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BMC Musculoskeletal Disorders Oct 2017It is difficult to gain an overview of musculoskeletal extremity complaints in childhood although this is essential to develop evidence-based prevention and treatment... (Review)
Review
BACKGROUND
It is difficult to gain an overview of musculoskeletal extremity complaints in childhood although this is essential to develop evidence-based prevention and treatment strategies. The objectives of this systematic review were therefore to describe the prevalence and incidence of musculoskeletal extremity complaints in children and adolescents in both general and clinical populations in relation to age, anatomical site and mode of onset.
METHODS
MEDLINE and EMBASE were electronically searched; risk of bias was assessed; and data extraction was individually performed by two authors.
RESULTS
In total, 19 general population studies and three clinical population studies were included with children aged 0-19 years. For most of the analyses, a division between younger children aged 0-12 years, and older children aged 10-19 years was used. Lower extremity complaints were more common than upper extremity complaints regardless of age and type of population, with the most frequent pain site changing from ankle/foot in the youngest to knee in the oldest. There were about twice as many non-traumatic as traumatic complaints in the lower extremities, whereas the opposite relationship was found for the upper extremities in the general population studies. There were relatively more lower extremity complaints in the general population studies than in the clinical population studies. The review showed no pattern of differences in reporting between studies of high and low risk of bias.
CONCLUSIONS
This review shows that musculoskeletal complaints are more frequent in the lower extremities than in the upper extremities in childhood, and there are indications of a large amount of non-traumatic low intensity complaints in the population that do not reach threshold for consultation. A meta-analysis, or even a simple overall description of prevalence and incidence of musculoskeletal extremity complaints in children and adolescents was not feasible, due to a large variety in the studies, primarily related to outcome measurements.
Topics: Adolescent; Child; Humans; Incidence; Lower Extremity; Musculoskeletal Diseases; Prevalence; Upper Extremity
PubMed: 29047337
DOI: 10.1186/s12891-017-1771-2 -
Environment International May 2021The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury... (Meta-Analysis)
Meta-Analysis
The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.
BACKGROUND
The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates.
OBJECTIVES
We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence).
DATA SOURCES
We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts.
STUDY ELIGIBILITY AND CRITERIA
We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of occupational exposure to ergonomic risk factors (any exposure to force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing ≥ 2 h/day) compared with no or low exposure to the theoretical minimum risk exposure level (<2 h/day) on the prevalence or incidence of MSD or OA.
STUDY APPRAISAL AND SYNTHESIS METHODS
At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using Navigation Guide tools adapted to this project.
RESULTS
In total eight studies (4 cohort studies and 4 case control studies) met the inclusion criteria, comprising a total of 2,378,729 participants (1,157,943 females and 1,220,786 males) in 6 countries in 3 WHO regions (Europe, Eastern Mediterranean and Western Pacific). The exposure was measured using self-reports in most studies and with a job exposure matrix in one study and outcome was generally assessed with physician diagnostic records or administrative health data. Across included studies, risk of bias was generally moderate. Compared with no or low exposure (<2 h per day), any occupational exposure to ergonomic risk factors increased the risk of acquiring MSD (odds ratio (OR) 1.76, 95% confidence interval [CI] 1.14 to 2.72, 4 studies, 2,376,592 participants, I 70%); and increased the risk of acquiring OA of knee or hip (OR 2.20, 95% CI 1.42 to 3.40, 3 studies, 1,354 participants, I 13%); Subgroup analysis for MSD found evidence for differences by sex, but indicated a difference in study type, where OR was higher among study participants in a case control study compared to study participants in cohort studies.
CONCLUSIONS
Overall, for both outcomes, the main body of evidence was assessed as being of low quality. Occupational exposure to ergonomic risk factors increased the risk of acquiring MSD and of acquiring OA of knee or hip. We judged the body of human evidence on the relationship between exposure to occupational ergonomic factors and MSD as "limited evidence of harmfulness" and the relationship between exposure to occupational ergonomic factors and OA also as "limited evidence of harmfulness". These relative risks might perhaps be suitable as input data for WHO/ILO modelling of work-related burden of disease and injury. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053 PROSPERO registration number: CRD42018102631.
Topics: Adolescent; Case-Control Studies; Cost of Illness; Ergonomics; Europe; Female; Humans; Musculoskeletal Diseases; Occupational Diseases; Occupational Exposure; Osteoarthritis, Hip; Risk Factors; World Health Organization
PubMed: 33546919
DOI: 10.1016/j.envint.2020.106349 -
International Journal of Nursing Studies Jun 2018Musculoskeletal injuries and musculoskeletal pain are prevalent among nurses compared to many other occupational groups. (Review)
Review
BACKGROUND
Musculoskeletal injuries and musculoskeletal pain are prevalent among nurses compared to many other occupational groups.
OBJECTIVE
To identify interventions that may be effective at reducing the prevalence and impact of musculoskeletal injuries and pain in registered nurses.
DESIGN
Systematic review.
DATA SOURCES
Seven databases were systematically searched, including MEDLINE, CINAHL, EMBASE, PsycInfo, Academic Search Complete, Health Source Nursing, and the Cochrane Database of Systematic Reviews.
REVIEW METHODS
Peer-reviewed journal articles reporting interventions designed to reduce the occurrence of musculoskeletal injuries and pain among registered nurses, published between January 2004 and June 2016, were eligible for inclusion. Randomised and non-randomised controlled trials, as well as studies implementing before-after designs were included. Studies investigating interventions in samples predominately comprised of nursing aides or non-nursing personnel were excluded. Relevant articles were collected and critically analysed using the Effective Public Health Practice Project methodology. Two reviewers independently extracted data and performed quality appraisals for each study. A narrative synthesis of study findings was performed.
RESULTS
Twenty studies met criteria for inclusion in the review. Types of interventions reported included: patient lift systems (N = 8), patient handling training (N = 3), multi-component interventions (N = 7), cognitive behavioural therapy (N = 1), and unstable shoes (N = 1). Only two studies received a 'strong' quality rating according to quality assessment criteria. One of these found no evidence for the effectiveness of patient handling training; the other found preliminary support for unstable shoes reducing self-reported pain and disability among nurses. Overall, evidence for each intervention type was limited.
CONCLUSIONS
There is an absence of high quality published studies investigating interventions to protect nurses from musculoskeletal injuries and pain. Further research (including randomised controlled trials) is needed to identify interventions that may reduce the high rates of injury and pain among nurses.
Topics: Humans; Musculoskeletal Diseases; Nursing Staff; Occupational Diseases
PubMed: 29605754
DOI: 10.1016/j.ijnurstu.2018.03.018 -
International Journal of Rheumatic... Feb 2023Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and... (Review)
Review
Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results. Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required.
Topics: Humans; Education, Medical, Undergraduate; Curriculum; Musculoskeletal Diseases; Educational Status; Students, Medical
PubMed: 36502533
DOI: 10.1111/1756-185X.14508 -
BMC Musculoskeletal Disorders Sep 2017This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research... (Review)
Review
BACKGROUND
This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs?
METHODS
PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies.
RESULTS
Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity.
CONCLUSIONS
Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided.
Topics: Cross-Sectional Studies; Diagnostic Imaging; Humans; Musculoskeletal Diseases; Neck Pain; Rotator Cuff Injuries; Shoulder Joint; Shoulder Pain
PubMed: 28899384
DOI: 10.1186/s12891-017-1694-y -
Acta Neurochirurgica Sep 2020Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of...
BACKGROUND
Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures.
METHODS
We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains.
RESULTS
We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics.
CONCLUSIONS
Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.
Topics: Carpal Tunnel Syndrome; Ergonomics; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Low Back Pain; Neurosurgeons; Occupational Diseases; Posture
PubMed: 32705353
DOI: 10.1007/s00701-020-04494-4 -
Journal of Medical Internet Research Jul 2023Musculoskeletal disorders (MSDs) are widespread in many countries and their huge burden on the society has necessitated innovative approaches such as digital health... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Musculoskeletal disorders (MSDs) are widespread in many countries and their huge burden on the society has necessitated innovative approaches such as digital health interventions. However, no study has evaluated the findings of cost-effectiveness of these interventions.
OBJECTIVE
This study aims to synthesize the cost-effectiveness of digital health interventions for people with MSDs.
METHODS
Electronic databases including MEDLINE, AMED, CIHAHL, PsycINFO, Scopus, Web of Science, and Centre for Review and Dissemination were searched for cost-effectiveness of digital health published between inception and June 2022 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. References of all retrieved articles were checked for relevant studies. Quality appraisal of the included studies was performed using the Quality of Health Economic Studies (QHES) instrument. Results were presented using a narrative synthesis and random effects meta-analysis.
RESULTS
A total of 10 studies from 6 countries met the inclusion criteria. Using the QHES instrument, we found that the mean score of the overall quality of the included studies was 82.5. Included studies were on nonspecific chronic low back pain (n=4), chronic pain (n=2), knee and hip osteoarthritis (n=3), and fibromyalgia (n=1). The economic perspectives adopted in the included studies were societal (n=4), societal and health care (n=3), and health care (n=3). Of the 10 included studies, 5 (50%) used quality-adjusted life-years as the outcome measures. Except 1 study, all the included studies reported that digital health interventions were cost-effective compared with the control group. In a random effects meta-analysis (n=2), the pooled disability and quality-adjusted life-years were -0.176 (95% CI -0.317 to -0.035; P=.01) and 3.855 (95% CI 2.023 to 5.687; P<.001), respectively. The meta-analysis (n=2) for the costs was in favor of the digital health intervention compared with control: US $417.52 (95% CI -522.01 to -313.03).
CONCLUSIONS
Studies indicate that digital health interventions are cost-effective for people with MSDs. Our findings suggest that digital health intervention could help improve access to treatment for patients with MSDs and as a result improve their health outcomes. Clinicians and policy makers should consider the use of these interventions for patients with MSDs.
TRIAL REGISTRATION
PROSPERO CRD42021253221; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=253221.
Topics: Humans; Cost-Benefit Analysis; Musculoskeletal Diseases; Outcome Assessment, Health Care; Qualitative Research; Fibromyalgia
PubMed: 37410542
DOI: 10.2196/41113 -
Journal of Evaluation in Clinical... Feb 2015Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often... (Review)
Review
RATIONALE, AIMS AND OBJECTIVES
Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as 'triage' services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on 'best practice' to assist health care facilities.
METHOD
A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken.
RESULTS
1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes.
CONCLUSIONS
This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics.
Topics: Health Personnel; Humans; Musculoskeletal Diseases; Orthopedics; Outpatient Clinics, Hospital; Referral and Consultation; Triage
PubMed: 25410703
DOI: 10.1111/jep.12260 -
Rheumatology (Oxford, England) Mar 2017To recommend robust and relevant measures of exercise adherence for application in the musculoskeletal field. (Review)
Review
OBJECTIVE
To recommend robust and relevant measures of exercise adherence for application in the musculoskeletal field.
METHOD
A systematic review of measures was conducted in two phases. Phase 1 sought to identify all reproducible measures used to assess exercise adherence in a musculoskeletal setting. Phase 2 identified published evidence of measurement and practical properties of identified measures. Eight databases were searched (from inception to February 2016). Study quality was assessed against the Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. Measurement quality was assessed against accepted standards.
RESULTS
Phase 1: from 8511 records, 326 full-text articles were reviewed; 45 reproducible measures were identified. Phase 2: from 2977 records, 110 full-text articles were assessed for eligibility; 10 articles provided evidence of measurement/practical properties for just seven measures. Six were exercise adherence-specific measures; one was specific to physical activity but applied as a measure of exercise adherence. Evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development or evaluation of any measure.
CONCLUSION
The significant methodological and quality issues encountered prevent the clear recommendation of any measure; future applications should be undertaken cautiously until greater clarity of the conceptual underpinning of each measure is provided and acceptable evidence of essential measurement properties is established. Future research should seek to engage collaboratively with relevant stakeholders to ensure that exercise adherence assessment is high quality, relevant and acceptable.
Topics: Exercise Therapy; Humans; Musculoskeletal Diseases; Observation; Patient Acceptance of Health Care; Patient Compliance; Surveys and Questionnaires
PubMed: 28013200
DOI: 10.1093/rheumatology/kew422 -
BMC Musculoskeletal Disorders May 2023Chronic musculoskeletal pain (CMP) is a complex condition that is mainly treated with analgesic drugs. However, antidepressant intervention is also an important factor... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic musculoskeletal pain (CMP) is a complex condition that is mainly treated with analgesic drugs. However, antidepressant intervention is also an important factor in the treatment of CMP. Duloxetine is an effective treatment option for patients with CMP as its antidepressant effect. The purpose of this article is to evaluate the efficacy and safety of duloxetine in treating CMP.
DATABASES AND DATA TREATMENT
We searched PubMed, Web of Science, Embase, Cochrane Library from inception to May, 2022. Randomized controlled trials (RCTs) evaluating the efficacy and safety of duloxetine versus placebo in patients with CMP were included. We identified 13 articles and studied a population of 4201 participants in 4 countries.
RESULTS
This meta-analysis showed that the duloxetine has statistically significant compared with the placebo control, benefits on 24-hour average pain, living quality, physical function, and global impressions and there was no difference in the incidence of serious adverse event. In general, duloxetine can improve mood and pain level at the same time.
CONCLUSIONS
This review shows a significant contribution of duloxetine to CMP symptom relief. This meta-analysis improved that duloxetine can significantly reduce the pain level of patients, improve depressive symptoms and global impression, and has no obvious serious adverse reactions. However, additional studies are required to confirm the relationship between psychological diseases and chronic pain and explore their internal links.
Topics: Humans; Duloxetine Hydrochloride; Musculoskeletal Pain; Analgesics; Chronic Pain; Antidepressive Agents
PubMed: 37198620
DOI: 10.1186/s12891-023-06488-6