Evaluation of the Nordic Musculoskeletal Questionnaire for Measuring Prevalence and the Consequence of Pain in a Danish Adult OI Population: A Pilot Study.

Pain is a challenge in persons with OI and causes much concern in the Osteogenesis Imperfecta (OI) population. We aim to evaluate the usability of the Nordic Musculoskeletal Questionnaire (NMQ) to identify painful sites in adults with OI and to describe the occurrence of musculoskeletal (MSK) pain and its impact on their work and daily activities. This cross-sectional pilot study uses the OI-NMQ to study MSK pain prevalence in nine separate anatomical regions (neck, upper back, lower back, shoulder, elbow, hand/wrist, hip, knee, and ankle/foot) and its impact on regular work and daily activities in adults with OI. The questionnaire was distributed among participants of the 2023 annual meeting of The Danish OI Society. The response rate was 68%, and all participants considered the OI-NMQ helpful in assessing the presence of pain and its consequences. The analysis included 27 adults with OI type I, III, or IV above 18 years. Among all 27 participants, MSK pain was present in 15-56% of the 9 sites within the last 7 days and 33-89% of the nine anatomical regions during the last 12 months. In 7-48% of all the participants, their regular work and daily activities had been affected by the presence of MSK pain. The OI-NMQ was feasible in assessing MSK pain among adults with OI and displayed a high prevalence of MSK pain with a moderate impact on their regular work and daily activities in this OI population. A larger and repeated measurement of MSK pain in adults with OI is needed to confirm these results.

Brain-derived neurotrophic factor contributes to activity-induced muscle pain in male but not female mice.

Activity-induced muscle pain increases interleukin-1ß (IL-1ß) release from muscle macrophages and the development of hyperalgesia is prevented by blockade of IL-1ß in muscle. Brain derived neurotrophic factor (BDNF) is released from sensory neurons in response to IL-1ß and mediates both inflammatory and neuropathic pain. Thus, we hypothesize that in activity-induced pain, fatigue metabolites combined with IL-1ß activate sensory neurons to increase BDNF release, peripherally in muscle and centrally in the spinal dorsal horn, to produce hyperalgesia. We tested the effect of intrathecal or intramuscular injection of BDNF-Tropomyosin receptor kinase B (TrkB) inhibitors, ANA-12 or TrkB-Fc, on development of activity-induced pain. Both inhibitors prevented the hyperalgesia when given before or 24hr after induction of the model in male but not female mice. BDNF messenger ribonucleic acid (mRNA) and protein were significantly increased in dorsal root ganglion (DRG) 24hr after induction of the model in both male and female mice. Blockade of IL-1ß in muscle had no effect on the increased BNDF mRNA observed in the activity-induced pain model, while IL-1ß applied to cultured DRG significantly induced BDNF expression, suggesting IL-1ß is sufficient but not necessary to induce BNDF. Thus, fatigue metabolites, combined with IL-1ß, upregulate BDNF in primary DRG neurons in both male and female mice, but contribute to activity-induced pain only in males.

Association of persistent musculoskeletal pain with dementia risk score in adults aged 45 years or older: The China health and retirement longitudinal study.

BACKGROUND: Recent studies have confirmed an association between pain and dementia. Whether musculoskeletal pain in the spine, upper limbs, and lower limbs is associated with dementia risk remains unclear. The longitudinal effect of musculoskeletal pain on dementia risk also remains unclear. AIMS: This work aimed to investigate the association between musculoskeletal pain and dementia risk score. METHODS: We conducted cross-sectional and longitudinal analyses using data from the China Health and Retirement Longitudinal Study. Participants aged 45 years or older were recruited in 2011. A total of 10,759 participants with complete pain information at baseline were eligible for the cross-sectional analysis, and 5,855 were eligible for the longitudinal analyses. We utilized the Rotterdam Study Basic Dementia Risk Model (BDRM) to assess dementia risk. Generalized estimating equations were used to investigate the associations. RESULTS: Compared with participants without persistent musculoskeletal pain, those with persistent musculoskeletal pain (standardized, ß = 0.83; 95 % CI: 0.06, 1.61, p = 0.036), multisite pain (sites≧5; ß = 1.52; 95 % CI: 0.13, 2.91, p = 0.032), neck pain (ß = 2.33; 95 % CI: 0.41, 4.25, p = 0.018), back pain (ß = 2.12; 95 % CI: 0.43, 3.82, p = 0.014), waist pain (ß = 1.09; 95 % CI: 0.07, 2.11, p = 0.037), shoulder pain (ß = 1.74; 95 % CI: 0.46, 3.02, p = 0.008), wrist pain (ß = 2.72; 95 % CI: 0.42, 5.02, p = 0.021), and knee pain (ß = 1.91; 95 % CI: 0.70, 3.13, p = 0.002) had a higher BDRM score during 4 years of follow-up. CONCLUSIONS: Promoting the management of musculoskeletal pain may be beneficial in reducing the dementia risk score.

Unintended Consequences of Immune Therapy for Immune-Mediated Diseases: Paradoxical Psoriasis and Dupilumab-Associated Musculoskeletal Syndrome.

Two presentations at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting focused on unintended consequences of immunomodulatory therapy for psoriasis (PsO). Dr. Elizabeth Wallace presented on unintended consequences of tumor necrosis factor inhibitors for treating PsO and other inflammatory disorders. These consequences include paradoxical PsO, which is defined as unexpected new PsO cases or worsening PsO symptoms seemingly induced by treatment. Dr. Bruce Kirkham focused on unintended consequences of dupilumab treatment, which can include a musculoskeletal syndrome similar to psoriatic arthritis.

Role of proprioceptors in chronic musculoskeletal pain.

Proprioceptors are non-nociceptive low-threshold mechanoreceptors. However, recent studies have shown that proprioceptors are acid-sensitive and express a variety of proton-sensing ion channels and receptors. Accordingly, although proprioceptors are commonly known as mechanosensing neurons that monitor muscle contraction status and body position, they may have a role in the development of pain associated with tissue acidosis. In clinical practice, proprioception training is beneficial for pain relief. Here we summarize the current evidence to sketch a different role of proprioceptors in 'non-nociceptive pain' with a focus on their acid-sensing properties.

Psychophysical changes after total sleep deprivation and experimental muscle pain.

Sleep disturbances exacerbate chronic pain, increase psychological load, and increase inflammation. Delayed onset muscle soreness (DOMS) mimics aspects of chronic pain, predominantly affecting peripheral pain mechanisms, while experimental sleep provocations have been shown to impact central pain mechanisms. This study aimed to combine a DOMS model with total sleep deprivation (TSD) to create a novel model affecting both peripheral and central pain mechanisms. A total of 30 healthy participants attended two sessions (baseline and follow-up) separated by 24 h of TSD and a home rating after 48 h. Assessments of interleukin 6 (IL-6) levels, sleep quality, pain catastrophising, affect, and symptoms of depression and anxiety were included in the baseline and follow-up sessions. Additionally, pressure pain and tolerance thresholds, temporal summation, and conditioned pain modulation (CPM) were assessed using cuff-pressure algometry in the baseline and follow-up sessions. DOMS was induced with eccentric calf raises during the baseline session followed by 24 h of TSD. At follow-up pain tolerance (p = 0.012) was significantly reduced, and CPM (p = 0.036) was significantly impaired compared to baseline. Psychological changes included decreases in pain catastrophising (p = 0.027), positive affect (p < 0.001), negative affect (p = 0.003), and anxiety (p = 0.012). Explorative regression models predicted 58% and 68% of DOMS pain intensity after 24 and 48 h, respectively, based on baseline body mass index, pain thresholds, psychological measures, and IL-6 (p < 0.01). Combining DOMS with 1 night of TSD induced pain hypersensitivity, impaired CPM, and altered psychological states. A combination of baseline inflammation, psychological measures, and pain sensitivity significantly predicted DOMS pain intensity after 24 and 48 h.

Impact of Chronic Pain on Use-Dependent Plasticity: Corticomotor Excitability and Motor Representation in Musicians With and Without Pain.

Long-term musical training induces adaptive changes in the functional representation of the motor cortex. It is unknown if the maladaptive plasticity associated with chronic pain, frequently affecting trained musicians, may alter the use-dependent plasticity in the motor cortex. This study investigated the interaction between adaptive and maladaptive plasticity in the motor pathways, in particular how chronic pain influences long-term use-dependent plasticity. Using transcranial magnetic stimulation (TMS), corticospinal excitability was assessed by measuring the amplitude of the motor-evoked potential (MEP), area of the motor map, volume, and center of gravity of the first dorsal interosseous muscle in 19 pain-free musicians, 17 upper limb/neck pain chronic pain musicians, and 19 pain-free non-musicians as controls. Motor map volume and MEP amplitude were smaller for both pain-free and chronic pain musicians compared to pain-free controls (P < 0.011). No significant differences were found between musicians with and without chronic pain. These findings confirm that long-term musical training can lead to focalized and specialized functional organization of the primary motor cortex. Moreover, the adaptive use-dependent plasticity acquired through fine-motor skill acquisition is not significantly compromised by the maladaptive plasticity typically associated with chronic pain, highlighting the potential of long-term sensorimotor training to counteract the effects of chronic pain in the motor system.

A calculator for musculoskeletal injuries prediction in surgeons: a machine learning approach.

BACKGROUND: Surgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice. METHODS: Cross-sectional study carried out using an online form (12/2021-03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP. RESULTS: A total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65-5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84-12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28-2.98 and 2.16, 1.37-3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons. CONCLUSIONS: The prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics.

Climacteric and fibromyalgia: a review.

Fibromyalgia (FM) and climacteric conditions share common epidemiological and clinical features, with FM symptoms often beginning during menopause. Musculoskeletal pain, arthralgia, myalgia and other symptoms are frequently seen in both conditions. Some research suggests a link between the cessation of sex hormones and FM symptoms. Women with FM tend to experience more severe symptoms after menopause, and the severity of FM symptoms can worsen in women who have had a hysterectomy with or without oophorectomy. Despite these similarities, it is essential to treat FM and climacteric conditions separately and follow established guidelines for management. However, it is also important to recognize that both conditions can coexist in the same patient. It is crucial to note that there is limited evidence supporting the effectiveness of menopausal hormone therapy for primary FM management. Therefore, menopausal hormone therapy should not be recommended for FM unless the patient also has climacteric syndrome.

Prevalence of Spinal Segmental Sensitization Syndrome in Outpatients Attending Physical Medicine and Rehabilitation Centers for Chronic Musculoskeletal Pain: A Multicenter Study.

OBJECTIVE: To determine the prevalence of spinal segmental sensitization (SSS) syndrome, a regional pain disorder, among patients visiting physical medicine and rehabilitation centers (PM&RCs) for chronic musculoskeletal pain (CMSP). DESIGN: An observational, descriptive, cross-sectional study conducted from March to July 2023. SETTING: Seven PM&RCs from 5 cities, representing 3 care systems: Social Security (SS), Ministry of Health (MH), and private practice (PP). PARTICIPANTS: All patients, regardless of age, attending a physiatry consultation for CMSP for the first time and who provided informed consent to participate were included. Nonprobabilistic sampling was employed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: We estimated the overall prevalence of SSS syndrome as a percentage among patients with CMSP, stratified by health care institution, sex, age, and occupation type. We also recorded the spinal segments involved and any concomitant painful disorders (CPDs). SSS syndrome was diagnosed using standardized criteria. RESULTS: Of the eligible participants, 319 with CMSP were enrolled; 73.4% were women, and the median age of participants was 56.9 (range, 13-89y) years. The overall prevalence of SSS syndrome was 53.3%. Of these, 69.1%, 42.2%, and 13.8% were in the SS, MH, and PP systems, respectively. The most affected were female participants (56.4%), those aged 50-64 years (60.4%), and those with active jobs (58.8%). Most commonly, the lumbosacral and lumbar segments were affected, followed by the lower and middle cervical levels. Spine pathologies were the most common CPDs. CONCLUSION: The prevalence of SSS syndrome was high among patients who visited PM&RCs for CMSP and varied according to the care system. Further research on SSS syndrome is warranted to relieve the burden it poses on patients with CMSP and ensure proper diagnosis in clinical practice.

Increased Duration and Intensity of Physical Activity Are Associated With Increased Pain in Individuals With Femoroacetabular Impingement Syndrome: An Ecological Momentary Assessment Study.

OBJECTIVE: To investigate the relation between accelerometer-measured physical activity and real-time pain in individuals with femoroacetabular impingement syndrome (FAIS). We tested the hypothesis that increased duration of high intensity activity would contribute to momentary increases in pain. DESIGN: Observational study. SETTING: Participants' natural, day-to-day environment. PARTICIPANTS: Population-based sample of 33 individuals with unilateral FAIS. Important eligibility criteria included no concomitant hip disorders or previous hip surgery. Key sociodemographic features include that all participants were required to have a smartphone. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Duration and intensity of physical activity as measured by a waist-worn accelerometer, and instantaneous pain reported in real-time smartphone-based ecological momentary assessment surveys. Physical activity variables included each person's average sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) in the 90 minutes proceeding all pain surveys as well as fluctuation in sedentary, LPA, and MVPA above or below average prior to each individual survey. RESULTS: Linear mixed models revealed that the significant predictors of pain included fluctuation in sedentary time (B=-0.031, P<.001), average LPA (B=0.26, P=.035), and the interaction between fluctuation in LPA and fluctuation in MVPA (B=0.001, P<.001). Fluctuation in sedentary time above a person's average was associated with lower pain, while average LPA and fluctuations above average in both LPA and MVPA were associated with higher pain. CONCLUSIONS: These results suggest that individuals with FAIS can engage in health-enhancing MVPA but should focus on avoiding concurrent increase above average in both high intensity and LPA in the same 90-minute period. Future work is warranted testing the efficacy of such an approach on pain. Additionally, given that high levels of LPA may arise from a host of socioeconomic factors, additional research is needed to disentangle the effect of LPA on pain in FAIS.

Determinants of health-related quality of life in older people with chronic musculoskeletal pain: a cross-sectional study.

BACKGROUND: This study aimed to identify the significant physical, psychological, and social determinants associated with EuroQuol-5D (EQ-5D) among Chinese older people with chronic musculoskeletal pain, and to evaluate how these determinants affected the five dimensions of EQ-5D. METHOD: This is a cross-sectional study. Data were collected through a cohort involving 946 community-dwelling older people aged ≥ 60 with chronic musculoskeletal pain in Hong Kong. Selected independent variables were categorized into physical, psychological, and social domains. Physical variables included age, sex, body mass index (BMI), pain severity score, number of pain regions, the most painful site, and the number of comorbidities. Psychological variables included depression level measured using the 9-question Patient Health Questionnaire (PHQ-9), and anxiety level measured using the Generalized Anxiety Disorder Assessment (GAD-7). Social variables included living, marital, and social welfare recipient's status. The dependent variables comprised the index scores and the five dimensions of the EQ-5D descriptive system. Ordinal least squares (OLS) model and logistic regression model were used for data analysis. RESULTS: The mean age of the participants was 67.1 (SD = 5.1), with 77.6% being female. Higher pain severity scores (beta (ß) coefficient =-0.044, P < 0.001), depression scores (ß=-0.007, P < 0.001) and higher anxiety scores (ß=-0.01, P < 0.001) were associated with lower EQ-5D index scores. Specifically, knee pain (ß=-0.061, P < 0.001) was significantly associated with lower EQ-5D index scores. Participants with higher pain severity and depression scores were more likely to report problems in most EQ-5D dimensions. Participants with anxiety primarily faced challenges related to mood, and those with knee pain were more likely to have problems with mobility and daily activities. CONCLUSION: Among the selected determinants in our study, pain intensity, depression, anxiety, and knee pain were identified as key determinants associated with reduced HRQoL in older Chinese people with chronic musculoskeletal pain. Each of these determinants showed distinct associations with different dimensions of the EQ-5D, potentially informed resource allocation and the development of targeted interventions to improve the overall HRQoL of this specific population.

Prevalence of musculoskeletal pain and associated factors among professional orchestra musicians in Norway.

BACKGROUND: Orchestra musicians have a high risk of experiencing musculoskeletal problems. These problems may lead to sleep and psychological disturbance. OBJECTIVES: This study investigated the occurrence of musculoskeletal pain (MSP) among orchestra musicians and the coherence between pain and predictors such as gender, age and instrument. Further, the impact of pain on sleep and mental health was analysed to assess pain as a predictor threatening musicians' wellbeing. METHODS: Some 358 musicians in eight different professional orchestras in Norway completed a questionnaire. Questions about pain experienced within the last 30 days were based on a national survey. Standardised screening tools like the Hopkins Symptom Checklist-25 (HSCL-25) and Bergen Insomnia Scale (BIS) were used to assess psychological distress and sleeping problems. Kruskal-Wallis tests were used to analyse the differences in the pain-related variables: experienced pain severity (EPS), number of pain areas, and work being perceived as the source of pain based on age. Mann-Whitney U tests were conducted to evaluate the statistical significance between gender and the pain-related variables. Spearman's rank correlations were used to examine the relationship between EPS and BIS, HSCL-25 and pain area. Additionally, simple linear regression models were employed to determine whether EPS can predict higher scores on the HSCL-25 and BIS scales. RESULTS: The prevalence of MSP experienced in the last 30 days among orchestra musicians in Norway was 85%. Musicians experienced frequent pain regardless of their gender, age or instrument group. Neck, shoulders and upper back represented the most reported pain areas. Further, it was observed that increased EPS was correlated with an increase in the number of pain areas and in work being perceived as the source of pain. EPS significantly predicted sleep- and psychological distress. CONCLUSIONS: Orchestra musicians have a high risk of encountering MSP. Furthermore, their psychological distress and sleeping problems seem to be related to experienced MSP. To deliver optimal health, these problems should be handled simultaneously.

Patient perspectives on the unwanted effects of multidisciplinary pain management programmes: A qualitative study.

OBJECTIVE: This study aimed to understand the impact of pain management programmes, focusing on the unwanted effects and their influence on patients' long-term use of self-management strategies. DESIGN: Qualitative study. SETTING: Specialist musculoskeletal hospital in North London, England. PARTICIPANTS: Patients with chronic musculoskeletal pain that have completed a pain management programme. INTERVENTION: Multidisciplinary pain management programmes. MAIN MEASURES: Data were collected regarding patients' experiences and unwanted effects from the pain management programme using semi-structured interviews. Data were analysed using thematic analysis. RESULTS: Fourteen participant interviews were included in the analysis (median age 54 years, 12 females). Four themes were generated from the data: Benefits and burdens, Pain management programme and real life, Social support and Healthcare interventions. Unwanted effects included heightened anxiety related to negative interactions with peers, being in a new environment, worries about ability to cope with the programme, social anxiety from being in a group, the strain on families due to participants being away from home and a sense of abandonment at end of the programme. Burdens associated with implementing pain management strategies were identified, including the emotional burden of imposing their self-management on close family and competing demands with time and energy spent on self-management at the expense of work or home commitments. CONCLUSIONS: Pain management programmes have an important role in helping patients to learn how to self-manage chronic pain. Their unwanted effects and the treatment burdens associated with long-term self-management may be an important consideration in improving the longevity of their beneficial effects.

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders: 'eHealth: it's TIME'.

OBJECTIVE: This study aimed to co-design and develop a user-centred, theory-based eHealth-mediated self-management support follow-up prototype for adults with musculoskeletal disorders. DESIGN: A three-step system development cycle was employed. Step 1 involved creating intervention features and content, with two focus groups reviewing prioritised eHealth intervention elements based on earlier research. Step 2 involved heuristic testing using Nielsen's 10 heuristic principles. Step 3 incorporated qualitative think-aloud interviews and the System Usability Scale. SETTING: Republic of Ireland. PARTICIPANTS: Step 1 included adults with musculoskeletal disorders (n = 12). Step 2 involved five reviewers. Step 3 included people with musculoskeletal disorders (n = 5) and musculoskeletal physiotherapists (n = 5). RESULTS: Participants in step 1 approved four main intervention components, which map to recognised theoretical frameworks, and suggested increased use of visual and interactive elements. Heuristic testing in step 2 identified design and navigation issues. In Step 3, usability testing, additional navigation, content and design recommendations were identified. The overall median system usability score (interquartile range) was 75 (0) out of 100 for adults with musculoskeletal disorders and 77.5 (2.5) out of 100 for musculoskeletal physiotherapists, indicating good usability. CONCLUSION: A theory-based, user-centred eHealth-mediated follow-up self-management support prototype has been developed for people with musculoskeletal disorders, with the next steps focusing on feasibility testing in clinical practice, with a more diverse population.

Responsiveness and minimal important change of specific and generic patient-reported outcome measures for back patients: the Norwegian Neck and Back Register.

PURPOSE: To evaluate responsiveness and minimal important change (MIC) of Oswestry Disability Index (ODI), pain during activity on a numeric rating scale (NRSa) and health related quality of life (EQ-5D) based on data from the Norwegian neck and back registry (NNRR). METHODS: A total of 1617 patients who responded to NNRR follow-up after both 6 and 12 months were included in this study. Responsiveness was calculated using standardized response mean and area under the receiver operating characteristic (ROC) curve. We calculated MIC with both an anchor-based and distribution-based method. RESULTS: The condition specific ODI had best responsiveness, the more generic NRSa and EQ-5D had lower responsiveness. We found that the MIC for ODI varied from 3.0 to 9.5, from 0.4 to 2.5 for NRSa while the EQ5D varied from 0.05 to 0.12 depending on the method for calculation. CONCLUSION: In a register based back pain population, the condition specific ODI was more responsive to change than the more generic tools NRSa and EQ5D. The variations in responsiveness and MIC estimates also indicate that they should be regarded as indicative, rather than fixed estimates.

Process evaluation of a randomised controlled trial - prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM).

BACKGROUND: Musculoskeletal disorders are commonly treated in primary healthcare and may, if not treated adequately, entail a risk for long-term disability and sickness absence. A team-based rehabilitation intervention (PREVention of Sickness Absence for Musculoskeletal disorders, PREVSAM) was evaluated in a randomised controlled trial. The purpose of this study was to evaluate the process of implementing the PREVSAM model in primary care rehabilitation. METHODS: This process evaluation was conducted alongside the trial, collecting quantitative and qualitative data to evaluate how the PREVSAM model was implemented, mechanisms of impact, and contextual factors. Acceptability, feasibility, appropriateness, adaptations, training and support, resources, recruitment, reach, retention, dose, fidelity, and readiness for change were investigated. Qualitative data were collected from healthcare professionals and patients. RESULTS: Eight of 22 invited rehabilitation clinics (36%) and 28 of 54 healthcare professionals (52%) were included in the PREVSAM trial and this process evaluation. Of 507 eligible patients, 261 (51%) were included. Of those, 134 were randomised to the intervention and 129 (96%) were retained. Twelve healthcare professionals and 15 patients participated in the qualitative evaluations. The model's essential components; individual assessments and structured, team-based rehabilitation with clear division of responsibilities agreed in a joint health plan; were generally delivered according to protocol. The optional components early access to psychological treatment and workplace contact were delivered to a lesser extent. Perceived acceptability, feasibility, and appropriateness of the PREVSAM model were moderate to high. Several contextual barriers, in the form of missing prerequisites, affected the implementation. Qualitative data showed that the model, with its holistic view, was appreciated by both healthcare professionals and patients. CONCLUSIONS: This process evaluation suggests that PREVSAM is acceptable, feasible and appropriate for patients with MSDs reporting psychological risk factors associated with increased risk for sickness absence. While essential components were implemented with fidelity for most patients, optional components were not. This variability reflects the complexity of the model, its mandatory and optional components, contextual barriers, and the person-centred approach meeting individual patient needs. As all model components were not delivered to all patients, the intervention may have been too similar to treatment as usual to detect differences on a group level. A limitation of the study is that half of the participating rehabilitation clinics withdrew prematurely.

The effect of commuting time on burnout: the mediation effect of musculoskeletal pain.

OBJECTIVES: This study explores the relationship among commuting, musculoskeletal (MS) pain, and burnout. METHODS: An observational and cross-sectional study was conducted at a medical university-affiliated hospital in Taichung, Taiwan in 2021. The two questionnaire was used and they included the Copenhagen Burnout Inventory (CBI) and the Nordic Musculoskeletal Questionnaire (NMQ). All participants were invited to complete the cross-sectional survey. A multiple linear regression was assessed correlations between commuting, MS pain, and burnout. RESULTS: After excluding those with missing data, 1,615 healthcare workers were deemed valid as research participants. In multiple linear regression, commuting time longer than 50 min was associated with personal burnout (PB) in the presence of adjusted confounders; however, long commuting time was not associated with work-related burnout (WB). Furthermore, the choice of commuting method did not affect PB or WB. Notably, both neck and shoulder pain (NBSP) and ankle pain (BAP) increase the risk of PB and WB. The mediation analysis demonstrated that NBSP is a mediating factor, increasing the level of PB and WB for commuting times longer than 50 min. CONCLUSIONS: Healthcare workers who commute for more than 50 min should be considered part of a high-risk group for burnout and musculoskeletal pain. They should also be provided with resources and programs focused on burnout prevention and MS pain relief.

Is patients' activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BACKGROUND: Prolonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients' activities of daily living (ADL) score may be a proxy for home care workers' standing time at work. The objective of the present study was to investigate the association between patients' ADL self-care score, and workers standing time. METHODS: This cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients' ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories. RESULTS: We analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients. CONCLUSION: Our findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers' total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Association between multisite musculoskeletal pain and disability trajectories among community-dwelling older adults.

BACKGROUND: Pain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated. OBJECTIVE: To examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort. DESIGN: We used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL). PARTICIPANTS: A total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study. METHODS: Group-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics. RESULTS: Persons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites. CONCLUSIONS: Persons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.