Associations of length of employment and working conditions with neck,shoulder and arm pain among nursery school teachers

A cross-sectional questionnaire study was carried out on nursery school (NS) teachers in public nursery schools in N city in Japan to determine the magnitude of associations of probable risk factors with neck, shoulder, and arm pain, adjusting for potential confounders in logistic regression models. Of 1438 subjects, responded to the questionnaire, 959 NS teachers in charge of a separate or mixed group of children were subjected to analyses. Prevalence of neck and/or shoulder pain was 33.6%-35.4% in NS teachers in charge of children aged 0, 0-1, 4, and 5 in contrast to 25.0-29.8% in those in charge of children aged 1,2, and 3. The prevalence of neck/shoulder pain tended to increase with the length of employment in all groups classified according to the age of children under care. In a logistic regression model that simultaneously adjusted demographic and personal variables, length of employment and care for children aged 0 in the workplace were found significantly associated with musculoskeletal pain. In further logistic models, pain in the neck/shoulders and arms had associations with some specific variables: care for children aged 0, holding/lifting a child/material, overwork, and poorly supported job situations. The odds ratios for those variables varied from 1.37 to 2.41. This results suggest that pain in the neck/shoulders and arms is induced by a wide variety of risk factors in NS teachers that include high physical workload, long working hours, job demand-support imbalance, and cumulative influence of workloads.     

Labor of freight-container tractor drivers and low-back pain. Characteristics of the low-back pain through clinical findings

In order to clarify the characteristics of the low-back pain which is prevalent among freight-container tractor drivers, a medical examination, composed of orthopedic tests and questions about health conditions, was carried out on 231 tractor drivers. Prevailing complaints were: dullness or stiffness of the shoulder (71%); dullness of the neck (69%); dullness of the low back (62%); low-back pain (42%); dullness of the lower limbs (39%) and dullness of the back (36%). The rates of complaints of dullness or pain of the neck, shoulder, upper limbs, back or lower limbs, and disturbance of daily activity were associated with the grade of low-back pain evaluated from the subjective symptoms. Orthopedic examination revealed fatigue signs of muscles i.e. tenderness of the body trunk and limbs, tenderness or percussion pain on the spinous processes, and poor results in some tests on muscle strength. These findings were seen more frequently in the group with subjective symptoms, but even among the group without symptoms, they were evident to some degree. These findings were considered to originate from the fact that the freight-container tractors had many ergonomic problems and the daily driving hours of many drivers were estimated to exceed the allowable vibration exposure time of the ISO.     

The association between exposure to a rear-end collision and future neck or shoulder pain: a cohort study

Neck pain is the most frequently reported feature in connection with whiplash injury, but it is also a common complaint in the general population. Therefore it is crucial to include an unexposed comparison group when evaluating the association between neck pain and a previous motor vehicle crash (MVC). To determine whether exposure to a rear-end collision, without or with whiplash injury, is associated with future neck or shoulder pain, a cohort study was conducted. The study population consisted of persons covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups, without reported whiplash injury (n = 204) and with reported whiplash injury (n = 232). Two comparison groups, unexposed to MVCs, consisting of 1599 and 2089 persons, were selected with consideration taken to the age and gender distribution in the exposed subgroups. A questionnaire concerning neck or shoulder pain and other subjective health complaints was mailed to all the study subjects at follow-up in 1994, 7 years after the rear-end collision. The relative risk of neck or shoulder pain at follow-up was 1.3 (95% CI 0.8-2.0) in the exposed subjects without whiplash injury compared with the unexposed. The corresponding relative risk in subjects with whiplash injury was 2.7 (95% CI 2.1-3. 5). We conclude that there is no increased risk of future neck or shoulder pain in drivers who did not report whiplash injury in connection with a rear-end collision 7 years earlier. In drivers with reported whiplash injury, the risk of neck or shoulder pain 7 years after the collision was increased nearly three-fold compared with that in unexposed subjects.     

Risk factors for specific upper limb disorders as compared with non-specific upper limb pain: assessing the utility of a structured examination schedule

BACKGROUND: Few community-based epidemiological investigations of upper limb disorders (ULDs) have classified cases by validated procedures involving a structured clinical examination. AIM: To compare risk factor profiles for different diagnostic categories of ULD using one such examination scheme. METHODS: A questionnaire about upper limb pain and demographic, occupational and psychosocial risk factors was mailed to 10,264 adults from two English general practices, followed by standardized physical examination in those with arm or neck pain. Logistic regression was used to compare those with specific ULDs and non-specific arm pain with those who had no neck or arm symptoms. RESULTS: There was a 59% response rate. A total of 1,197 subjects with arm or neck pain underwent standardized physical examination and were classified as having one or more of 11 specific ULDs or non-specific regional pain. Among these, 250 subjects with specific ULDs and 176 with only non-specific arm pain were compared with 2,248 subjects who had no neck or arm symptoms. Certain physical risk factors were more strongly associated with specific disorders than with non-specific pain. In comparison with pain-free subjects, the odds ratios (ORs) in keyboard users (>or=1 h versus <1 h/day) were 3.1 (95% CI 1.3, 7.8) for hand-wrist tendonitis but 1.3 (0.8, 2.1) for non-specific hand-wrist pain. Other differential associations were found with age, sex, manual versus non-manual employment and smoking. Unexpectedly, low vitality was similarly associated with both specific disorders and non-specific pain. CONCLUSION: These findings suggest that the schedule may usefully distinguish disorders that differ in their association with physical risk factors.     

High incidence and recurrence of shoulder and neck pain in nursing home employees was demonstrated during a 2-year follow-up

OBJECTIVE: This study describes the course of shoulder and neck complaints in a working population over time. STUDY DESIGN AND SETTING: Questionnaires were administered on neck and shoulder complaints over 3 consecutive years. RESULTS: We observed 12-month incidence rates for neck and shoulder complaints of 16% to 18%, 12-month prevalence rates roughly twice as high, and 12-month recurrence rates approximately twice the prevalence rates. Each year, medical care was sought by 21% to 38% of the subjects with neck or shoulder pain, and 13% to 21% were absent from work. Although at the population level the occurrence of neck and shoulder complaints remained constant, the course of complaints within individuals demonstrated a strong episodic nature of neck and shoulder pain. Results from this study suggest that neck and shoulder complaints for most subjects run a recurrent course characterized by a strong variation in occurrence and a self-limiting course. CONCLUSION: These findings suggest that clinical trials should have a sufficiently long follow-up period to demonstrate sustainability of the therapeutic results.     

Subjective complaints in orthopedists and general surgeons

The aim of this study was to investigate the prevalence of subjective complaints among two groups of health care personnel. Using a mail questionnaire, 63 male orthopedists and 78 male general surgeons were asked to respond to questions on their subjective musculoskeletal complaints as well as their age, occupational career, and daily working time. In the final analysis, 54 orthopedists and 63 general surgeons who were aged 59 years and had worked for at least 5 years in clinical practice were considered. The mean age was 43.3 (SD 7.6) years for the orthopedists and 41.8 (SD 9.5) years for the general surgeons. Their mean employment time was 18.1 (SD 8.9) years and 16.6 (SD 9.5) years, respectively. The average working time per day was 9.5 h. In general, the orthopedists had a higher prevalence of subjective complaints than the general surgeons. Problems in the shoulders and lower back were the most frequently reported complaints, followed by neck problems. There were significant differences (P < 0.05) between the two groups regarding stiffness in the shoulders, stiffness in the lower back, pain in the neck, and numbness in the fingers. When subjective complaints were compared between the junior (employment time: < 20 years) and senior (employment time: 20 years) staff, the junior orthopedists had significantly higher prevalence rates for stiffness in the shoulders, pain in the neck, and stiffness in the lower back. This subgroup had significantly higher odds ratios (ORs) for some subjective complaints as compared to the junior surgeons, e.g., pain in the neck [OR = 6.19, 95% confidence interval (95% Cl) 1.91–20.04], shoulder stiffness (OR = 3.75, 95% Cl 1.36–10.31), pain in the shoulders (OR = 4.41, 95% Cl 3.64–4.70), and stiffness in the lower back (OR = 4.93, 95% Cl 1.74–13.94). It was concluded that ergonomic intervention to improve the working environment is imperative. In addition to ergonomic factors, consideration might also be given to psychological factors with a view to reducing the risk of subjective complaints among these subjects.     

An inquiry into the factors affecting the complaints of subjective symptoms in VDT operators

In a study of VDT workers the relationship between 1) their general life condition and working environment and 2) their eye, shoulder, neck, arm, waist and back complaints and their psychological symptoms was investigated. The subjects of the study were (147 workers whose age ranged from 18 to 39 years, and who had used VDT for a monthly average of more than 40 h. The results were as follows: 1) For most of the symptoms, a tendency was observed for females to complain more than males and for younger workers to complain more than the older workers. Neck, shoulder, arm, waist and back complaints were more common than psychological symptoms. These physical complaints appeared to be the most common among VDT workers. 2) The occurrence of eye-related symptoms is related to items directly affecting sight. This reaffirms the importance of illumination for the visual system. 3) This investigation showed that a relatively good VDT working environment was secured for the subjects of the present study. It is important that consideration be given to labor management such as provision of rest period and supervision.     

Predictive validity of symptoms and signs in the neck and shoulders

A standardized examination protocol was developed for the assessment of neck and shoulder disorders in primary health care. We investigated to what extent the symptoms and signs can predict sick leave due to neck and shoulder disorders. Our study involved 474 patients seeking medical advice from an occupational health service. Most of the 20 symptoms and 15 signs of the protocol were associated with the number of sick leave days within the 60-day postexamination period, but only three symptoms (short duration, high pain intensity, and continuous pain) and two signs (pain in the upper limb during rotation of head and pain in the shoulder during abduction of arm) retained their significance in a multivariate model. No unambiguous subset of protocol items can be suggested for general use. The predictive validity should be tested in other populations and settings before a conclusion is drawn about the external validity of the results.     

Multivariate analysis on the relationship between subjective symptoms and risk factors for the development of symptoms including working conditions, life habits and physical status in forestry workers using chain saw]

To determine the risk factors of the subjective symptoms experienced by chain saw workers, we surveyed 206 forestry workers using this device in their work. The strength of the relationship between their symptoms and such potential risk factors as occupational, behavioral, and physical factors was evaluated by a multiple logistic regression model. It was found that many years of chain saw operation, and numerous hours of chain saw operation per day, increased the risk of white finger, numbness of hands and arms, chillness of hands and arms and difficulty in joint movement, indicating that these symptoms were closely related to vibration exposure. Many years of forestry work before chain saw work also increased the risk of joint pain, suggesting that bone and joint disorders are related to heavy manual work not using a chain saw. A second job involving manual labor increased the risk of weakness in the arms, stiffness of the shoulders, and lumbago. Infrequent bathing was associated with increased risk of pain in hands and arms and lumbago. Older workers had a higher prevalence of stomach discomfort. No risk factor was found to significantly increase the risk of easy fatigability, forgetfulness and sleep disorder. It was found that not only exposure to vibration but also other factors contributed to the prevalence of pain in hands and arms, joint pain, weakness in arms, stiffness of shoulder, and lumbago. Second job and infrequent bathing appeared to be related to the occurrence of certain subjective symptoms. These contributory factors should be taken into account when evaluating subjective symptoms encountered in field studies of forestry workers.     

Assessment of hand-arm vibration exposure among traffic police motorcyclists

 The aims of this study were (1) to evaluate subjective symptoms in the hand-arm system of all traffic police motorcyclists of a city located in the central part of Japan and (2) to assess their hand-arm vibration exposure associated with traffic police motorcycle riding. The study population consisted of 119 motorcycling traffic policemen and 49 male controls. By means of a questionnaire, information on the occupational history and the presence of subjective symptoms in the hand-arm system of all subjects was obtained. Vibration was measured on the handlebars of the representative motorcycles and on the hands of the riders. The 4- and 8-h energy-equivalent frequency-weighted acceleration as well as the lifetime vibration dose were calculated for all police motorcyclists. The prevalence of finger blanching in the traffic police motorcyclists was 4.2%, but none of the controls had this symptom. The rates of finger numbness (19.3%), finger stiffness (16.0%), shoulder pain (13.4%), and shoulder stiffness (45.4%) were significantly higher among police motorcyclists as compared with controls. The root-mean-square (rms) frequency-weighted acceleration on the handlebars of police motorcycles was in the range of 2.2–4.9 m/s² rms. The computed 4- and 8-h energy-equivalent frequency-weighted acceleration values were 2.8– 4.5 and 2.0 –3.2 m/s² rms, respectively. A pattern of increasing percentage prevalence with increasing cumulative vibration dose was noticed. The subjects with a lifetime vibration dose of more than 20.1 m² h ³ s^-4 (ln scale) showed significantly higher prevalence rates for symptoms in the fingers and shoulders as compared with the control group. As occupational vibration exposure of traffic police motorcyclists might be considered a risk factor for the development of symptoms in the hand-arm system of the riders, its evaluation and control is needed for prevention methodology evolution. Received: 15 April 1996/Accepted: 8 November 1996     

Exposure to vibration and self-reported health complaints of riveters in the aircraft industry

Workers using vibrating tools may experience neurological and vascular symptoms in the fingers and hands. The effect of vibration exposure on bone and joint disorders in the hand, arm and shoulder is less clear. In a cross-sectional study, riveters and controls in an aircraft company were investigated for vibration exposure and health complaints. Vibration measurements showed that frequency-weighted acceleration levels for riveting hammers and bucking bars ranged from 5.5 to 12.3 m s -2. The calculated equivalent frequency-weighted acceleration for a period of 4 h was the questionnaire survey 101 riveters reported statistically significant more complaints of pain and stiffness in their hands and arms when compared with 76 controls with no, or little, exposure to vibration. After 10 years of exposure statistically significant age-adjusted odds ratios (P less than 0.05) were found for vibration-induced white finger (VWF) (1.9) and pain or stiffness of the wrist (3.2). Although they were not statistically significant (0.05 less than P less than 0.10) odds ratios appreciably greater than 1 were found for numbness in fingers (1.6) and pain or stiffness in the elbow (1.6) and the shoulder (1.5), and these complaints were strongly associated with duration of exposure to vibration. With logistic regression the probabilities for a riveter of having symptoms of VWF after 10 and 20 years of exposure was estimated to be P = 0.18 and P = 0.29, respectively, which can be compared with the prevalences predicted by the dose-response relationship for VWF in ISO 5349, which are 10 and 30%. The results of this study suggest that exposure to vibration from working with impact power tools can contribute to complaints of pain and stiffness in the hand, arm and shoulder, and especially in the wrist.     

Seasonal variation in neck and shoulder symptoms.

The objective of the investigation was to study the course of neck and shoulder symptoms and the predictors for these symptoms among women in light sedentary work. Postal surveys were conducted among 351 tellers (age 20-50 years) of a bank company in September, December, March, and May. The response rates were 74-90%. The outcome was the frequency of the symptoms during the previous three months. In the analysis, univariate explorations and random-effects logistic binomial regression for distinguishable responses were used. A change in the frequency of neck and shoulder symptoms was seen in 40.5% of the subjects during the follow-up period from autumn to spring. The frequency of the symptoms decreased from autumn and winter towards spring. The stability of the frequency of the symptoms was positively associated with age. Seasonal variation in symptoms should be considered when preventive programs against neck and shoulder disorders are planned and evaluated.     

Social and psychological factors influenced the course of arm, neck and shoulder complaints

OBJECTIVE: To investigate the clinical course and prognostic factors of complaints of arm, neck, and shoulder. STUDY DESIGN AND SETTING: A prospective cohort study in physical therapy practice. Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and/or upper extremities. Participants filled in questionnaires at baseline, 3 months, and 6 months. The main outcome measure was the persistence of complaints over 6-month follow-up. Possible predictors like social and psychological factors, physical factors, and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements. RESULTS: Of the 624 participants at baseline 543 (87%) returned at least one follow-up questionnaire. At 6-month follow-up, 40% had persisting pain and discomfort. Somatization, kinesiophobia, catastrophizing, and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population. In those with paid work (77%), catastrophizing, low decision authority at work, and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months. CONCLUSION: 40% of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course.     

Musculoskeletal complaints among Italian X-ray technologists

The aim of this study was to determine the prevalence of musculoskeletal complaints among X-ray technologists and to examine their relationship with physical and psychosocial factors. A cross-sectional study was performed in 2006 among 203 X-ray technologists working in 13 hospitals in the Apulia region of southern Italy. A questionnaire was used to collect data on personal characteristics, physical workload, psychosocial aspects, and the presence of musculoskeletal symptoms in the neck, shoulders, low back, hand/wrist and legs. Univariate analyses and multiple logistic regression analyses were then performed. The prevalence of complaints at any body site in the previous 12 months was 67%. Low back pain was the most commonly reported symptom (59.6%), followed by shoulder (21.2%), neck (19.7%), leg (13.8%) and hand/wrist pain (12.3%). Age was associated with low back pain, while high physical workload was associated with symptoms in the neck, low back and hand/wrist. High job demands were associated with neck and shoulder pain. Overall, our study suggests high prevalence rates of musculoskeletal complaints may exist among Italian X-ray technologists. Physical workload, psychosocial and individual factors appear to be important risk factors for musculoskeletal disorders within this occupational group.     

Arm pain and daytime sleepiness among nursing home employees

We investigated the relationship between musculoskeletal disorders and sleep problems among 98 employees (79 women) at three nursing homes. Self-reported data were collected regarding pain in the neck, shoulders, arms, legs, and low back, sleep disturbances, daytime sleepiness (Epworth Sleepiness Scale), and the level of workload on the hands, legs, and low back by type of care. Pain in the arms was significantly associated with less difficulty initiating sleep, fewer symptoms of insomnia, and a higher level of daytime sleepiness. After adjusting for age and gender, only the association between arm pain and daytime sleepiness remained significant (Odds Ratio 6.70, 95% Confidence Interval 1.40-31.97). Participants with both arm pain and daytime sleepiness showed significantly greater levels of workload in some kinds of care in a systemic manner than counterparts without either complaint. These findings suggest that arm pain is associated with elevated sleep propensity/fatigue in nursing home work.     

The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users

Objectives  To assess the influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users. Methods  The study is a prospective cohort study with an observation period of 10 months. A baseline questionnaire about symptoms in the neck, shoulder and arm/hand during previous month, individual factors, work content, physical and psychosocial work-related exposures was answered by 1,283 computer operators (response rate 84%). Incidence data were collected by ten monthly questionnaires regarding the occurrence of symptoms categorized into three gross body regions: neck, shoulders and arms/hands. A case, in the specific gross body region, was defined as a subject who was classified as non-symptomatic in that region at baseline or during minimum one follow-up period and later reported symptoms (≥3 days). Univariable and multivariable incidence rate ratios with 95% confidence intervals for first occurrence of neck, shoulder and arm/hand cases, respectively, were calculated with Cox regression analysis. Results  The incidence rate was 67, 41 and 47 cases per 100 person years for neck, shoulder and arm/hand symptoms, respectively. In the multivariable analyses, comfort of the computer work environment and gender were related to the incidence of symptoms in all body regions (RR = 1.5–1.9 for low comfort and 1.8–2.1 for females, respectively). Duration of mouse use predicted arm/hand symptoms (RR = 1.7 for ≥3 h/day) and job strain (high demands and low decision latitude) predicted neck symptoms (RR = 1.6 and 2.2 for medium and high strain, respectively). Additionally, age was related to neck and shoulder symptoms. Conclusion  Preventive strategies to reduce neck and upper limb symptoms among computer users should include measures to reduce mouse use, to increase the comfort of the work environment and to reduce job strain. Although the effect estimates were relatively weak to moderate, preventive measures may have a marked impact on the incidence of neck and upper limb symptoms in the general population because of the widespread use of computers in working life as well as at home.     

Upper extremity musculoskeletal symptoms among female office workers: Associations with video display terminal use and occupational psychosocial stressors

The relationships between musculoskeletal symptoms and both video display terminal (VDT) use and occupational psychosocial stress were assessed among women office workers by self-administered questionnaires. Significantly increased odds ratios for neck or shoulder symptoms were observed from subjects who had ever used a VDT, had less job security, and had more stressful work during the 2 weeks prior to completion of the questionnaire. Significantly increased odds ratios for arm and hand symptoms were observed for subjects who had used a VDT for more than 6 years, reported a very crowded workplace, or reported very stressful work during the 2 weeks prior to completion of the questionnaire. Among current non-users, those who previously used VDTs were more likely to report upper extremity musculoskeletal symptoms than those who had never used VDTs. This suggests that individuals with symptoms may be more likely to reduce their VDT usage, distorting results of cross-sectional studies. © 1996 Wiley-Liss, Inc.     

Chronic neck and shoulder pain,age, and working conditions: longitudinal results from a large random sample in France

Aims: To analyse the effects of age and occupational factors on both the incidence and the disappearance of chronic neck and shoulder pain after a five year follow up period.

Methods: A prospective longitudinal investigation (ESTEV) was carried out in 1990 and 1995 in seven regions of France. A random sample of male and female workers born in 1938, 1943, 1948, and 1953 was selected from the occupational physicians' files. In 1990, 21 378 subjects were interviewed (88% of those contacted), and 87% were interviewed again in 1995. Chronic neck and shoulder pain satisfying specific criteria, and psychosocial working conditions were investigated by a structured self administered questionnaire and a clinical examination.

Results: Prevalence (men 7.8%, women 14.8% in 1990) and incidence (men 7.3%, women 12.5% for the period 1990–95) of chronic neck and shoulder pain increased with age, and were more frequent among women than men in every birth cohort. The disappearance rate of chronic neck and shoulder pain decreased with age. Some adverse working conditions (repetitive work under time constraints, awkward work for men, repetitive work for women) contributed to the development of these disorders, independently of age. Psychosocial factors seemed to play a role in both the development and disappearance of chronic neck and shoulder pain. Data did not show specific interactions between age and working conditions.

Conclusions: The aging of the workforce appears to contribute to the widespread concern about chronic neck and shoulder pain. A better understanding of work activity regulation of older workers can open up new preventive prospects.

     

Life events and the risk of low back and neck/shoulder pain of the kind people are seeking care for: results from the MUSIC-Norrtalje case-control study

OBJECTIVE: To expand the knowledge about the occurrence of life events, and how they affect the risk of low back and neck/shoulder pain. DESIGN: A population-based case-control study. SETTING: Men and women 20-59-years old, living in and not working outside the municipality of Norrt?lje, Sweden, from November 1993 to November 1997. PARTICIPANTS: Cases (n = 1,148) were defined as all subjects from the study base who sought healthcare for a new episode of low back and/or neck/shoulder pain by any of the care givers in the municipality. Controls (n = 1,700) were selected as a stratified random sample from the study base, considering sex and age. Study subjects were interviewed about life events and critical life changes. Critical life changes were defined as events that brought about a marked psychosocial change. Odds ratios (ORs) associated with different numbers of life events or critical life changes were calculated. RESULTS: Having experienced at least two life events during the preceding 5 years was associated with an increased risk of neck/shoulder pain (OR = 1.6, 95% CI 1.1 to 2.4). At least two critical life changes were associated with an increased risk of neck/shoulder pain (OR = 1.9, 95% CI 1.3 to 2.7). In general, no associations were observed in relation to risk of low back pain. CONCLUSION: Life events and critical life changes are of importance for the risk of neck/shoulder pain of the kind that people are seeking care for. The study provides useful information for clinical practice and for future aetiological research on neck/shoulder pain.