Disclosing Strain: How Psychosocial Risk Factors Influence Work-Related Musculoskeletal Disorders in Healthcare Workers Preceding and during the COVID-19 Pandemic.

Healthcare workers, particularly nurses, engage in a daily work routine that takes a toll on their emotional well-being, rendering them vulnerable to psychosocial risk factors. This research seeks to analyse the influence of psychosocial risk factors on the occurrence of work-related musculoskeletal disorders among nurses. An additional analysis was performed to understand the role of age in work-related musculoskeletal disorders and the perception of psychosocial risk factors. The study was conducted during two separate periods-pre-pandemic and pandemic times-involving a sample of 456 nurses from both public and private hospitals in Portugal. The INSAT-Health and Work Survey-was used as measuring instrument. The primary observations indicated a consistency between psychosocial risk factors and the occurrence of work-related musculoskeletal disorders. The findings revealed a significant exposure to psychosocial risk factors, with work pace, intensity, work relationships, and emotional demands exhibiting higher global average percentages during both periods, pre-pandemic and pandemic. Nonetheless, we find that the psychosocial risk factors change when we analyse the pre-pandemic and pandemic results. During the period before the pandemic, the psychosocial risk factors that were most commonly reported included the demanding pace of work, long working hours, and emotional demands. Through the pandemic, the most pronounced psychosocial risk factors were work relationships, employment relationships, and ethical and values conflicts. Therefore, research in this domain is essential to understanding psychosocial risk factors and assessing the less obvious links between work and health.

The chiropractors' dilemma in caring for older patients with musculoskeletal complaints: Collaborate, integrate, coexist, or separate?

The world's elderly population is growing at a rapid pace. This has led to an increase in demand on the health and welfare systems due to age-related disorders, with musculoskeletal complaints driving the need for rehabilitation services. However, there are concerns about health services' ability to meet this demand. While chiropractic care is gaining recognition for its benefits in treating older adults with musculoskeletal disorders, there is limited scientific literature on chiropractors' role and experiences in this area. To bridge this gap, we interviewed 21 chiropractors in Great Britain, the Netherlands, Norway, and Sweden. Inductive qualitative content analysis was used to analyse the interviews, and despite differences in integration and regulation between the countries, several common facilitators and barriers in caring for and managing older patients with musculoskeletal complaints emerged. While participants expressed optimism about future collaborations with other healthcare professionals and the integration of chiropractic into national healthcare systems, they also highlighted significant concerns regarding the existing healthcare infrastructure. The participants also felt that chiropractors, with their non-surgical and holistic approach, were well-positioned to be the primary point of contact for older patients. However, there were some common barriers, such as the affordability of care, limited integration of chiropractic, and the need to prioritise musculoskeletal complaints within public healthcare. Our findings suggest that chiropractors experience their clinical competencies as an underutilised resource in the available healthcare systems and that they could contribute to and potentially reduce the escalating burden of musculoskeletal complaints and associated costs among older patients. Additionally, our findings highlight the desire among the participants to foster collaboration among healthcare professionals and integrate chiropractic into the national public healthcare system. Integrating chiropractors as allied health professionals was also perceived to improve coordinated, patient-centred healthcare for older adults.

Musculoskeletal disorders and quality of life for Chilean teachers during the COVID-19 pandemic at the academic year-end.

Introduction: Schoolteachers have reported multiple demands contributing to poor perceptions regarding their quality of life and high rates of musculoskeletal disorders. However, there are few studies about the association between musculoskeletal disorders and quality of life from the end of the academic period during the COVID-19 pandemic. Objective: Evaluate musculoskeletal disorders rates and their association with quality of life perceptions among teachers from the last academic period during the COVID-19 pandemic. Participants and methods: A total sample of 161 Chilean schoolteachers was included in a cross-sectional study musculoskeletal disorders prevalence was evaluated using the Standardized Nordic Questionnaire, and quality of life was evaluated through the Short-Form 12 Health Survey Instrument. A logistic regression was applied to evaluate the association between musculoskeletal disorders and quality of life perceptions adjusted by gender, age, and contract type. Results: 98% of teachers have suffered from some type of musculoskeletal disorders during the last 12 months, and 64% have had six or more painful regions. Women showed a higher musculoskeletal disorders rate than men. The group of teachers with the most musculoskeletal disorders (≥p50) saw significantly greater risk of low scores on the physical (OR: 2.16; p < 0.05) and mental components (OR: 4.86; p < 0.01) of quality of life, regardless of gender, age, and contract type. Conclusion: High musculoskeletal disorders rates suggest that preventive and informative actions must be taken regarding these disorders in order to protect teachers' mental and physical health, considering the effects of the school year and the COVID-19 health crisis.

The Ergonomic Behaviors Evaluation Tool (EBET) based on social cognitive theory for the assembly line workers: development and psychometric assessment.

BACKGROUND: Ergonomic behaviors play a crucial role in preventing work-related musculoskeletal disorders (WMSDs). To measure these behaviors, this research aimed to develop and evaluate an ergonomic behaviors tool (EBET) based on the Social Cognitive Theory (SCT) among women workers on assembly lines (WwAL). METHODS: The study was conducted from December 2022 to January 2023 with a focus on the psychometric assessment of EBET. Initially, a literature review and interviews were carried out to identify crucial concepts and primary items. The questionnaire's validity was evaluated using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). To determine the domains of the tool, construct validity was examined by administering the items to 270 eligible women. The reliability of the tool was assessed using McDonald's Omega coefficient. RESULTS: From a total of 67 primary items, 50 were confirmed. The study demonstrated good validity with CVR = 0.92 and CVI = 0.97, along with reliable results indicated by McDonald's Omega coefficient of 0.74. The exploratory factor analysis (EFA) revealed ten distinct dimensions: outcome expectations, outcome expectancies, normative beliefs, perceived barriers, social support, observational learning, reinforcement, behavioral skills, self-efficacy, and intention. Together, these dimensions accounted for 66.25% of the variance in the data. Additionally, the confirmatory factor analysis results supported the presence of these ten constructs and demonstrated a satisfactory fit. CONCLUSIONS: EBET is a dependable and valid instrument for evaluating the ergonomic behaviors of workers, utilizing the principles of SCT. Researchers can employ EBET to gather data and implement suitable training interventions to enhance ergonomic behavior among WwAL. However, it is crucial to recognize that EBET may not encompass all facets of ergonomic behaviors. Therefore, it is imperative for future research to prioritize the evaluation of EBET's suitability among diverse worker populations and to consider additional dimensions of ergonomics to ensure its wider applicability and effectiveness.

Passion and performance anxiety: How it affects the incidence of musculoskeletal disorders in dancers.

OBJECTIVES: This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks. DESIGN: Prospective cohort study. METHODS: A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary. RESULTS: A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (ß = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season. CONCLUSIONS: Findings of this study support the role of obsessive passion in the development of MDEs in dancers.

Return to work after sick leave due to musculoskeletal disorder or injury: a longitudinal study conducted in Brazil.

BACKGROUND: Musculoskeletal disorders and injuries (MSDI) are conditions that affect the locomotor system characterized by pain and impairment of functionality. They are the leading cause of years lived with disability. The aim of this study was to analyze the factors that influence the return to work (RTW) among workers on sick leave due to MSDI.   METHODS: A longitudinal study was conducted in the city of São Paulo, Brazil, between 2020-2022. The participants were 216 workers who required social security compensation due to MSDI. They filled out online questionnaires about their sociodemographic characteristics, health risk behaviors, work characteristics and health conditions. They were followed for 365 days after their first day of sick leave. A Cox regression was performed to identify the factors that influenced their first RTW. RESULTS: Most participants were male (53.0%), mean age was 39.5 years (SD 10.6), 70.4% returned to work within the one-year follow-up period. The mean duration of sick leave was 192.6 days. Factors associated with a lower RTW were age 40 years and older (HR 0.54; 95%CI 0.39-0.76) and the interaction between perceptions of the need for improvement in the physical and psychological domains of quality of life (HR 0.67; 95%CI 0.48-0.94). CONCLUSIONS: Occupational healthcare professionals should pay greater attention to patients who are aging and those with perceived worse physical and psychological conditions, in order to facilitate the reintegration process and promote sustained RTW after sick leave due to musculoskeletal disorder or injury.

Internal consistency and construct validity of the Short Musculoskeletal Function Assessment (SMFA) in older adults.

OBJECTIVE: The primary objectives of this study were to 1) investigate the internal consistency 2) and construct validity of the Short Musculoskeletal Function Assessment Questionnaire (SMFA) in older adults commencing physical rehabilitation in an outpatient setting. METHODS: This cross-sectional study recruited older adults who had commenced physical rehabilitation in an outpatient setting. The SMFA consists of two indices: 1) dysfunction capturing the impact of musculoskeletal disorders on physical limitations, and 2) bothering capturing how the individual is emotionally affected by their disorder. SMFA holds four categories: 'mobility', 'daily activities', 'emotional status', and 'function of the arm and hand'. Participants answered the SMFA alongside other patient-reported questionnaires (such as the 36-Item Short Form Survey, SF-36) and similar) and objectively measured muscle strength for the upper and lower body and functional capacity. RESULTS: We included 115 older adults with a median age of 74 years (IQR 9). Adequate internal consistency was seen with Cronbach's alpha values of 0.90-0.94 for the SMFA indices and 0.77-0.91 for the SMFA categories. The strongest correlations between the SMFA indices were observed with the SF-36 physical component summary (SMFA-Dysfunction r = 0.74, p < 0.05, SMFA-Bother r = 0.72, p < 0.05). Only fair correlations were found between SMFA index scores and clinical outcome measures. DISCUSSION: This study demonstrated that the SMFA has adequate internal consistency and construct validity for self-reported health status in older adults, especially when considering components covering physical health status. However, we only observed fair correlations between SMFA and clinical outcome measures, indicating that SMFA does not adequately capture muscle strength and functional capacity.

Low Back Pain and Upper-Extremity Musculoskeletal Disorders in French Postal Workers Driving Light-Duty Vehicles for Mail and Parcel Delivery.

Occupational driving of light-duty vehicles (LDVs) became increasingly important in parcel delivery faced with the explosive growth of e-commerce. Since musculoskeletal disorders (MSDs) represent the most reported driving-related health problem, we aimed to analyze the risk of low back pain (LBP) and upper-extremity musculoskeletal disorders (UEMSDs) associated with driving LDVs for parcel delivery. In 306 postal workers exposed to driving and 100 unexposed workers, information on occupational driving, physical/psychosocial constraints, and work organization were collected via a questionnaire. MSDs were assessed using the Nordic Questionnaire, 14 additional questions regarding LBP, and a standardized clinical examination for UEMSDs. Statistical modeling consisted of multivariable logistic regression for UEMSDs and the item response theory approach for LBP. UEMSDs were associated with the distance of rural rounds and inversely associated with urban/mixed delivery rounds. Handling heavy loads was associated with LBP, and high physical demands during delivery rounds were related to MSDs. Karasek dimensions and mobbing actions were associated with MSDs. Work recognition, driving training, using an automatic gearbox, and the utilization of additional staff during peak periods were inversely associated with MSDs. Our results suggest that the distance driven in rural settings and high physical demands were associated with MSDs, while some organizational factors could protect from MSDs.

The perceptions of individuals with musculoskeletal disorders towards prognosis: An exploratory qualitative study.

QUESTION(S): How do individuals living with musculoskeletal disorders perceive the concept of prognosis? DESIGN: Exploratory phenomenological study. PARTICIPANTS: Individuals aged 18 years or older currently experiencing a musculoskeletal disorder. DATA ANALYSIS: Single semi-structured one-on-one interviews were conducted. Data was analysed using inductive coding and thematic analysis. RESULTS: Five themes were identified. First, participants defined prognosis as the likely outcome associated with their diagnosis. Their prognosis was often associated with outcomes related to pain, tissue health, and function. Second, participants perceived pain as having a negative impact on their prognosis by limiting their function and having a psychological impact. Third, participants held biomedical views in that tissue health was perceived as a cause for their pain and that tissue healing was essential for pain cessation. It was also difficult for participants to distinguish between pain related to tissue damage, and pain that was not. Fourth, participants use their ability to complete leisure and functional activities to determine the success of their recovery. Finally, participants perceived receiving individual prognoses for pain, tissue health, and function that may be simultaneously occurring as both important and beneficial. CONCLUSION: Overall, participants viewed receiving prognostic information as important and beneficial. When constructing their views on prognosis participants perceived that pain, tissue health, and functional ability could all impact upon prognosis, whilst having a prognosis of their own. Physiotherapists should consider conceptualising and discussing prognosis in terms of pain, tissue health, and function when managing musculoskeletal disorders.

Ergonomic and psychosocial risks related to musculoskeletal problems among Brazilian labor judges in telework during the COVID-19 pandemic.

Objectives. The aim of this study was to evaluate the ergonomic and psychosocial risks in telework and their relationship with musculoskeletal problems in Brazilian labor judges during the COVID-19 pandemic. Methods. A cross-sectional study was conducted with 119 participants. Data were collected through a sociodemographic and occupational questionnaire, from the Brazilian versions of the revised Maastricht upper extremity questionnaire (MUEQ-Br revised), the rapid office strain assessment (ROSA-Br) and the Nordic musculoskeletal questionnaire (NMQ), added to a numerical pain scale. Results. According to the ROSA-Br, 47.06% of the participants showed an outcome where it is considered that there is a need for immediate intervention in the workplace. Results of the ROSA-Br and the MUEQ-Br revised presented a significant correlation with the intensity of complaints in the neck and shoulders in the last 12 months and in the last 7 days. The total score of MUEQ-Br revised presented more important correlations with problems in these body regions and with the intensity of complaints in the upper back, wrists/hands and lower back in both periods. Conclusions. Companies should propose ways to assess the ergonomic and psychosocial risks among their employees in telework as a way to prevent the occurrence of musculoskeletal problems.

Priorities for Advancing Mental and Social Health Among People Presenting for Care of Musculoskeletal Symptoms : International Consortium for Mental and Social Health in Musculoskeletal Care.

An international group of clinicians and researchers formed a consortium to advance mental and social health among people seeking musculoskeletal specialty care: The International Consortium for Mental and Social Health in Musculoskeletal Care (I-MESH). As a first step to organize the work of the consortium, we sought to identify important, appropriate, and feasible interventions to address mental and social health. Members of I-MESH responded to a list of 10 queries intended to elicit mental and social health priorities. Open text answers were analyzed by 2 researchers to elicit individual themes. A modified RAND/UCLA Delphi Appropriateness process was conducted of 32 candidate social and mental health priorities using a 15-person panel of I-MESH members, using 2 rounds of independent voting with intervening discussion via surveys and video teleconferences. Panelists rated each potential priority for importance, feasibility, and appropriateness on a 9-point Likert scale. Top level priorities scored both mean and median greater than 7 in all 3 categories. Second level priorities scored a median 7 or greater on the final scoring in all 3 categories. Candidate priorities were organized into 9 themes: viable business model, coordination of specialty and non-specialty care, actionable measurement, public health/cultural interventions, research, adequate and timely access, incorporating assessment in care, strategies to develop the patient-clinician relationship, communication strategies that can directly enhance health, and support for mental and social health. Twelve top level (met mean and median criteria) and 17 s level priorities (met median criterion) were identified. Implementing evidence-based strategies to efficiently diagnose, prioritize, and begin addressing mental and social health opportunities has the potential for notable impact on both musculoskeletal and overall health. It is our hope that the results of this Delphi panel will generate enthusiasm and collaboration for implementing the mounting evidence that social and mental health are integral to musculoskeletal health.

The impaired healing hypothesis: a mechanism by which psychosocial stress and personal characteristics increase MSD risk?

While the effects of physical risk factors on MSD development have been a primary focus of musculoskeletal research, psychological stressors, and certain personal characteristics (e.g. ageing, sex, and obesity) are also associated with increased MSD risk. The psychological and personal characteristics listed above share a common characteristic: all are associated with disruption of the body's neuroendocrine and immune responses resulting in an impaired healing process. An impaired healing response may result in reduced fatigue life of musculoskeletal tissues due to a diminished ability to keep pace with accumulating damage (perhaps reparable under normal circumstances), and an increased vulnerability of damaged tissue to further trauma owing to the prolonged healing process. Research in engineered self-healing materials suggests that decreased healing kinetics in the presence of mechanical loading can substantially reduce the fatigue life of materials. A model of factors influencing damage accrual and healing will be presented. Practitioner summary: This article provides a potential reason why musculoskeletal disorder risk is affected by psychosocial stress, age, sex, and obesity. The reason is that these factors are all associated with a slower than normal healing response. This may lead to faster damage development in musculoskeletal tissues resulting in higher MSD risk.

Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders.

ABSTRACT: Many veterans have negative views about the service connection claims process for posttraumatic stress disorder (PTSD), which likely impacts willingness to file service connection claims, re-file claims, and use Veterans Healthcare Administration care. Nevertheless, veterans have reported that PTSD claims are important to them for the financial benefits, validation of prior experience and harm, and self-other issues such as pleasing a significant other. It is unknown if reported attitudes are specific to PTSD claimants or if they would be similar to those submitting claims for other disorders, such as musculoskeletal disorders. Therefore, the purpose of this study was to compare attitudes and beliefs about service connection processes between veterans submitting service connection claims for PTSD and musculoskeletal disorders.Participants were Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans filing service connection claims for PTSD (n = 218) or musculoskeletal disorder (n = 257) who completed a modified Disability Application Appraisal Inventory. This secondary data analysis using multiple regression models tested the effect of demographics, clinical characteristics, and claim type on 5 Disability Application Appraisal Inventory subscales: Knowledge about service connection claims, Negative Expectations about the process, and importance of Financial Benefits, importance of Validation of veteran's experience/condition, and importance of Self-Other attitudes.The PTSD group assigned significantly less importance to financial benefits than the musculoskeletal disorder group. In addition, the subset of the PTSD group without depression had significantly more Negative Expectations than musculoskeletal disorder claimants without depression. Negative Expectations did not differ between the PTSD and musculoskeletal disorder groups with depression. Depression was significantly positively associated with Negative Expectations, importance of Financial Benefits, and importance of Validation.Most perceptions around seeking service connection are not specific to PTSD claimants. Depression is associated with having negative expectations about service connection claims and motivations to file claims. Addressing depression and negative expectations during the compensation and pension process might help veterans at this important point of contact with Veterans Healthcare Administration services.

Do psychosocial factors mediate the appearance of musculoskeletal symptoms? Evidence of an empirical study about the role of mental workload in computer workers.

The emergence of musculoskeletal symptoms (MSSs) in computer workers is a relevant occupational health problem. This study tests a multilevel model of analysis of risk factors in the appearance of musculoskeletal pain and discomfort in computer workers that integrates indicators from different areas: temporal usage patterns, ergonomic factors, psychosocial factors, and individual variables, specifically testing the possible mediating role of the mental workload. A cross-sectional study was performed through online registration with a non-probabilistic sample of 1198 workers from Spanish organizations. The results show that mental workload has a higher association than the rest of the factors with the onset of pain and discomfort in various body areas: neck in men, neck, shoulders and upper back in women. They also support the mediation role of mental workload in the relationship between usage patterns and the appearance of musculoskeletal symptoms. The use of multilevel theoretical models that adequately consider the complexity of the relationships between the different risk factors is necessary for a better understanding and intervention on MSSs in computer workers.

In Orthopaedic Speciality Care, Longer Explanations Are Not More Caring or More Satisfying.

BACKGROUND: Research consistently documents no correlation between the duration of a musculoskeletal specialty care visit and patient experience (perceived empathy of the specialist and satisfaction with care). Based on a combination of clinical experience and other lines of research, we speculate that longer visits are often related to discordance between specialist and patient interpretation of symptoms and weighting of available test and treatment options. If this is true, then the specific duration of time discussing the specialist's interpretations and options with the patient (expertise transfer) might correlate with satisfaction with care and perceived empathy of the clinician even if the total visit time does not. QUESTIONS/PURPOSES: (1) What demographic or mental health factors are associated with the duration of expertise transfer? (2) What factors, including the duration of expertise transfer, are associated with the patient's satisfaction with the visit and perceived clinician empathy? METHODS: In a cross-sectional study, 128 new and returning English-speaking adult outpatients seeking care from one of three orthopaedic specialists in two urban practices between September and November 2019 were enrolled and agreed to audio recording of the visit. A total of 92% (118) of patients completed the questionnaire and had a usable recording. Participants completed a sociodemographic survey, the Patient-Reported Outcome Measure Information System Depression computer adaptive test (PROMIS Depression CAT; a measure of symptoms of depression), the Short Health Anxiety Index (SHAI-5; a measure of symptoms of hypochondriasis, a form of symptoms misinterpretation), the Pain Catastrophizing Scale (PCS-4; a measure of misinterpretation of symptoms), an ordinal measure of patient satisfaction (dichotomized into satisfied or not because of strong ceiling effects), and the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE; a measure of perceived clinician empathy). The duration of expertise transfer and the total duration of the visit were measured by two raters with acceptable reliability using software that facilitates segmentation of the visit audio recording. To determine factors associated with the duration of expertise transfer, satisfaction, and empathy, we planned a multivariable analysis controlling for potential confounding variables identified in exploratory bivariable analysis. However, there were insufficient associations to merit multivariable analysis. RESULTS: A longer duration of expertise transfer had a modest correlation with catastrophic thinking (r = 0.24; p = 0.01). Complete satisfaction with the visit was associated with less health anxiety (6 [interquartile range 5 to 7] for complete satisfaction versus 7 [5 to 7] for less than complete satisfaction; p = 0.02) and catastrophic thinking (4 [1 to 7] versus 5 [3 to 11]; p = 0.02), but not with the duration of expertise transfer. Greater perceived clinician empathy had a slight correlation with less health anxiety (r = -0.19; p = 0.04). CONCLUSION: Patients with greater misinterpretation of symptoms experience a slightly less satisfying visit and less empathetic relationship with a musculoskeletal specialist despite a longer duration of expertise transfer. This supports the concept that directive strategies (such as teaching healthy interpretation of symptoms) may be less effective then guiding strategies (such as nurturing openness to alternative, healthier interpretation of symptoms using motivational interviewing tactics, often over more than one visit or point of contact). LEVEL OF EVIDENCE: Level II, therapeutic study.

The effect of COVID-19 public health restrictions on the health of people with musculoskeletal conditions and symptoms: the CONTAIN study.

OBJECTIVE: To quantify the change in quality of life, disease-specific indicators, health and lifestyle before and during the COVID-19 pandemic among people with musculoskeletal diagnoses and symptoms. METHODS: We undertook an additional follow-up of two existing UK registers involving people with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) and participants in a trial in the UK who had regional pain and were identified at high risk of developing chronic widespread pain. Participants completed the study questionnaire between July and December 2020, throughout which time there were public health restrictions in place. RESULTS: The number of people taking part in the study was 1054 (596 axSpA, 162 PsA, 296 regional pain). In comparison with their previous (pre-pandemic) assessment, there was an age-adjusted significant, small decrease in quality of life measured by EQ-5D [-0.020 (95% CI -0.030, -0.009)] overall and across all population groups examined. This was primarily related to poorer mental health and pain. There was a small increase in fibromyalgia symptoms, but a small decrease in sleep problems. There was a small deterioration in axSpA disease activity, and disease-specific quality of life and anxiety in PsA participants. Predictors of poor quality of life were similar pre- and during the pandemic. The effect of lockdown on activity differed according to age, gender and deprivation. CONCLUSION: Important lessons include focusing on addressing anxiety and providing enhanced support for self-management in the absence of normal health care being available, and awareness that all population groups are likely to be affected.

Assessment of impact of the COVID-19 pandemic from the perspective of patients with rheumatic and musculoskeletal diseases in Europe: results from the REUMAVID study (phase 1).

AIM: To assess the impact of the COVID-19 pandemic on patients with rheumatic and musculoskeletal diseases (RMDs). METHODS: REUMAVID is a cross-sectional study using an online survey developed by an international multidisciplinary patient-led collaboration across seven European countries targeting unselected patients with RMDs. Healthcare access, daily activities, disease activity and function, well-being (WHO Five Well-Being Index (WHO-5)), health status, anxiety/depression (Hospital Anxiety and Depression Scale (HADS)) and access to information were evaluated. Data were collected in April-July 2020 (first phase). RESULTS: Data from the first phase included 1800 patients with 15 different RMDs (37.2% axial spondyloarthritis, 29.2% rheumatoid arthritis, 17.2% osteoarthritis and others). Mean age was 53, 80% female and 49% had undertaken university studies. During the beginning of the pandemic, 58.4% had their rheumatology appointment cancelled and 45.6% reported not having received any information relating to the possible impact of SARS-CoV-2 infection in their RMDs, with the main source being patient organisations (27.6%).Regarding habits, 24.6% increased smoking, 18.2% raised their alcohol consumption, and 45.6% were unable to continue exercising. Self-reported disease activity was high (5.3±2.7) and 75.6% reported elevated pain. Half the patients (49.0%) reported poor well-being (WHO-5) and 46.6% that their health had changed for the worse during lockdown. According to HADS, 57.3% were at risk of anxiety and 45.9% of depression. CONCLUSION: Throughout the first wave of the COVID-19 pandemic, patients with RMDs have experienced disruption in access to healthcare services, poor lifestyle habits and negative effects on their overall health, well-being and mental health. Furthermore, information on COVID-19 has not reached patients appropriately.

The impact of the COVID-19 pandemic on people with rheumatic and musculoskeletal diseases: insights from patient-generated data on social media.

OBJECTIVES: During the COVID-19 pandemic, much communication occurred online, through social media. This study aimed to provide patient perspective data on how the COVID-19 pandemic impacted people with rheumatic and musculoskeletal diseases (RMDs), using Twitter-based patient-generated health data (PGHD). METHODS: A convenience sample of Twitter messages in English posted by people with RMDs was extracted between 1 March and 12 July 2020 and examined using thematic analysis. Included were Twitter messages that mentioned keywords and hashtags related to both COVID-19 (or SARS-CoV-2) and select RMDs. The RMDs monitored included inflammatory-driven (joint) conditions (ankylosing spondylitis, RA, PsA, lupus/SLE and gout). RESULTS: The analysis included 569 tweets by 375 Twitter users with RMDs across several countries. Eight themes emerged regarding the impact of the COVID-19 pandemic on people with RMDs: (i) lack of understanding of SARS-CoV-2/COVID-19; (ii) critical changes in health behaviour; (iii) challenges in healthcare practice and communication with healthcare professionals; (iv) difficulties with access to medical care; (v) negative impact on physical and mental health, coping strategies; (vi) issues around work participation; (vii) negative effects of the media; and (viii) awareness-raising. CONCLUSION: The findings show that Twitter serves as a real-time data source to understand the impact of the COVID-19 pandemic on people with RMDs. The platform provided 'early signals' of potentially critical health behaviour changes. Future epidemics might benefit from the real-time use of Twitter-based PGHD to identify emerging health needs, facilitate communication and inform clinical practice decisions.

Investigation of psychosocial factors on upper limb musculoskeletal disorders and the prevalence of its musculoskeletal disorders among nurses: a systematic review and meta-analysis.

OBJECTIVE: Musculoskeletal disorders are one of the most important occupational problems especially among nurses. The aim of this study was to investigate the prevalence of musculoskeletal disorders in upper limbs and its associated psychosocial factors in the workplace. METHODS: A systematic review was conducted by searching the Medline/PubMed, EMBASE, Scopus, ISI/web of knowledge and Google Scholar databases. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. The statistical analysis was performed using Stata software. RESULTS: We found 1742 articles in our initial search. After reviewing the titles, abstracts and full texts, 66 articles were finally analyzed. Psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses were identified which included boring work, inadequate staffing, job demands, insufficient support, time pressure, decision latitude, job dissatisfaction, and job stress. There was a significant relationship between these factors and prevalence of musculoskeletal disorders in the wrists, shoulders, neck and shoulders, and wrists and hands. CONCLUSION: Collectively, the results of this study provide strong evidence of some psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses. Thus, organizational interventions to minimize these stressors may be promising in reducing one risk factor for the development of nurses' musculoskeletal disorders. These interventions should not only consider the factors of physical ergonomics but also seek to improve the organizational aspects of the workplace.