Inter-rater and test-retest reliability of movement control tests for the neck, shoulder, thoracic, lumbar, and hip regions in military personnel.

Strategies are needed to mitigate the high rates and related risks of musculoskeletal complaints and injuries (MSCI) in the military aviator community. Previous work on Swedish Armed Forces (SwAF) soldiers have shown that proper screening methods have been successful in reducing early discharge from military training. Research has pointed at the importance of optimal spinal movement control in military aviators. The aim of this work was to investigate the inter-rater and test-retest reliability of a battery of clinical tests for evaluating movement control in the neck, shoulders, thoracic, lumbar, and hip regions in a population of SwAF military personnel. Inter-rater and test-retest reliability of 15 movement control tests were assessed by crude and prevalence-adjusted kappa coefficient. The study included 37 (inter-rater) and 45 (test-retest) SwAF personnel and was performed with two physiotherapists simultaneously observing and rating the movements on the first occasion and repeated with one physiotherapist on the second occasion. For inter-rater reliability, the kappa coefficient ranged from .19 to .95. Seven tests showed substantial to almost perfect agreement (kappa > .60). With the adjusted kappa, three more tests reached the level of substantial agreement. The corresponding values for test-retest reliability ranged from .26 to .65. Substantial agreement was attained for two tests, three with adjusted kappa. The following tests can reliably be used when screening for biomechanically less advantageous movement patters in military aviators: Shoulder flexion, and rotation, Neck flexion in sitting and supine, Neck extension and rotation in sitting, Pelvic tilt, Forward lean and Single and Double knee extension tests. Grading criteria for tests in supine and quadruped positions need to be further elaborated.

How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway: the SWENOR Study.

INTRODUCTION: Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. METHODS AND ANALYSIS: This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. ETHICS AND DISSEMINATION: This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT02024126; Pre-results.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people.

BACKGROUND AND AIM: Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling. METHODS: Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit. RESULTS: The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (ß=0.13, p=0.059) but it was a predictor of HS either through affecting PA (ß=0.31, p<0.001) or I (ß=0.57, p<0.001). CONCLUSION: Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Short- and long-term effects of exercise on neck muscle function in cervical radiculopathy: A randomized clinical trial.

OBJECTIVE: To compare short- and long-term changes in neck muscle endurance, electromyography measures of neck muscle activation and fatigue and ratings of fatigue and pain after neck-specific training or physical activity in people with cervical radiculopathy. DESIGN: Randomized clinical trial. SUBJECTS/PATIENTS: Seventy-five patients with cervical radiculopathy. METHODS: Patients underwent neck-specific training in combination with a cognitive behavioural approach or prescribed physical activity over a period of 14 weeks. Immediately after the intervention and 12 months later, surface electromyography was recorded from neck flexor and extensor muscles during neck endurance tests. Time to task failure, amplitude and median frequency of the electromyography signal, and subjective fatigue and pain ratings were analysed in 50 patients who completed at least one follow-up. RESULTS: A significant increase in neck flexor endurance time was observed for both groups at 14 weeks compared with baseline and this was maintained at the 12-month follow-up (p < 0.005). No change was identified for the slope of the median frequency. For the neck-specific training group, splenius capitis was less active during neck flexion at both follow-ups (p < 0.01), indicating reduced muscle co-activation. CONCLUSION: Both specific and general exercise increased neck flexor endurance, but neck-specific training only reduced co-activation of antagonist muscles during sustained neck flexion.

Long-Term Effects of Individually Tailored Physical Training and Activity on Physical Function, Well-Being and Cognition in Scandinavian Nursing Home Residents: A Randomized Controlled Trial.

BACKGROUND: The preservation of physical functions such as muscle strength, balance and mobility is fundamental to maintaining independence in activities of daily living (ADL). The physical activity level of most nursing home residents is very low, which implies that they are often subject to a decline in health, mobility, autonomy and social contacts and are also at risk of suffering a decline in mental well-being. In a previous study, we demonstrated that transfers, balance and physical activity level improved after 3 months of individually tailored intervention in nursing home residents. OBJECTIVE: To evaluate the long-term effects on ADL, balance function, physical activity level, physical performance, falls-related self-efficacy, well-being and cognitive function 3 months after the completion of our intervention in nursing home residents. METHODS: The study was a multicenter randomized, controlled clinical trial with a parallel-group design. It was conducted in nursing homes in Sweden, Norway and Denmark, with an intervention period lasting 3 months and a follow-up at 6 months. Initially, 322 nursing home residents with a mean age of 85 years were included; 85 from Sweden, 171 from Norway and 66 from Denmark. Of these, 241 [129 intervention group (IG), 112 control group (CG)] were eligible for the 6-month follow-up tests. The level of dependence in ADL, physical activity level, several dimensions of physical function, well-being, falls-related self-efficacy and cognitive function were assessed with reliable and valid instruments at baseline, immediately after 3 months of intervention and 3 months later at the 6-month follow-up. RESULTS: After 3 months of intervention and an additional period of 3 months without intervention, only the following 2 variables demonstrated significant group differences: social and cognitive function, measured by the Functional Independence Measure n-r, where the IG deteriorated while the CG was almost stable. However, regarding transfers, the IG deteriorated significantly less than the CG. CONCLUSION: Without supervised physical exercise that challenged the individuals' capability, gains in ADL function, balance and transfer ability deteriorated during the 3 months following the intervention period. Thus, continuous, individually adjusted and supported physical activity seems crucial for the maintenance of physical functions in these vulnerable elderly persons.

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy: A Cross-Sectional Study.

This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were "present neck pain intensity," "fear avoidance," and "anxiety." The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables "present neck pain intensity," "fear avoidance," and "anxiety" had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy.

Influence of the implementation of a comprehensive intervention programme on premature discharge outcomes from military training.

OBJECTIVE: The study describes and analyses the influence of a comprehensive intervention on premature discharges (i.e. the military training cannot be completed). PARTICIPANTS: 862 male soldiers from three military units were included. METHODS: The intervention included a screening protocol with a questionnaire and physical tests for musculoskeletal complaints or injuries and functional limitations and, where needed, treatment, early rehabilitation and individually-adjusted physical training. The intervention also included organisation-based training in ergonomics and exercise physiology for officers plus enhanced teamwork between officers and physiotherapist. Not all the soldiers underwent the intervention as planned. RESULTS: The discharge rate was lower in all three units after either of the intervention programmes comparing premature discharge figures with before-implementation study figures. However, significantly fewer soldiers were discharged from the group who underwent the intervention as planned 6.1% compared to the group with the less intensive intervention, 13.1% (p=0.002). CONCLUSIONS: The results indicate that the comprehensive intervention programme can reduce the number of premature discharges from the Swedish Armed Forces. The differences between the groups indicate that the effectiveness was greater when the intervention was fully implemented with regard to intensity.

Inter-examiner reliability of a proposed decision-making treatment based classification system for low back pain patients.

Evolving evidence has shown increased clinical outcomes, when low back pain (LBP) patients are classified and receive matched physical treatment. The present study aimed to examine the inter-examiner reliability of a proposed new decision-making classification system for non-specific LBP patients, using a mixed simultaneous and independent examiner design. With minimal familiarization, two pairs of experienced physiotherapists trained in Orthopedic Manual Therapy (OMT) at two different out-patient clinics in primary care, examined and classified 64 consenting consecutive patients. Further, inter-examiner reliability on five examination items was examined. The agreement between examiners was expressed by percentage of agreement (%) and by the un-weighted (κ) or weighted (κ(w)) kappa coefficient. The overall % agreement, categorizing patients into one of four classifications was 80% and κ = 0.72. For each classification, pain modulation, stabilization exercise, mobilization and training, agreement was 90%, 83%, 58% and 89% (κ = 0.77, 0.67, 0.11 and 0.75), respectively. Agreement on five individual examination items was; irritability 82% (κ(w) = 0.41), specific movement pattern 68% (κ = 0.38), specific segmental signs 67% (κ = 0.28), uni- or bilateral signs 62% (κ = 0.42), and neurological signs and symptoms 92% (κ = 0.84). This study demonstrated that this new classification system had substantial inter-examiner reliability when used by clinically experienced OMT-trained physiotherapists. Agreement within classification was substantial, except for mobilization which was poor. Inter-examiner reliability for the individual examination items varied from fair to almost perfect. Further studies are needed to investigate utility and validity of this new classification system.

Catastrophizing during and after pregnancy: associations with lumbopelvic pain and postpartum physical ability.

BACKGROUND: There is a lack of knowledge about the possible role of catastrophizing in lumbopelvic pain during and after pregnancy and in postpartum physical ability. OBJECTIVE: The aims of this study were to explore how catastrophizing fluctuates over time during and after pregnancy and to investigate the associations between catastrophizing and lumbopelvic pain and between catastrophizing and postpartum physical ability. DESIGN: A prospective questionnaire was used. METHODS: The Pain Catastrophizing Scale was used to assess exaggerated negative thoughts about pain experiences in weeks 19 to 21 and weeks 34 to 37 of pregnancy and at 6 months postpartum. The Disability Rating Index was used to assess physical ability at 6 months postpartum. The occurrence of lumbopelvic pain was reported by participants. Parametric and nonparametric tests were used for the analyses. RESULTS: A total of 242 of 324 women were categorized according to reported levels of catastrophizing. A majority of women (57.9%) reported not catastrophizing at all test occasions, whereas 10.3% reported catastrophizing at all occasions. For the remaining 31.8%, the levels of catastrophizing varied over time. Women who catastrophized at 1 or more of the occasions reported higher proportions of postpartum lumbopelvic pain and had more restricted postpartum physical ability than women who did not catastrophize. LIMITATIONS: The fact that some women did not complete the questionnaire at all test occasions might have reduced the generalizability of the results. CONCLUSIONS: The common idea that levels of catastrophizing are "stable" within personality should be reconsidered, because for 1 of 3 women, the levels of catastrophizing changed over time. A majority of women reported not catastrophizing. However, catastrophizing in relation to pregnancy seems to be associated with lumbopelvic pain and postpartum physical ability. The results indicated that the role of catastrophizing in this context should be studied further.

Feasibility and effects of a physical exercise programme in adults with myotonic dystrophy type 1: a randomized controlled pilot study.

OBJECTIVE: To investigate the feasibility and effects of a physical exercise programme on functioning and health-related quality of life in adults with myotonic dystrophy type 1. DESIGN: A randomized controlled trial. SUBJECTS: Thirty-five adults with myotonic dystrophy type 1. METHODS: After stratification for level of functioning, study participants were assigned by lot to either a training group or a control group. Training-group participants attended a 60-minute comprehensive group-training programme, Friskis&Svettis® Open Doors, twice a week for 14 weeks. The six-minute walk test was the primary outcome measure and the timed-stands test, the timed up-and-go test, the Epworth sleepiness scale and the Short Form-36 health survey were secondary outcome measures. RESULTS: Intention-to-treat analyses revealed no significant differences in any outcome measures, except for an increased between-group difference after intervention in the Short Form-36 mental health subscale and a decrease in the vitality subscale for the control group. The programme was well tolerated and many training-group participants perceived subjective changes for the better. No negative effects were reported. CONCLUSION: The Friskis&Svettis® Open Doors programme was feasible for adults with myotonic dystrophy type 1 who had been screened for cardiac involvement, had distal or mild-to-moderate proximal muscle impairment, and no severe cognitive impairments. No beneficial or detrimental effects were evident.

Functioning and disability in adults with myotonic dystrophy type 1.

PURPOSE: To provide a comprehensive description of functioning and disability with regard to stages of disease progression in adults with myotonic dystrophy type 1 (DM1). Further to explore associations of measures of manual dexterity and of walking capacity with measures of activities of daily living (ADL) and participation in social and lifestyle activities. METHODS: Seventy persons with DM1 underwent examinations, tests and answered questionnaires. Stages of disease progression were based on the muscular impairment rating scale. RESULTS: Overweight, cardiac dysfunctions, respiratory restrictions, fatigue and/or low physical activity levels were found in approximately 40% of those with DM1. Over 75% had muscle impairments, and activity limitations in manual dexterity and walking. Dependence in personal and instrumental ADL was found in 16% and 39%, respectively, and participation restrictions in social and lifestyle activities in 52%. The presence of concurrent body-function impairments, activity limitations and participation restrictions was high. Significant differences were found in muscle impairment, manual dexterity, mobility, ADL and social and lifestyle activities with regard to disease progression. Cut-off values in measures of manual dexterity and walking capacity associated to functioning are proposed. CONCLUSION: This information can be used for developing clinical practise and for health promotion for persons with DM1.

Pain-related fear, catastrophizing and pain in the recovery from a fracture.

Background and aims Pain-related fear and catastrophizing are prominently related to acute and persistent back pain, but little is known about their role in pain and function after a fracture. Since fractures have a clear etiology and time point they are of special interest for studying the process of recovery. Moreover, fracture injuries are interesting in their own right since patients frequently do not recover fully from them and relatively little is known about the psychological aspects. We speculated that catastrophizing and fear-avoidance beliefs might be associated with more pain and poorer recovery after an acute, painful fracture injury. Methods To this end we conducted a prospective cohort study recruiting 70 patients with fractures of the wrist or the ankle. Participants completed standardized assessments of fear, pain, catastrophizing, degree of self-rated recovery, mobility and strength within 24 h of injury, and at 3- and 9-month follow-ups. Participants were also categorized as having high or low levels of fear-avoidance beliefs by comparing their scores on the first two assessments with the median from the general population. To consolidate the data the categorizations from the two assessments were combined and patients could therefore have consistently high, consistently low, increasing, or decreasing levels. Results Results indicated that levels of fear-avoidance beliefs and catastrophizing were fairly low on average. At the first assessment 69% of the patients expected a full recovery within 6 months, but in fact only 29% were fully recovered at the 9-month follow-up. Similarly, comparisons between the affected and non-affected limb showed that 71% of those with a wrist fracture and 58% with an ankle fracture were not fully recovered on grip strength and heel-rise measures. Those classified as having consistently high or increasing levels of fear-avoidance beliefs had a substantially increased risk of more intense future pain (adjusted OR = 3.21). Moreover, those classified as having consistently high or increasing levels of catastrophizing had an increased risk for a less than full recovery of strength by almost six-fold (adjusted OR = 5.87). Conclusions and implications This is the first investigation to our knowledge where the results clearly suggest that fear and catastrophizing, especially when the level increases, may be important determinants of recovery after an acute, painful, fracture injury. These results support the fear-avoidance model and suggest that psychological factors need to be considered in the recovery process after a fracture.

Neck/shoulder exercise for neck pain in air force helicopter pilots: a randomized controlled trial.

STUDY DESIGN: The study was a randomized, controlled trial with blinded outcome assessment. A 6-week intervention was followed up directly afterwards and after 12 months. OBJECTIVE: The purpose was to evaluate the preventive efficacy of a neck/shoulder exercise regimen for neck pain in air force helicopter pilots. SUMMARY OF BACKGROUND DATA: Neck pain is a significant medical problem in modern military aviation. Research shows neck-muscle dysfunction in subjects with various neck disorders. So far, evidence for neck exercise as prevention or early intervention is sparse, and few trials use randomized controlled design. METHODS: Sixty-eight helicopter pilots on active flying duty with or without neck pain were randomly assigned to a supervised neck/shoulder exercise regimen or a control group receiving no such regimen. The key outcome was change in the prevalence of neck pain cases at the 12-month follow-up, rated for the previous week and the previous 3 months. Secondary outcomes included neck-flexor surface electromyographic activity during active craniocervical flexion and pain-related fear regarding physical activity. In addition, a secondary regression analysis included preintervention predictors that may be associated with change in prevalence of neck-pain cases at the 12-month follow-up. RESULTS: Eighty-two percent (56/68) of the participants assigned at random completed the intervention and provided data at month 12. Regression analysis showed a reduction in the prevalence of neck pain cases in the exercise group, which was significant for pain ratings during the previous week, OR = 3.2 (95% CI = 1.3-7.8), and previous 3 months, OR = 1.9 (95% CI = 1.2-3.2). Electromyographic activity at the highest contraction level was significantly reduced in the exercise group, P < 0.05, whereas no between-groups effect emerged for pain-related fear. Results from the secondary analysis showed that general strength training for more than 1 hour per week before the intervention predicted reduction in prevalence of pain at follow-up. CONCLUSION: A supervised neck/shoulder exercise regimen was effective in reducing neck pain cases in air force helicopter pilots. This was supported by improvement in neck-flexor function postintervention in regimen members. However, no effect emerged for pain-related fear. General strength training before the intervention predicted reduction in prevalence of pain at follow-up.

Perceived functioning and disability in adults with myotonic dystrophy type 1: a survey according to the International Classification Of Functioning, Disability and Health.

OBJECTIVE: The purpose of this study was to describe and analyse self-rated perceived functioning, disability and environmental facilitators/barriers with regard to disease severity, using the International Classification of Functioning, Disability and Health (ICF) checklist, in adults with myotonic dystrophy type 1. DESIGN: Cross-sectional design. SUBJECTS: Forty-one women and 29 men with myotonic dystrophy type 1. METHODS: A modified ICF checklist was used for self-rating of perceived problems in 29 body-function categories, difficulties in 52 activity and participation categories, and facilitators/barriers in 23 environmental-factor categories according to the verbal anchors of the ICF qualifiers. Disease severity classification was based on the muscular impairment rating scale. RESULTS: Of the persons with myotonic dystrophy type 1, 80% perceived problems of excessive daytime sleepiness, 76% of muscle power, and 66% of energy and drive functions, while over 59% perceived difficulties in physically demanding mobility activities. Disabilities in mobility, self-care and domestic life were more frequently reported by persons with severe disease. Support from the immediate family, medicines and social security services were perceived as facilitators for 50-60% of the participants. CONCLUSION: Disabilities and important environmental facilitators in adults with myotonic dystrophy type 1 were identified, and this clinically-relevant information can be used for developing health services for people with this condition.

Individual risk factors associated with premature discharge from military service.

Research on military populations indicates that failure to complete training is a significant problem for armed forces around the world. The present study estimated the prevalence of musculoskeletal complaints or injuries and potential individual risk factors leading to premature discharge from Swedish military service. Male conscripts, n=469 answered a questionnaire and performed physical tests at the start of their military service. A high prevalence of complaints or injuries in lower back and knee was shown. Logistic regression analyses showed an increased risk of discharge (odds ratio, OR) when reporting current complaints or injuries in any part of the body (OR 4.6), being physically inactive (OR 2.0), cigarette smoking (OR 2.7), or poor mental health (OR 3.6). The findings highlight the need for improved preenlistment examination and/or early preventive strategies addressing both physical and psychological interventions.

Screening tests detect knee pain and predict discharge from military service.

This study evaluated the capacity of a screening test to predict discharge from military training. When starting their training, 590 artillery and 258 ranger conscripts were tested in step-up, step-down, rising from a 0.40-m-high bench, and bilateral squat tests, with pain intensity ratings. Ranger conscripts who did not complete their training were noted. The rising test identified 82% and the step-down test 81% of artillery conscripts who reported pain at any level during any of the screening tests. Receiver operating characteristic curve analysis revealed that both the step-down test and the rising test were good in predicting discharge from military ranger training because of knee problems. The step-down test identified 80% of ranger conscripts who did not complete training because of knee disorders. The tests constitute a simple, time-saving, cost-effective tool in a systematic process for screening knee pain to identify high-risk groups, for prioritization of interventions.

Strategies for prevention and management of musculoskeletal conditions. Neck pain.

The aim of this article was to summarise the existing evidence concerning interventions for non-specific neck pain. Neck-and-shoulder pain is commonly experienced by both adolescents and adults. Although the prevalence appears to vary among different nations, the situation is essentially the same, at least in the industrialised nations. Explanations for the wide variation in incidence and prevalence include various methodological issues. Back and neck disorders represent one of the most common causes for both short- and long-term sick leave and disability pension. Evidenced risk factors for the onset and maintenance of non-specific neck and back pain include both individual and work-related psychosocial factors. Based on the existing evidence different forms of exercise can be strongly recommended for at-risk populations, as well as for the acute and chronic non-specific neck pain patient. Furthermore, for symptom relief this condition can be treated with transcutaneous electric nerve stimulation, low level laser therapy, pulse electromagnetic treatment or radiofrequency denervation.

A lower-limb functional capacity test for enlistment into Swedish Armed Forces ranger units.

The present work validated minimal performance standards for a lower-limb functional capacity test used at enrollment to predict the risk of discharge from strenuous military ranger training in the Swedish Armed Forces. To set a relevant level of performance, trained conscripts in a ranger unit (n = 38) performed a maximal physical fitness test, including the newly developed ranger test, during the last week of their 1-year basic training. The following year, basic training started with an initial strength test performed by all conscripts (n = 285). They performed the ranger test as a submaximal one. The relative risk was high (risk ratio, 48.5) for discharge attributable to knee problems for conscripts who failed the submaximal ranger test during the initial strength test. The area under the receiver operating characteristic curve was 0.91 (SE, 0.09) for failing the test. The submaximal ranger test had a high discriminating ability and predictive value for discharge caused by knee problems.

Neck pain and related disability in helicopter pilots: A survey of prevalence and risk factors.

INTRODUCTION: Today's demands on helicopter missions-often using helmet-mounted visual technology-place much physical stress on the cervical spine. The objective of the present analytical survey was to estimate the prevalence of, and associated risk factors for, helicopter pilots' neck pain and related disability. METHODS: There were 127 Swedish helicopter pilots consecutively enrolled for the study who completed a structured questionnaire during their regular medical health checkups. The questionnaire concerned flight-related and individual risk indicators, frequency of neck pain episodes, and disability. Multivariate regressions, with the potential to control for confounding factors, were used to estimate relative risks (RR). RESULTS: The 3-mo prevalence of neck pain was 57%, with 32% reporting frequent pain. A history of previous neck pain (RR = 1.8, 95% CI = 1.2-2.7) and recent shoulder pain (RR = 1.6, 95% CI = 1.1-2.4) were significant risk factors, while the use of night-vision goggles and muscle strength-training showed a non-significant associated trend, the latter toward a decreased risk. In neck pain cases, 58% and 55% reported that their pain interfered with their flying and leisure, respectively, and those with frequent pain risked pain interfering with flying duty (RR = 1.6, 95% CI = 1.1-2.5). However, only 25% of the cases had ever been on sick leave due to neck pain. CONCLUSIONS: Neck pain is common among helicopter pilots, and certain factors are identified for use in risk reduction. The link between cases with frequent pain and reported interference with flying duty highlights the need for early prevention of neck pain when planning and implementing helicopter pilots' health care. More clinical trials of good design are required.