The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study

BACKGROUND: Work-related neck and upper limb pain has mainly been studied in specific occupational groups, and little is known about its impact in the general population. The objectives of this study were to estimate the prevalence and population impact of work-related neck and upper limb pain. METHODS: A cross-sectional survey was conducted of 10 000 adults in North Staffordshire, UK, in which there is a common local manual industry. The primary outcome measure was presence or absence of neck and upper limb pain. Participants were asked to give details of up to five recent jobs, and to report exposure to six work activities involving the neck or upper limbs. Psychosocial measures included job control, demand and support. Odds ratios (ORs) and population attributable fractions were calculated for these risk factors. RESULTS: The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects (OR = 1.4); prolonged bending of neck (OR = 2.0); working with arms at/above shoulder height (OR = 1.3); little job control (OR = 1.6); and little supervisor support (OR = 1.3). The population attributable fractions were 0.24 (24%) for exposure to work activities and 0.12 (12%) for exposure to psychosocial factors. CONCLUSION: Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Inferences of cause-and-effect from cross-sectional studies must be made with caution; nonetheless, our findings suggest that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk

Gender difference in symptomatic radiographic knee osteoarthritis in the Knee Clinical Assessment – CAS(K): A prospective study in the general population

<p>Abstract</p> <p>Background</p> <p>A recent study of adults aged ≥50 years reporting knee pain found an excess of radiographic knee osteoarthritis (knee ROA) in symptomatic males compared to females. This was independent of age, BMI and other clinical signs and symptoms. Since this finding contradicts many previous studies, our objective was to explore four possible explanations for this gender difference: X-ray views, selection, occupation and non-articular conditions.</p> <p>Methods</p> <p>A community-based prospective study. 819 adults aged ≥50 years reporting knee pain in the previous 12 months were recruited by postal questionnaires to a research clinic involving plain radiography (weight-bearing posteroanterior semiflexed, supine skyline and lateral views), clinical interview and physical examination. Any knee ROA, ROA severity, tibiofemoral joint osteoarthritis (TJOA) and patellofemoral joint osteoarthritis (PJOA) were defined using all three radiographic views. Occupational class was derived from current or last job title. Proportions of each gender with symptomatic knee ROA were expressed as percentages, stratified by age; differences between genders were expressed as percentage differences with 95% confidence intervals.</p> <p>Results</p> <p>745 symptomatic participants were eligible and had complete X-ray data. Males had a higher occurrence (77%) of any knee ROA than females (61%). In 50–64 year olds, the excess in men was mild knee OA (particularly PJOA); in ≥65 year olds, the excess was both mild and moderate/severe knee OA (particularly combined TJOA/PJOA). This male excess persisted when using the posteroanterior view only (64% vs. 52%). The lowest level of participation in the clinic was symptomatic females aged 65+. Within each occupational class there were more males with symptomatic knee ROA than females. In those aged 50–64 years, non-articular conditions were equally common in both genders although, in those aged 65+, they occurred more frequently in symptomatic females (41%) than males (31%).</p> <p>Conclusion</p> <p>The excess of knee ROA among symptomatic males in this study seems unlikely to be attributable to the use of comprehensive X-ray views. Although prior occupational exposures and the presence of non-articular conditions cannot be fully excluded, selective non-participation bias seems the most likely explanation. This has implications for future study design.</p

Predictors of new-onset widespread pain in older adults: results from a population-based prospective cohort study in the UK.

OBJECTIVE: In older adults, widespread pain (WP) is common, although its etiology is unclear. This study sought to identify factors associated with an increased risk of developing WP in adults age ≥50 years. METHODS: A population‐based prospective study was conducted. A baseline questionnaire was administered to subjects to collect data on pain, psychological status, lifestyle and health behaviors, and sociodemographic and clinical factors. Participants free of WP (as defined by the American College of Rheumatology 1990 criteria for fibromyalgia) were followed up for 3 years, and those with new‐onset WP at followup were identified. Logistic regression analyses were used to test the relationship between baseline factors and new‐onset WP. Multiple imputation was used to test the results for sensitivity to missing data. RESULTS: In this population‐based study, 4,326 subjects (1,562 reporting no pain at baseline and 2,764 reporting some pain at baseline) participated at followup. Of these participants, 800 (18.5%) reported a status of new WP at followup (of whom, 121 [7.7%] had reported no pain at baseline and 679 [24.6%] had reported some pain at baseline). The majority of the study factors were associated with new‐onset WP. However, only a few factors showed a persistent association with new‐onset WP in the multivariate analysis, including age (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.96–0.99), baseline pain status (OR 1.1, 95% CI 1.08–1.2), anxiety (OR 1.5, 95% CI 1.01–2.1), physical health‐related quality of life (OR 1.3, 95% CI 1.1–1.5), cognitive complaint (OR 1.3, 95% CI 1.04–1.6), and nonrestorative sleep (OR 1.9, 95% CI 1.2–2.8). These associations persisted after adjustment for the presence of diffuse osteoarthritis (OA), which led to a modest increase in model fit (C‐statistic 0.738, compared with 0.731 in the model excluding diffuse OA). The results were not sensitive to missing data. CONCLUSION: Of the factors measured in this study, nonrestorative sleep was the strongest independent predictor of new‐onset WP

Flow diagram of responders to the North Staffordshire Osteoarthritis Project, United Kingdom (2002–2008).

<p>^aUnadjusted percentage responding before removing those who had moved or died.</p

Two year consultation and prescription prevalence per 1,000 persons at each survey point in CiPCA comparison population and NorStOP responders.

<p>NorStOP = North Staffordshire Osteoarthritis Project; CiPCA = Consultations in Primary Care Archive; COPD = Chronic obstructive pulmonary disease; URTI = Upper respiratory tract infection; NSAID = Non-steroidal anti-inflammatory drug; CI = Confidence interval.</p><p>^a Consultation and prescriptions for the 2 years prior to baseline survey for NorStOP baseline responders; for CiPCA comparison population time period 2001–2002.</p><p>^b Consultation and prescriptions for the 2 years before 3-year follow-up survey for NorStOP 3-year responders; for CiPCA comparison population time period 2004–2005.</p><p>^c Consultation and prescriptions for the 2 years before 6-year follow-up survey for NorStOP 6-year responders; for CiPCA comparison population time period 2007–2008.</p

The three time periods and denominator populations for NorStOP and CiPCA, North Staffordshire, UK (2000–2008).

<p>NorStOP = North Staffordshire Osteoarthritis Project; CiPCA = Consultations in Primary Care Archive; SD = Standard deviation.</p><p>^a At end of time period.</p