The ProFitMap-neck--reliability and validity of a questionnaire for measuring symptoms and functional limitations in neck pain.

PURPOSE: To assess overall reliability and validity of a neck-specific questionnaire, the Profile Fitness Mapping neck questionnaire (ProFitMap-neck), on three chronic neck pain groups. METHOD: Participating groups were as follows: whiplash associated disorders, inpatient care (IP-WAD, n=127); nonspecific neck pain, inpatient care (IP-NS, n=83) and nonspecific neck pain subjects (non-IP-NS, n=104). All groups answered the ProFitMap-neck and the SF-36, whereas non-IP-NS also answered the Neck Disability Index (NDI) and the Functional Self-Efficacy Scale (SES). Internal consistency, test-retest reliability and components of convergent construct, face and content validity were determined for the ProFitMap-neck. RESULTS: The ProFitMap-neck showed good internal consistency in all three groups, and ICC test-retest reliability (0.80-0.91). Good correlation (0.66-0.78) and highest agreement was reached with NDI. According to the International Classification of Functioning, Disability and Health, the symptom scale of the ProFitMap-neck was mainly classified to the domain of impairments-body functions, and the functional limitation scale to the activity limitation domain. CONCLUSION: The results indicate that the ProFitMap-neck is valid for measuring symptoms and functional limitations in people with chronic neck pain. The combination of a composite total score of symptoms and function as well as separate scores of each domain makes ProFitMap-neck suitable for research as well as in clinical practice.

The effects of a 1-year physical exercise programme on development of fatigue during a simulated ambulance work task.

The aim of the study was to evaluate the effects of individually prescribed physical exercise programmes on development of fatigue during the carrying of a loaded stretcher up and down the stairs. Nineteen ambulance personnel performed the training for 1 year. Testing occurred before and after 1 year of the training. Both the training group (n = 19) and the control group (n = 15) were assessed for physical capacity and lactate concentration in blood and ratings of perceived exertion during carrying a stretcher on the stairs. When comparisons were made between those who had been training three times/week for 1 year and the control group, lactate concentration was significantly decreased. In conclusion, markers of fatigue during stretcher carrying can be reduced by the use of individually prescribed physical exercise programmes.

The assessment of symptoms and functional limitations in low back pain patients: validity and reliability of a new questionnaire.

Many of the existing low back pain (LBP) questionnaires of function and symptoms have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. The present study describes the development of a clinically derived back-specific questionnaire incorporating both a functional limitation and a symptom scale, with a further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aims of the study were to assess the overall reliability and validity of the new questionnaire, named the Profile Fitness Mapping questionnaire (PFM). A total of 193 chronic LBP patients answered the PFM together with five validated criterion questionnaires. For the internal consistency of the questionnaires, the three indices of the PFM had the highest Cronbach's alpha (0.90-0.95) and all items had item-total correlations above 0.2. The correlation coefficients between the PFM and the back-specific criterion questionnaires ranged between 0.61 and 0.83, indicating good concurrent criterion validity. The best discriminative ability between patients with different pain severities was demonstrated by the functional limitation scale of the PFM. Well centered score distribution with no patient's score at the floor or the ceiling level indicates that the PFM has the potential to detect the improvement or worsening of symptoms and functional limitations in chronic LBP patients. Classification according to the International Classification of Functioning, Disability and health (ICF) of WHO revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. The present study suggests that the PFM has a high internal consistency and is a valid indicator of symptoms and functional limitations of LBP patients. It offers the combination of a composite total score and the possibility of evaluations within specific domains of disability. Complementary evaluation of test-retest reliability and responsiveness to change is warranted.

Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: a randomized controlled study.

OBJECTIVE: To evaluate the effects of a cognitive behavioural training programme and a physical activity programme for patients with stress-related illnesses. DESIGN: In a randomized controlled study, patients were allocated randomly to 1 of 3 groups, where group 1 participated in a cognitive behavioural training programme, group 2 participated in a physical activity programme, and group 3, the control group, was offered usual care for the course of the study. SUBJECTS: A total of 75 patients participated in the study. They had been on sick leave for at least 50% of the time for between 1 month and 2 years due to stress-related illnesses. METHODS: Measurements of autonomic activity, pressure-pain thresholds and subjective ratings of health and behaviour were made before and after a 10-week intervention period, and at 6 and 12 months after the intervention. RESULTS: Minor differences in autonomic activity and pressure-pain thresholds were found between the groups immediately after the intervention. At the 6- and 12-month follow-up assessments, the differences were no longer present. Patients in the cognitive behavioural training group improved their ratings of general health compared with the physical activity group throughout the study. CONCLUSION: The study showed little difference in the effect of cognitive behavioural training and physical activity, compared with usual care, for patients with stress-related illnesses.

Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems.

BACKGROUND: Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration. OBJECTIVES: The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms. DESIGN: A qualitative grounded theory approach guided the study in data collection and analysis. SETTINGS: Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals. PARTICIPANTS: Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages. METHODS: A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons. RESULTS: The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness. CONCLUSION: This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.

Musculoskeletal pain complaints and performance on cognitive tasks over the adult life span.

The present study aimed at comparing participants with and without self reported musculoskeletal pain in a normal population with regard to performance on a range of tests for episodic memory, semantic memory, and other cognitive functions and to see if expected differences interacted with age. The results showed that participants with pain performed worse on a range of tasks as compared to participants without pain, and that these differences occurred regardless of age. The most robust effects of pain were displayed on tests for vocabulary and construction ability as these were the only effects that remained significant after controlling for years of education and reported depression in separate analyses. When depression and education were controlled for in the same analysis, even these effects were eliminated, suggesting interplay between pain, depressive status, and educational level in the negative effects on cognitive functioning.

Stress monitoring of ambulance personnel during work and leisure time.

OBJECTIVES: The aim of the present study was to assess physiological and subjective stress markers during a 24-h ambulance work shift and during the next two work-free days, and relate these parameters to self-reported health complaints. METHODS: Twenty-six ambulance personnel were followed during a 24-h work shift and during the next two work-free days with electrocardiogram, cortisol assessments and diary notes. The ambulance personnel also performed tests of autonomic reactivity before and at the end of the work shift. The subjects were categorized into two groups according to their number of health complaints. RESULTS: In general, stress markers did not show differences between the work shift and leisure time. However, a modest deviation in heart rate variability pattern and higher morning cortisol values during work in comparison with work-free days were observed in personnel with many health complaints. CONCLUSIONS: Subjective and physiological characteristics of ambulance personnel did not indicate distinctive stress during the 24-h work shift. Relationships between frequent health complaints and specific work-related factors require further prospective studies.

Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel.

This cross-sectional study on a random sample of 1,500 ambulance personnel investigated the relationships between self-reported work-related physical and psychosocial factors, worry about work conditions, and musculoskeletal disorders among female and male ambulance personnel. Three different outcomes, complaints, activity limitation, and sick leave, for the neck-shoulder and low-back region, respectively, were chosen. Among the female personnel, physical demands was significantly associated with activity limitation in the neck-shoulder (OR 4.13) and low-back region (OR 2.17), and psychological demands with neck-shoulder (OR 2.37) and low-back (OR 2.28) complaints. Among the male personnel, physical demands was significantly associated with low-back complaints (OR 1.41) and activity limitation (OR 1.62). Psychological demands and lack of social support were significantly associated with neck-shoulder complaints (OR 1.86 and OR 1.58, respectively) and activity limitation (OR 3.46 and OR 1.71) as well as activity limitation due to low-back complaints (OR 2.22 and OR 1.63). Worry about work conditions was independently associated with activity limitation due to low-back complaints among the female (OR 5.28), and to both neck-shoulder and low-back complaints (OR 1.79 and OR 2.04, respectively) and activity limitation (OR 2.32 and OR 1.95) among the male personnel. In conclusion, the association patterns between physical and psychological demands and MSDs suggest opportunities for intervention.

Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.

This study aimed at investigating the relationships between work-related psychosocial factors, worry about work conditions and health complaints (sleeping problems, headache and stomach symptoms) among female and male ambulance personnel. Out of 4000 ambulance personnel in Sweden, 1500 (300 female and 1200 male personnel) were randomly selected. They answered a questionnaire including items on self-reported health complaints, individual characteristics, work-related psychological demands, decision latitude, social support and worry about work conditions. Twenty-five per cent of the female and 20% of the male ambulance personnel reported two or more health complaints sometimes or often. According to the demand-control-support questionnaire, ambulance personnel reported a generally positive psychosocial work environment, although psychological demands were associated with sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Another factor that was significantly associated with health complaints among both genders was worry about work conditions. When worry about work conditions was added to the regression models, this variable took over the role from psychological demands as a predictor for health complaints among the female ambulance personnel. The prevalence of sleeping problems, headache and stomach symptoms were significantly associated with psychological demands among both female and male ambulance personnel. Notably, worry about work conditions seems to be an important risk factor for health complaints. This suggests that worry about work conditions should not be neglected when considering risk factors among ambulance personnel.

Autonomic activity, pain, and perceived health in patients on sick leave due to stress-related illnesses.

OBJECTIVE: The aim of the present study was to compare autonomic activity, pressure-pain thresholds, and subjective assessments of health and behavior between patients with stress-related illnesses and healthy control subjects. METHODS: Twenty sick-listed patients with stress-related illnesses and 20 age- and gender-matched healthy subjects performed tests of autonomic regulation and algometric tests, and completed questionnaires about physical and mental health and behavioral patterns. RESULTS: Patients exhibited higher autonomic reactivity to cognitive and physical laboratory tasks (p < 0.05), and had lower pressure-pain thresholds in the shoulders and lower back than healthy control subjects (p < 0.05). Furthermore, the patients rated considerably poorer health and health behavior than the control subjects (p < 0.05). CONCLUSIONS: The results indicate an engagement of the autonomic nervous system in stress-related illnesses. Furthermore, they show that patients with stress-related illnesses experience symptoms of musculoskeletal pain, and it is therefore recommended that assessments of musculoskeletal pain be incorporated in the clinical examinations and the rehabilitation of patients with stress-related illnesses.

Muscle strength assessment from functional performance tests: role of body size.

The aim of the study was to test the hypothesis that the body size plays an important role in assessment of muscle ability to exert force by standard functional performance tests. Twenty-one male students were tested on maximal isometric lift, one leg rising, vertical jump, and box lift tests, and the maximal isokinetic strength of hip and knee extensors was also recorded. When indices of the 4 functional performance tests were related to the strength of each of the 2 leg extensor muscle groups, only maximal isometric lift demonstrated positive correlation with knee extensors strength. When muscle strength was corrected for body mass, however, the aforementioned relationship became insignificant, but the 1 leg rising performance demonstrated a positive relationship with knee extensor strength. In addition, maximal isometric lift and 1 leg rising test performance provided positive and negative correlation, respectively, with body mass. The obtained findings were in line with the effects of scale applied on the tested performance. We generally conclude that the assessment of muscle capability to exert force based on some standard functional performance tests could be confounded by the body size effect.