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2001. DRSI series. MSD risk factors.

May 25, 2012
by Andrew@Reliabilityoxford.co.uk
0 Comment
Identification of risk factors is a sensible precursor to designing interventions and seeing if they work as expected. It would seem obvious then that if a supposed risk factor turns out not to be valid then it should not feature in intervention studies or duty of care standards.

Evidence from: 

M.Hakkanen et al. Occupational and Environmental Medicine (2001) Vol.58 #2 p.129.

Results show that the most significant risk factor for absence with diagnosable arm, neck and shoulder disorders is age: Age 30-40 Risk Ratio = 2.9 (95% confidence interval 1.2 to 7.1). High physical load was protective.

The Radar report is available to subscribers:

SK 1#2 5

Evidence from:

G.A.M.Ariens et al. Occupational and Environmental Medicine (2001) Vol.58 #3 p.200.

Among those sitting, neck pain (but not a diagnosis) was more likely if the neck was flexed by 20 degrees for more than 70% of the time.

The Radar report is available to subscribers:

SK 1#2 6

Evidence from:

RSI conference 2nd March 2001.

RSI was regarded by one speaker to be an almost meaningless term.

The development of chronic pain conditions is a multi-factorial problem, with contributions from psychological, psychosocial, ergonomic and organisational factors.

The Radar report is available to subscribers:

SK 1#3 1

Evidence from:

JMcBeth et al. Arthritis and Rheumatism, April (2001) Vol.44 #4 p940.

Out of 1953 people who were considered for the study 295 (15%) were excluded because they already had chronic widespread pain (CWP).

Prevalence of new CWP (at 12 months after enrollment) ranged from 5.3% (95% CI = 3.1,7.5) to 7.4%(95% CI = 4.8,10.0) ages 18-34 and 50-64 respectively.

Predictive factors were measured.

The Radar report is available to subscribers:

SK 1#4 1

Evidence from:

MWeber et al. Pain. April (2001) Vol.91 #3 p 251

Chronic regional pain syndrome (CRPS)  may provide insight into DRSI. In this study a hypersensitive neurological state was observed in CRPS cases. Similar hypersensitivity might be observable in DRSI cases; worth looking into…Screening for neural hypersensitivity could help reduce the incidence of pain problems at work.

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SK 1#4 2

Evidence from:

P Fearnon and M Hotopf. BMJ. May (2001) #7295 p 1145

At age 33, 9.3% had multiple somatic complaints, 13.9% had evidence of psychiatric morbidity. Women and children of the manual classes were over-represented in this outcome set.

The above finding is not strong enough to show on the balance of probabilities, that adult problems are entirely due to factors that were also present in childhood, but the precision of the findings are strongly suggestive a definite link.

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SK 1#5 4

Evidence from:

S Bergman et al. Journal of Rheumatology. June (2001) Vol. 28 #6 p 1369.

Prevalence of chronic pain increased with age, for example, 17% at age 20-24 to 50% at age 60-64.

Employers should have an expectation that a significant proportion of their work force will be in pain regardless of conditions at work.

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SK 1#6 4

Evidence from:

ES Nahit, GJ Macfarlane et al. Journal of Rheumatology. June (2001) Vol. 28 # p 1378.

There is a clear association between pain and stress. At present, from these results, it is not possible to distinguish whether the pain causes the perception of stress or the perception of stress causes the pain?

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SK 1#6 5

Evidence from:

Report of the employers forum: a one day meeting on the 7th September 2001, Edinburgh.

It was generally agreed that physical work factors are rarely the cause of the development of chronicity, though some reduction of workload or variation of tasks would be appropriate in many cases until the problem had sufficiently resolved. The key factor was the retention of the worker at the workplace while resolution occurred. This would avoid losing the working habit and losing social contacts at work as well as encouraging normal levels of physical activity. On the other hand, poor work habits should not be maintained.

The forum was strongly influenced by the flags model of risk factors for pain states.

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SK 1#9 1

Evidence from:

GAM Ariens et al. Spine. September (2001) Vol. 26 #17 p 1896.

Significant associations between neck pain and psychosocial variables were: High Job demands RR = 2.14 (95% CI = 1.28 to 3.58) Low Co worker support RR = 2.43 (95% CI = 1.11 to 5.29)

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SK 1#9 4

Evidence from:

J McBeth et al. Journal of Rheumatology. October (2001) Vol. 28 #10 p 2305.

This result is at odds with findings (mainly from USA) which find strong links between CWP and child sex abuse. The finding counts against the examination of life histories in the search for causes of CWP.

This was a relatively good study.

The Radar report is available to subscribers:

SK 1#10 6

Evidence from:

HJCG Coury et al. International Journal of Industrial Ergonomics (2002) Vol. 29 p.33.

When doing the same manual job, women took more sick leave than did men. But the main explanatory variable was length of tenure as opposed to pain or disability.

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SK 1#12 1

Evidence from:

KT Palmer et al. Occupational Med. (2001) Vol. 51 p. 392.

Shoulder pain and wrist/hand pains were significantly associated with keyboard use. Prevalence ratios were of the order of 1.4 (95% CI = 1.1 to 1.7). Prevalence of problems among women was higher than among men (>30% higher) typically 10% had pain within the last week.

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SK 1#12 2

Evidence from:

NM Cherry et al. Occupational Med. (2001) Vol. 51 p. 450.
The Musculoskeletal Occupational Surveillance Scheme (MOSS) is run by Manchester University, taking reports from consultant rheumatologists since 1997.
On average there are 2700 new cases of occupational MSD occurring each year. Approximately 44% of diagnoses concern the hand/wrist/forearm and 35% of these (i.e. 15% of the total, or 400 cases a year) are described as “pain with ill-defined pathology”, which could include diffuse RSI.
Women account for a more than half these diagnoses.
Comment
There are arguments that suggest this is a somewhat low figure for the incidence of pain with ill-defined pathology. It is certainly lower than figures obtained by asking working people directly, or their GPs. Consultants tend to see particularly difficult cases and are increasingly reluctant to assign work as the cause.
Evidence from:
EA Kemp et al. International Journal of Industrial Ergonomics (2002) Vol.29 p.1
Prolonged muscle tension is thought to be a factor in the development of DRSI. Use of keyboards may encourage prolonged tension.
Software has been developed that requires DSE users to take micro breaks. This research evaluates a large number of such software products and tests 3 of them on a small group of keyboard workers.
People with existing symptoms preferred different packages to those with no symptoms. However, there were no particular features that made compliance with micro-breaks any more effective, other than being given a choice of which software to keep.
Comment
A balance between annoyance and value of compulsory breaks needs to be found if these products are to be used effectively.
The value of micro breaks is as yet uncertain.
Evidence from:

S Hollmann et al. Work and Stress. March (2001) Vol. 15#1 p. 29.

Further research on the proposed link between occupational stress and MSK complaints. The study found that people with higher physical workloads reported greater psychosocial demand and more msk complaints. The cause of this correlation could not be ascertained from this study design.

The Radar report is available to subscribers:

SK 1#12 8

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