Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review.

BACKGROUND: Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention. METHODS: This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against. RESULTS: Of 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome. CONCLUSIONS: Five constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.

Organization of Work Factors Associated with Work Ability among Aging Nurses.

The United States (U.S.) workforce is aging. There is a paucity of literature exploring aging nurses' work ability. This study explored the work-related barriers and facilitators influencing work ability in older nurses. We conducted a qualitative descriptive study of aging nurses working in direct patient care (N = 17). Participants completed phone or in-person semi-structured interviews. We used a content analysis approach to analyzing the data. The overarching theme influencing the work ability of aging nurses was intrinsically motivated. This was tied to the desire to remain connected with patients at bedside. We identified factors at the individual, unit-based work level and the organizational level associated with work ability. Individual factors that were protective included teamwork, and feeling healthy and capable of doing their job. Unit-based level work factors included having a schedule that accommodated work-life balance, and one's chronotype promoted work ability. Organizational factors included management that valued worker's voice supported work ability.

Improving the Quality of Consumer Health Information on Wikipedia: Case Series.

BACKGROUND: Wikipedia is one of the most consulted health resources in the world. Since the public is using health information from Wikipedia to make health care decisions, improving the quality of that health information is in the public interest. The open editable content design of Wikipedia and quality control processes in place provide an opportunity to add high-value, evidence-based information and take an active role in improving the health care information infrastructure. OBJECTIVE: The aim of this project was to enhance Wikipedia health pages using high-quality, current research findings and track the persistence of those edits and number of page views after the changes to assess the reach of this initiative. METHODS: We conducted Wikipedia Editathons with 3 different cohorts of Physical Therapy (PT) students to add high-quality health information to existing Wikipedia pages. Students synthesized best evidence information and updated and/or corrected existing Wikipedia entries on specific health pages. To evaluate the impact of these contributions, we examined two factors: (1) response to our contributions from the Wikipedia editing community, including number and type of subsequent edits as well as persistence of the student contributions and (2) number of page views by the public from the time of the page edits. RESULTS: A total of 98 PT students in 3 different cohorts engaged in Editathons, editing 24 health pages. Of the 24 edits, 22 persisted at the end of the observation period (from time of entry to May 31, 2018) and received nearly 8 million page views. Each health page had an average of 354,724 page views. CONCLUSIONS: The Wikipedia Editathon is an effective way to continuously enhance the quality of health information available on Wikipedia. It is also an excellent way of bridging health technology with best-evidence medical facts and disseminating accurate, useful information to the public.

Does Coordinated, Multidisciplinary Treatment Limit Medical Disability and Attrition Related to Spine Conditions in the US Navy?

BACKGROUND: Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team. QUESTIONS/PURPOSES: Is a multidisciplinary spine team effective in limiting disability and attrition related to work-disabling spine conditions as compared with the current standard of care for US military active-duty service members? METHODS: This is a retrospective, pre-/post-study with a separate, concurrent control group using administratively collected data from two large military medical centers during the period 2007 to 2009. In this study, disability is expressed as the proportion of active-duty service members seeking treatment for a work-disabling spine condition that results in the assignment of a first-career limited-duty status. Attrition is expressed as the proportion of individuals assigned a first-career limited-duty status for a work-disabling spine condition who were referred to a Physical Evaluation Board. We analyzed 667 individuals assigned a first-career limited-duty for a work-disabling spine condition between 2007 and 2009 who received care at the Naval Medical Center Portsmouth or Naval Medical Center San Diego. RESULTS: Rates of first-career limited-duty assignments for spine conditions decreased from 2007 to 2009 at both sites, but limited-duty rates decreased to a greater extent at the intervention site (Naval Medical Center Portsmouth; from 8.5 per 100 spine cases in 2007 to 5.1 per 100 cases in 2009, p < 0.001) as compared with the control site (Naval Medical Center San Diego; 16.0 per 100 spine cases in 2007 and 14.1 per 100 cases in 2009, p = 0.38) after the Spine Team was implemented in 2008. The risk of disability was lower at Naval Medical Center Portsmouth as compared with Naval Medical Center San Diego for each of the 3 years studied (in 2007, the relative risk was 0.53 [95% confidence limit {CL}, 0.42-0.68; p < 0.001]) indicating a protective effect of Naval Medical Center Portsmouth in limiting disability (in 2008, it was 0.58 [95% CL, 0.45-0.73; p < 0.001] and in 2009 0.34 [95% CL, 0.27-0.47; p < 0.001]); the relative risk improved in 2009 after the introduction of the Spine Team at Naval Medical Center Portsmouth. There were no differences observed in rates of attrition from the period before the introduction of the Spine Team to after at Naval Medical Center Portsmouth, and no overall differences could be statistically detected between the two sites. CONCLUSIONS: This study provides suggestive evidence that a multi-disciplinary Spine Team may be effective in limiting disability. No conclusion can be drawn about the Spine Team's effectiveness in limiting attrition. Additional study is warranted to examine the effect of the timing of the introduction of multidisciplinary care for work-disabling spine conditions. LEVEL OF EVIDENCE: Level III, therapeutic study.

Prognostic factors in complex regional pain syndrome 1: a systematic review.

OBJECTIVE: The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. METHODS: MEDLINE, Embase, PsychINFO, CENTRAL and screened reference lists of included studies were searched for studies of parameters associated with the prognosis of the condition. Studies investigating stroke-related complex regional pain syndrome were excluded. RESULTS: Searches retrieved 2,577 references, of which 12 articles were included in the study. The preferred diagnostic criteria were the Veldman and the International Association for the Study of Pain criteria. The mean level of study quality was insufficient. A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. For many parameters the evidence is contradictory. CONCLUSION: Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. Further high-quality aetiological and clinical research is needed.

Prevention and management of chronic back pain.

Low back pain is prevalent, and both debilitating for the patient and costly for society if it becomes a chronic condition. The initial prognosis at the onset of low back pain is positive, however the rate of recurrence is high and about 20% of patients seeking care develop a chronic problem that may or may not lead to disability. The main message, based on the best evidence, is that keeping active despite low back pain is "healthy". A large portion of patients seeking care can manage their short term and even longer term incapacity. However, for those who cannot manage their pain, significant relief can be found in a variety of conservative treatments. Passive treatment should be kept to a minimum as evidence shows that active treatments are more effective for improving function and return to work. There is evidence that identifying psychosocial symptoms and barriers, and referral to appropriate interventions improves outcomes. There are currently no clear indications for surgery in nonspecific low back pain.

Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To critically appraise and synthesize the literature on assessment of neck pain. SUMMARY OF BACKGROUND DATA: The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain. RESULTS: We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. CONCLUSION: The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research.

Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To critically appraise and synthesize the literature on assessment of neck pain. SUMMARY OF BACKGROUND DATA: The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain. RESULTS: We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. CONCLUSION: The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research.

Musculoskeletal symptom survey among cement and concrete workers.

Work in construction is associated with a high risk for musculoskeletal disorders and injuries. The symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the cement and concrete workers and identify the most problematic work-related activities and job factors that might have contributed to the occurrence of these disorders. Findings revealed that a large proportion of the laborers (77%) experienced at least one musculoskeletal disorder in the last year. Low back pain was reported as the most frequently experienced symptom (66%). 'Working while in pain' the concrete workers perceived as the major problem in the trade. Other problematic work-related activities included 'bending or twisting the back', 'work in hot, cold or wet conditions', and 'handling heavy objects'. Most of the laborers (82%) requested on-the-job safety training. Survey results combined with the outcomes of focus groups discussions and work site observations were used in the design of a training program aimed at the prevention of musculoskeletal morbidity in the trade. The program incorporated ergonomics principles, hazard recognition, safe work practices, problem solving and personal protection in the training curriculum for membership of the trade.

Musculoskeletal symptom survey among mason tenders.

BACKGROUND: Low back pain (LBP) constitutes a major problem in construction. The magnitude and musculoskeletal injury characteristics in certain construction trades have been studied extensively. Musculoskeletal research targeting mason tenders is limited. High physical demands of the job primarily contribute to an increased risk of LBP experienced by these laborers. METHODS: A symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the mason tenders, and to identify work-related activities perceived by them as contributing to their disorders. RESULTS: The findings revealed that 82% of the mason tenders experienced at least one musculoskeletal symptom in the last year. LBP was the most frequently reported symptom (65%). Due to LBP, 12% of the laborers missed work and 18% of them visited a physician. Bending or twisting the back, working in the same position or in pain, and heavy lifting they perceived as the most problematic work-related activities. The vast majority of the laborers requested job-safety training. CONCLUSIONS: The mason tenders experienced high prevalence of LBP. To address the problem a model for primary prevention of LBP was developed and implemented in the trade. The model incorporated ergonomic principles, hazard recognition, and problem solving in the training curriculum for the union instructors teaching apprentices the trade-specific skills.