To perform a European survey of the evidence needs and training demands of insurance medicine professionals related to professional tasks and evidence-based practice.
International survey.
...Professionals working in insurance medicine.
Experts designed an online questionnaire including 26 questions related to 4 themes: evidence needs; training demands; evidence-seeking behaviour; and attitudes towards evidence-based medicine. Descriptive statistics were presented by country/conference and the total sample.
A total of 782 participants responded. Three-quarter of participants experienced evidence needs at least once a week, related to mental disorders (79%), musculoskeletal disorders (67%) and occupational health (65%). Guidelines (76%) and systematic reviews (60%) were the preferred types of evidence and were requested for assessment of work capacity (64%) and prognosis of return-to-work (51%). Evidence-based medicine was thought to facilitate decision-making in insurance medicine (95%). Fifty-two percent of participants felt comfortable finding, reading, interpreting, and applying evidence. Countries expressed similar needs for reviews on typical topics.
This study reveals evidence gaps in key areas of insurance medicine, supporting the need for further research, guidelines and training in evidence-based insurance medicine. Importantly, insurance medicine professionals should recognize that evidence-based practice is crucial in producing high-quality assessments.
Cross-sectional magnetic resonance imaging (MRI) study.
To find out whether different patterns of lumbar disc degeneration related to different physical work types (static vs. dynamic) can be found.
...The association of lumbar disc degeneration with physical workload as well as the association of disc degeneration with low back pain (LBP) has been debated controversially. Nevertheless, many of the mainly invasive treatment concepts are based on disc degeneration models.
An MRI study was performed in female subjects aged 45 to 62 years with persistent LBP and in age-matched controls. Subjects (n = 109) were selected from nursing and administrative professions. A questionnaire was used to assess the subjects' exposure to physical workplace factors. Disc degeneration, disc herniation, nerve root compromise, high intensity zones, endplate changes, and facet joint osteoarthritis were evaluated based on sagittal T1- and T2-weighted as well as axial T2-weighted images.
The two occupational groups could clearly be distinguished by the physical workplace factors: administrative work was associated with predominantly sitting postures whereas nursing work was associated with frequent walking, pushing, pulling, and lifting. Except for endplate (Modic) changes at L5-S1, MRI findings did not differ between the four groups, namely, nurses and secretaries with and without LBP. When analyzing the MRI findings within the two vocational groups, nerve root compromise and endplate changes in the lower lumbar spine were found to be significant (P < 0.05) risk factors for LBP. Disc degeneration, disc herniation, nerve root compromise, and facet joint osteoarthritis were present in more than 50% of the intervertebral spaces studied.
These findings give evidence that in subjects performing nonheavy work, patterns of lumbar disc degeneration are not associated with the job type and characteristic physical loadings.
The Continuing Training Courses of Medical Assessors and Legal Medical Advisors in Swiss Insurance Medicine (SIM)
In the context of insurance medicine, the medical assessor has the task of clarifying ...the state of health in a professional manner and making a medical assessment. The medical appraisal is to be carried out in the context of the legal context based on legislation and case law. With the professional expert clarification of the state of health and the medical assessment, the medical expert places his knowledge in the service of the jurisdiction. Around the turn of the millennium, it became apparent that specialization and medical experience alone were not sufficient to meet the increasing requirements of a medical expert in a legal context. For this reason, Swiss Insurance Medicine (SIM), on behalf of the FMH, established and, over time, expanded a structured continuing education program for medical experts. In recent years, further training opportunities have been created for the early assessments and second opinions necessary for rapid and sustainable professional integration, as well as for continuing education.
Work-related musculoskeletal disorders in the neck-shoulder area and upper extremities are common among computer users, especially women. We comparedtemporal changes of motor unit (MU) activation in ...the trapezius muscle during finger tapping using both appropriate and inappropriate ergonomic desk adjustments. Sixteen intensive and nonintensive computer users with either moderate or severe musculoskeletal disorders participated in the study. Six-channel intramuscular electromyographic (EMG) signals and 2-channel surface EMG were recorded from 2 positions of the trapezius muscle. A statistically significant increase in activity was observed with a desk adjusted 5 cm higher than appropriate and was attributable mainly to increased duration of MU activity. Participants with severe symptoms activated more MUs, and these were also active longer. In women, on average, MUs were active nearly twice as long as in men during the same tapping task. This study demonstrates that it is possible to evaluate ergonomic topics on the MU level and that incorrectly adjusted office equipment, in addition to motor demands imposed by the work task, results in prolonged activity of MUs. A potential application of this research is an increased awareness that certain individuals who work with incorrectly adjusted office equipment may be at greater risk of developing work-related musculoskeletal disorders.
Recurrent low back pain (LBP) is a common pain condition in elderly workers in a variety of occupations, but little is known about its origin and the mechanisms leading to an often disabling ...sensation of pain that may be persistent or intermittent. In the present study we evaluated the pressure pain thresholds (PPTs) in subjects suffering from recurrent LBP, as well as in healthy controls, to investigate if recurrent LBP is associated with an increased sensitivity of the muscular and ligamentous structures located on the lower back. One hundred and six female workers, aged between 45 and 62 years and working either in administrative or nursing professions were examined. The subjects were classified into LBP cases and controls based on the Nordic questionnaire. Subjects indicating 8-30 or more days with LBP during the past 12 months were graded as cases. PPTs were measured on 12 points (six on each side of the body) expected to be relevant for LBP (paravertebral muscles, musculus quadratus lumborum, os ilium, iliolumbar ligament, musculus piriformis and greater trochanter), as well as on a reference point (middle of the forehead) using a digital dolorimeter. The PPTs on all points on the lower back highly correlated with each other and a high internal consistency was found with a Cronbach alpha coefficient > 0.95. There was a moderate and significant correlation of the PPT on the forehead with the PPT on the lower back with correlation coefficients ranging from 0.36 to 0.49. In LBP cases from administrative professions, the PPT on the forehead was significantly decreased (P < 0.05). The PPT on the lower back did not significantly differ between the four groups studied, namely nurses and administrative workers with and without recurrent LBP. These results give evidence that recurrent LBP is not associated with an altered sensitivity of the muscular and myofascial tissues in the lumbar region. Furthermore, they raise questions about the value of reference point measurements in recurrent LBP.
Back pain in the working age population can coincide with work-related activities and may lead to temporary or permanent work disability in the case of functional impairment that interacts with ...workplace demands. This can lead to economic if not existential problems for the affected individual. Although neurogenic or inflammatory back pain may be the cause, the big majority of all cases is caused by "common" low back pain with or without irradiating pain, the main problem being frequent recurrencies of acute pain episodes (periodic or relapsing course). After early exclusion of specific causes (i. e. "red flags": usually identified through history and simple laboratory findings!) repetitive examinations should be avoided. Structural changes and physical job demands should not be overestimated as causal factors. In the early phase of a work disability more emphasis should be laid however on appropriate information and medication and, in case of persistent impairment, active treatment (after 3 weeks or relapse). Longtime workplace absence has important individual and socioeconomic consequences. The risk for chronification can be estimated through evaluation of "yellow flags" and observation of characteristics of the course in the individual case. An early return to work and to activities of daily life is urgent. In cases at risk for chronification and/or with obstacles to reintegration at work an interdisciplinary work-oriented rehabilitation or social and occupational reintegration should be organised.
Purpose
High levels of pain behavior adversely affect the success of multidisciplinary rehabilitation of patients with chronic nonspecific low back pain (CNSLBP). Functional capacity evaluation (FCE) ...assessment should detect high levels of pain behavior to prevent the inclusion of unsuitable patients to functional rehabilitation programs. The aim of this study was to develop a Pain Behavior Assessment (PBA) and to evaluate its construct validity.
Methods
The PBA was developed by experts in the field and is literature-based. Inclusion criteria for participants of the validation study were: CNSLBP, age 20–60 years, referral for fitness-for-work evaluation. The PBA was applied by physiotherapists during FCE. Rasch analysis was performed to evaluate the construct validity of the PBA. Internal consistency was indicated by the person separation index (PSI), which corresponds to Cronbach’s alpha.
Results
145 male (72.5 %) and 55 female patients were included. Rasch analysis removed 11 items due to misfit and redundancy, resulting in a final PBA of 41 items. Item mean fit residual was −0.33 (SD 1.06) and total item Chi square 100.39 (
df
= 82,
p
= 0.08). The PSI value was 0.83. DIF analysis for age and gender revealed no bias.
Conclusions
The PBA is a valid assessment tool to describe pain behavior in CNSLBP patients. The high PSI-value justifies the use of the PBA in individuals. The PBA may help to screen patients for high levels of pain behavior.
Background The work incapacity of ankylosing spondylitis (AS) ranges between 3% and 50% in Europe. In many countries, work incapacity is difficult to quantify. The work ability index (WAI) is applied ...to measure the work ability in workers, but it is not well investigated in patients. Aims To investigate the work incapacity in terms of absence days in patients with AS and to evaluate whether the WAI reflects the absence from work. Hypothesis Absence days can be estimated based on the WAI and other variables. Design Cross-sectional design. Setting In a secondary care centre in Switzerland, the WAI and a questionnaire about work absence were administered in AS patients prior to cardiovascular training. The number of absence days was collected retrospectively. The absence days were estimated using a two-part regression model. Participants 92 AS patients (58 men (63%)). Inclusion criteria: AS diagnosis, ability to cycle, age between 18 and 65 years. Exclusion criteria: severe heart disease. Primary and secondary outcome measures Absence days. Results Of the 92 patients, 14 received a disability pension and 78 were in the working process. The median absence days per year of the 78 patients due to AS alone and including other reasons was 0 days (IQR 0–12.3) and 2.5 days (IQR 0–19), respectively. The WAI score (regression coefficient=−4.66 (p<0.001, CI −6.1 to −3.2), ‘getting a disability pension’ (regression coefficient=−106.8 (p<0.001, 95% CI −141.6 to −72.0) and other not significant variables explained 70% of the variance in absence days (p<0.001), and therefore may estimate the number of absence days. Conclusions Absences in our sample of AS patients were equal to pan-European countries. In groups of AS patients, the WAI and other variables are valid to estimate absence days with the help of a two-part regression model.
The purpose of this prospective cohort study was to determine whether the maximal width of the base of support (BSW) measure is able to predict the risk of multiple falls in community-dwelling women. ...Thirty-eight community-dwelling women (mean age of 72 ± 8 years old) participated. Falls were prospectively recorded during the following year. Overall, 29 falls were recorded; six (16%) women were multiple fallers and 32 (84%) were nonfallers. There was a significant difference in the BSW between the fallers and nonfallers (F1, 37 = 5.134 p = .030). A logistic regression analysis indicated a significant contribution of the BSW test to the model (odds ratio = 0.637; 95% CI 0.407, 0.993; p = .046 per 1 cm).The cut-off score was determined to be 27.8 cm (67% sensitivity and 84% specificity). These results indicate that women with a smaller BSW at baseline had a significantly higher risk of sustaining a fall.
PDF
