’objectif était d’étudier le pronostic professionnel après intervention pour syndrome du canal carpien.Les patients opérés en 2002-2003 dans les Pays de la Loire ont rempli un autoquestionnaire. 1 248 questionnaires ont été retournés (62%) ; 253 hommes et 682 femmes déclaraient un emploi au moment de l’opération. Les facteurs de mauvais pronostic identifiés étaient : intervention simultanée sur un autre trouble musculo-squelettique du membre supérieur, catégorie socioprofessionnelle "ouvriers", arrêt de travail pour maladie professionnelle et imputabilité par le patient à une cause professionnelle. Cette étude souligne l’implication de multiples facteurs à prendre en compte pour le pronostic professionnel

High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial

BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before. RESULTS: Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1-Q3], 14 [10.5-15] vs 11 [10-12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54-96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51-0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0-1] vs 3 [1-4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65-99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05-0.73]; P = .015). CONCLUSIONS: High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover