Association Between Ergonomic Burden Assessed Using 20-Item Agricultural Work-Related Ergonomic Risk Questionnaire and Shoulder, Low Back, and Leg Pain in Korean Farmers.

OBJECTIVES: This study aimed to determine the agricultural ergonomic burden in Korean farmers and to analyze its correlation with musculoskeletal pain. METHODS: In total, 1001 farmers (525 females and 476 males; mean age, 59.6±7.5years) who owned or rented a farm and belonged to an agricultural cooperative unit were recruited. Ergonomic burdens were assessed using a 20-item Agricultural Work-related Ergonomic Risk Questionnaire (20 agricultural works). The presence of musculoskeletal pain (shoulder, low back, and leg/foot), Farm Stressor Inventory, subjective stress index, and agricultural workload (low, moderate, somewhat hard, or hard) were collected using structured questionnaires. RESULTS: Factor analysis of the Agricultural Work-related Ergonomic Risk Questionnaire revealed a four-factor solution: neck and upper limb, trunk and push - pull, machine and heavy lifting, and repetitive trauma. Cronbach's alpha was greater than 0.65. For 18 of the 20 items, there was a significant association with the Farm Stressor Inventory, subjective stress index, and agricultural workload. The most frequent ergonomic burdens were squatting (51.2%), highly repetitive wrist movements (53.5%), shoulder flexion at 45-90° (51.2%), and trunk flexion or twisting at≥45° (48.8%). Ergonomic burdens were significantly different in 13 items between sexes. The musculoskeletal pain was associated with increased agricultural burdens in 10 items in male farmers and 14 items in female farmers. CONCLUSION: Increased agricultural ergonomic burdens were associated with musculoskeletal pain. Ergonomic burden showed different patterns between male and female farmers, with female farmers appearing to be more affected by ergonomic burden than male farmers.

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.