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1.
BMC Musculoskelet Disord ; 21(1): 303, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32408863

RESUMO

BACKGROUND: The high numbers of musculoskeletal disorders (MSD) among soldiers in the Swedish Armed Forces has led to the implementation of an effective prevention program, the musculoskeletal screening protocol (MSP), including questionnaires, physical tests and individual intervention of their MSD. A corresponding MSP for the Swedish Air Force is also needed due to earlier reported high prevalence of MSD. We therefore investigated the prevalence of MSD in Swedish Air Force personnel (AF) and compared this to Swedish Army deployed soldiers (DS). Individual, health- and work-related factors associated with MSD were also investigated. METHODS: Cross-sectional questionnaire-based study on 166 male AF and 185 DS. AF consisted of fighter pilots, helicopter pilots and rear crew from one Swedish air base. RESULTS: The one-year and point prevalence, respectively, of MSD were significantly higher for AF compared to DS with regard to both the upper quarter of the body (i.e. neck, shoulder and thoracic regions) (AF = 54.8 and 31.3%, DS = 26.1 and 13.6%, p = 0.01) and the lumbar region (AF = 38.0 and 18.7%, DS = 22.2 and 7.1%, p = 0.00). No significant differences were present between fighter pilots, helicopter pilots and rear crew regarding MSD prevalence. Factors significantly associated with having both upper quarter and lumbar regions MSD were group (i.e. greater odds for AF than DS) and self-reported physical health as less than excellent. Additionally, being older and taller were also factors associated with lumbar region MSD. DISCUSSION: Despite a generally healthy lifestyle, MSD were commonly reported by AF and DS, with generally higher prevalence in AF who mainly reported MSD in the upper quarter of the body. The results from this study indicate that the MSP can be a meaningful tool to prevent MSD in air force personnel and that questions regarding general health and MSD in specific body regions should be included in screening protocols. The development of the preventive program MSP is therefore recommended for the Swedish Air Force.

2.
J Rehabil Med ; 52(2): jrm00019, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-31995224

RESUMO

OBJECTIVE: To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures. METHODS: A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, fused by principal component analyses using the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional functioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes. CONCLUSION: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.


Assuntos
Dor Crônica/reabilitação , Emoções/fisiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sistema de Registros , Suécia , Fatores de Tempo , Adulto Jovem
3.
Scand J Pain ; 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31150362

RESUMO

Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.

4.
BMJ Open ; 9(5): e025150, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092646

RESUMO

OBJECTIVES: To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course. DESIGN: Prospective observational cohort study with weekly follow-ups. PARTICIPANTS: Fifty-three SwAF marines entering the training course. OUTCOMES: Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports. RESULTS: During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time. CONCLUSIONS: Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.


Assuntos
Dor nas Costas/epidemiologia , Exercício Físico/fisiologia , Militares , Doenças Profissionais/epidemiologia , Adulto , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Estudos Prospectivos , Autorrelato , Suécia/epidemiologia
5.
J Pain Res ; 12: 891-908, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881099

RESUMO

Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments. Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods. Results: Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R 2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes. Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.

6.
BMC Musculoskelet Disord ; 20(1): 44, 2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30696437

RESUMO

BACKGROUND: Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria. METHODS: Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire. RESULTS: For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8-30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1-7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06-3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48-9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21-4.31, p = 0.011) to be significantly associated with neck pain. CONCLUSIONS: The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.


Assuntos
Aeronaves , Dor Lombar/epidemiologia , Cervicalgia/epidemiologia , Doenças Profissionais/epidemiologia , Dor de Ombro/epidemiologia , Adulto , Áustria/epidemiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Polícia/estatística & dados numéricos , Prevalência , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos
7.
Clin J Pain ; 35(2): 148-173, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30371517

RESUMO

OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR). MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE). DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/reabilitação , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/reabilitação , Dor Crônica/fisiopatologia , Humanos , Dor Musculoesquelética/fisiopatologia , Prognóstico
8.
PLoS One ; 13(9): e0204552, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30252903

RESUMO

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.


Assuntos
Militares , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/fisiopatologia , Adulto , Aeronaves , Fenômenos Biomecânicos , Feminino , Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Doenças Musculoesqueléticas/etiologia , Pescoço , Variações Dependentes do Observador , Exame Físico/métodos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Ombro , Coluna Vertebral , Suécia
9.
Physiother Theory Pract ; 33(5): 386-397, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28537819

RESUMO

This study evaluated inter- and intra-observer reliability and discriminative validity of three movement control tests: 1) standing knee-lift test; 2) static lunge test; and 3) dynamic lunge test. Thirty-eight subjects, 21 with low-back pain and 17 healthy, were video-recorded while performing the tests. Four physical therapists scored the tests according to a standardized protocol and calculated a composite score for each test based on the number of incorrect test components. Inter-observer reliability for the composite scores ranged between 0.68 and 0.80 (ICC 2,k) and intra-observer reliability between 0.54 and0.82 (ICC 2,1). The separate test components ranged between 0.32 and 0.91 (κfree) for inter-observer reliability and 0.42 and1.00 for intra-observer reliability. Test components showing the highest values were: back extension; arm lowering; and shoulders moving backwards. Components hip hitch, trunk lateral flexion, knee not lifted straight up and hips moving backwards did not reach accepted thresholds. Discriminative validity ranged between 0.47 and 0.56 (AUC). As our results showed an overall good agreement for the composite, scores and for the majority of the included test components the tests can be considered reliable enough. As the tests' discriminative ability was close to "none", they should, however, not be used for diagnostic purposes but should be further evaluated toward predicted validity.


Assuntos
Articulação do Quadril/fisiopatologia , Dor Lombar/diagnóstico , Vértebras Lombares/fisiopatologia , Movimento , Exame Físico/métodos , Modalidades de Fisioterapia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Postura , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Gravação em Vídeo , Adulto Jovem
10.
Sports Med Open ; 3(1): 16, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28411326

RESUMO

BACKGROUND: Susceptible to injury, the neck is subject to scientific investigations, frequently aiming to elucidate possible injury mechanisms via surface electromyography (EMG) by indirectly estimating cervical loads. Accurate estimation requires that the EMG-force relationship is known and that its measurement error is quantified. Hence, this study examined the relationship between EMG and isometric force amplitude of the anterior neck (AN), the upper posterior neck (UPN), and the lower posterior neck (LPN) and then assessed the relationships' test-retest reliability across force-percentiles within and between days. METHODS: EMG and force data were sampled from 18 participants conducting randomly ordered muscle contractions at 5-90% of maximal voluntary force during three trials over 2 days. EMG-force relationships were modeled with general linear mixed-effects regression. Overall fitted lines' between-trial discrepancies were evaluated. Finally, the reliability of participants' fitted regression lines was quantified by an intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). RESULTS: A rectilinear model had the best fit for AN while positively oriented quadratic models had the best fit for UPN and LPN, with mean adjusted conditional coefficients of determination and root mean square errors of 0.97-0.98 and 4-5%, respectively. Overall EMG-force relationships displayed a maximum 6% between-trial discrepancy and over 20% of maximal force, and mean ICC was above 0.79 within day and 0.27-0.61 between days across areas. Corresponding SEM was below 12% both within and between days across areas, excluding UPN between days, for which SEM was higher. CONCLUSIONS: EMG-force relationships were elucidated for three neck areas, and provided models allow inferences to be drawn from EMG to force on a group level. Reliability of EMG-force relationship models was higher within than between days, but typically acceptable for all but the lowest contraction intensities, and enables adjustment for measurement imprecision in future studies.

11.
Appl Ergon ; 60: 1-11, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28166867

RESUMO

PURPOSE: Dynamic chairs have the potential to facilitate movements that could counteract health problems associated with sedentary office work. This study aimed to evaluate whether a dynamic chair can increase movements during desk-based office work. METHODS: Fifteen healthy subjects performed desk-based office work using a dynamic office chair and compared to three other conditions in a movement laboratory. In a field study, the dynamic office chair was studied during three working days using accelerometry. RESULTS: Equivocal results showed that the dynamic chair increased upper body and chair movements as compared to the conventional chair, but lesser movements were found compared to standing. No differences were found between the conditions in the field study. CONCLUSIONS: A dynamic chair may facilitate movements in static desk-based office tasks, but the results were not consistent for all outcome measures. Validation of measuring protocols for assessing movements during desk-based office work is warranted.


Assuntos
Decoração de Interiores e Mobiliário/instrumentação , Movimento/fisiologia , Saúde do Trabalhador , Acelerometria , Adulto , Ergonomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura , Distribuição Aleatória , Análise e Desempenho de Tarefas , Tronco/fisiologia , Extremidade Superior/fisiologia , Local de Trabalho , Adulto Jovem
12.
Aerosp Med Hum Perform ; 88(2): 121-127, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28095956

RESUMO

INTRODUCTION: High prevalence of neck pain among skydivers is related to parachute opening shock (POS) exposure, but few investigations of POS deceleration have been made. Existing data incorporate equipment movements, limiting its representability of skydiver deceleration. This study aims to describe POS decelerations and compare human- with equipment-attached data. METHODS: Wearing two triaxial accelerometers placed on the skydiver (neck-sensor) and equipment (rig-sensor), 20 participants made 2 skydives each. Due to technical issues, data from 35 skydives made by 19 participants were collected. Missing data were replaced using data substitution techniques. Acceleration axes were defined as posterior to anterior (+ax), lateral right (+ay), and caudal to cranial (+az). Deceleration magnitude [amax (G)] and jerks (G · s-1) during POS were analyzed. RESULTS: Two distinct phases related to skydiver positioning and acceleration direction were observed: 1) the x-phase (characterized by -ax, rotating the skydiver); and 2) the z-phase (characterized by +az, skydiver vertically oriented). Compared to the rig-sensor, the neck-sensor yielded lower amax (3.16 G vs. 6.96 G) and jerk (56.3 G · s-1 vs. 149.0 G · s-1) during the x-phase, and lower jerk (27.7 G · s-1 vs. 54.5 G · s-1) during the z-phase. DISCUSSION: The identified phases during POS should be considered in future neck pain preventive strategies. Accelerometer data differed, suggesting human-placed accelerometry to be more valid for measuring human acceleration.Gladh K, Lo Martire R, Äng BO, Lindholm P, Nilsson J, Westman A. Decelerations of parachute opening shock in skydivers. Aerosp Med Hum Perform. 2017; 88(2):121-127.


Assuntos
Aviação , Desaceleração , Gravitação , Cervicalgia , Aceleração , Acelerometria , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
BMJ Open Sport Exerc Med ; 2(1): e000108, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27900175

RESUMO

INTRODUCTION: Neck pain is a widespread health problem in the skydiver athlete population, epidemiologically linked to repeated exposure to parachute opening shock (POS). During POS, a parachutist is subjected to considerable deceleration forces. This study aims to evaluate the use of preventive free fall acrobatics to reduce the biomechanical load on the neck of parachutists during parachute opening. METHODS AND ANALYSIS: Interventional study with a cross-over, within-subject, repeated measures design. Two consecutive skydives are made on the same day with random ordering of either an 'intervention jump' or a 'control jump'. The intervention jump contains two acrobatic elements prior to main parachute extraction: Reducing parachute deployment airspeed and positioning the human body head high. The primary outcome measure is the magnitude of initial Gx deceleration. All other directions of accelerations will be measured as well, as will magnitudes of multidirectional jerks (rates of changes of accelerations) and lower neck torque. Repeated within group measures analysis of variance will be used to quantify effects, and regression used to test for relationships between the elements of the intervention. ETHICS AND DISSEMINATION: Regional Medical Research Ethics Committee of Stockholm approval 2015/1189-31. The intervention protocol has been systematically prevalidated with an emphasis on participant safety. The study will be conducted in compliance with the Declaration of Helsinki, and its results published in peer-reviewed journals, preferably Open Access, to maximise access for the target athlete population. TRIAL REGISTRATION NUMBER: NCT02625896. Pre-results.

14.
Aerosp Med Hum Perform ; 87(11): 928-932, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27779951

RESUMO

INTRODUCTION: Flight-induced neck pain is common in high performance jet pilots, with incidents frequently attributed to high Gz flight maneuvers. The additional load of helmet-mounted night vision goggles (NVG) is believed to increase the risk, possibly from neck muscle strain in counteracting muscles. Hence, the aim was to investigate the effect of NVG on neck muscle strain as well as on the activity level distribution through a simulated flight session in air force pilots. METHODS: In this post hoc randomized crossover trial, four senior air force pilots each completed two identical 1.5-h dynamic flight simulations in a human centrifuge: one with a standard helmet and NVG, and one with a standard helmet only. Simulations included repeated exposure to 3-7 Gz, during which neck muscle activity was recorded bilaterally from the anterior neck, the upper and lower posterior neck, and the upper shoulders. The number of muscle activities surpassing 50% of maximum voluntary electrical activity (MVE) and total time of activity at each MVE percentile were compared between NVG and control flights. RESULTS: There was no overall effect in number of neck strain activities between NVG and control flights; however, significantly more activities emerged in the anterior neck. In addition, MVE percentile data showed a tendency of higher activity in the lower posterior neck during NVG flights. CONCLUSIONS: The results showed that the additional load of helmet-mounted NVG increases neck muscle strain in anterior stabilizing muscles, indicating that the inertia of head-worn NVG elevates the risk of flight-related neck pain. Pousette MW, Lo Martire R, Linder J, Kristoffersson M, Äng BO. Neck muscle strain in air force pilots wearing night vision goggles. Aerosp Med Hum Perform. 2016; 87(11):928-932.


Assuntos
Dispositivos de Proteção dos Olhos , Dispositivos de Proteção da Cabeça , Militares , Músculos do Pescoço/fisiopatologia , Visão Noturna , Pilotos , Entorses e Distensões/fisiopatologia , Adulto , Medicina Aeroespacial , Estudos Cross-Over , Eletromiografia , Humanos , Cervicalgia , Estresse Mecânico
15.
BMC Musculoskelet Disord ; 17: 319, 2016 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-27474034

RESUMO

BACKGROUND: It is recognised that back pain (BP) is a debilitating medical problem in the soldier community, which limits operational readiness as well as work ability. As such, identification of risk factors is a necessity for effective preventive actions, but also regarded as important from a safety perspective. The aim of this prospective cohort study was therefore to identify risk factors for back pain and BP limiting work ability in active duty marines within a 6 and 12-month period. METHODS: Demographic characteristics, health-related factors and occupational exposure information, as gathered from questionnaires, as well as clinical test of movement control among 137 Swedish marines were regressed with multivariable logistic regressions, and strength of associations was presented as odds ratio (OR) with 95 % confidence intervals (CI). BP within 6 and 12 months were used as primary outcomes, whereas BP limiting work ability within 6 and 12 months served as secondary outcomes. RESULTS: Previous BP and tall body height (≥1.86 m) emerged as risk factors for back pain within 6 months (OR 2.99, 95 % CI 1.22-7.30; OR 2.81, 95 % CI 1.16- 6.84, respectively), and 12 months (OR 6.75, 95 % CI 2.30-19.80; 2.75, 95 % CI 1.21-6.29, respectively). Previous BP was also identified as risk factor for BP limiting work ability within 12 months (OR 6.64, 95 % CI 1.78-24.78), and tall body height emerged as a risk within both six (OR 4.30, 95 % CI 1.31-14.13) and 12 months (OR 4.55, 95 % CI 1.53-13.57) from baseline. CONCLUSIONS: Marines with a history of BP are at risk of further BP episodes, which, thus, emphasise the importance of early BP preventive actions. Tall body height also emerged as an important risk which may reflect that personal equipment and work tasks are not adapted for the tallest marines. While this should be considered when introducing new work equipment, further studies are warranted to clarify the underlying mechanism of this association.


Assuntos
Dor nas Costas/epidemiologia , Estatura , Militares , Doenças Profissionais/epidemiologia , Adulto , Dor nas Costas/complicações , Dor nas Costas/prevenção & controle , Índice de Massa Corporal , Peso Corporal , Humanos , Modelos Logísticos , Masculino , Doenças Profissionais/complicações , Doenças Profissionais/prevenção & controle , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Suécia , Adulto Jovem
16.
BMJ Open ; 6(6): e011681, 2016 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-27324717

RESUMO

BACKGROUND: High-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea. Although questionnaire surveys are widely used for identifying exposures, outcomes and associated risks with high accuracy levels, until now, no validated epidemiological tool exists for surveying occupational health and performance in these populations. AIM: To develop and validate a web-based questionnaire for epidemiological assessment of occupational and individual risk exposure pertinent to the musculoskeletal health conditions and performance in high-performance marine craft populations. METHOD: A questionnaire for investigating the association between work-related exposure, performance and health was initially developed by a consensus panel under four subdomains, viz. demography, lifestyle, work exposure and health and systematically validated by expert raters for content relevance and simplicity in three consecutive stages, each iteratively followed by a consensus panel revision. The item content validity index (I-CVI) was determined as the proportion of experts giving a rating of 3 or 4. The scale content validity index (S-CVI/Ave) was computed by averaging the I-CVIs for the assessment of the questionnaire as a tool. Finally, the questionnaire was pilot tested. RESULTS: The S-CVI/Ave increased from 0.89 to 0.96 for relevance and from 0.76 to 0.94 for simplicity, resulting in 36 items in the final questionnaire. The pilot test confirmed the feasibility of the questionnaire. CONCLUSIONS: The present study shows that the web-based questionnaire fulfils previously published validity acceptance criteria and is therefore considered valid and feasible for the empirical surveying of epidemiological aspects among high-performance marine craft crews and similar populations.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Ocupações , Navios , Inquéritos e Questionários/normas , Feminino , Humanos , Internet , Masculino , Psicometria/métodos , Reprodutibilidade dos Testes , Estresse Psicológico , Suécia , Recursos Humanos
17.
BMJ Open ; 5(12): e008711, 2015 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-26656015

RESUMO

OBJECTIVE: The abdominal drawing-in manoeuvre (ADIM) is a common clinical tool for manually assessing whether a preferential activation of the deep abdominal muscles in patients with low back pain (LBP) is 'correct' or not. The validity and reliability of manual assessment of the ADIM are, however, as yet unknown. This study evaluated the concurrent and discriminative validity and reliability of the manually assessed ADIM. DESIGN: Single-blinded cross-sectional study. SETTINGS: General population in Stockholm County, Sweden. PARTICIPANTS: The study sample comprised 38 participants seeking care for LBP, and 15 healthy subjects. MEASURES: The manual ADIM was assessed as correct or not following a standard procedure. Ultrasound imaging (USI) was used as the concurrent reference (gold standard) for the manually assessed ADIM by calculating a ratio of the change in muscle thickness between the resting and the contracted states: the correlation between manual test and USI was calculated. Discriminative validity was analysed by calculating sensitivity and specificity. A sample of 24 participants was analysed with κ coefficients for interobserver reliability between two raters. RESULTS: The concurrent validity between the manual ADIM and the ADIM-USI ratios showed poor correlations (r=0.13-0.40). The discriminative validity of the manually assessed ADIM to predict LBP showed a sensitivity/specificity of 0.30/0.73, while the ADIM-USI ratio to predict LBP showed 0.19/0.87. The interobserver reliability for the manually assessed ADIM revealed substantial agreement: K=0.71, CI (95%) 0.41 to 1.00. CONCLUSIONS: Although the interobserver reliability of the manually assessed ADIM was high, the concurrent and discriminative validity were both low for examining the preferential activity of the deep abdominal muscles. Neither the manually assessed ADIM nor the ultrasound testing discriminated between participants with LBP and healthy subjects regarding preferential activity of the transversus muscle as this ability/inability was also present in healthy subjects.


Assuntos
Músculos Abdominais/fisiopatologia , Dor Lombar/diagnóstico , Exame Físico/métodos , Músculos Abdominais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego , Ultrassonografia , Adulto Jovem
18.
BMJ Open ; 5(10): e007943, 2015 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-26443649

RESUMO

OBJECTIVES: To estimate the prevalence of self-rated musculoskeletal pain and pain limiting work ability in Swedish Armed Forces (SAF) marines, and to study factors potentially associated with pain limiting work ability for the most prevalent pain regions reported. DESIGN: Population-based, cross-sectional survey. PARTICIPANTS: There were 272 SAF marines from the main marine battalion in Sweden included in the study. OUTCOMES: Self-assessed musculoskeletal pain and pain limiting the marines' work ability within a 6-month period, as obtained from structured questionnaires. The association of individual, health and work-related factors with musculoskeletal pain limiting work ability was systematically regressed with multiple logistic models, estimating OR and 95% CI. RESULTS: Musculoskeletal pain and pain limiting work ability were most common in the back, at 46% and 20%, and lower extremities at 51% and 29%, respectively. Physical training ≤1 day/week (OR 5.3, 95% CI 1.7 to 16.8); body height ≤1.80 m (OR 5.0, 95% CI 1.6 to 15.1) and ≥1.86 m (OR 4.4, 95% CI 1.4 to 14.1); computer work 1/4 of the working day (OR 3.2, 95% CI 1.0 to 10.0) and ≥1/2 (OR 3.3, 95% CI 1.1 to 10.1) of the working day were independently associated with back pain limiting work ability. None of the studied variables emerged significantly associated with such pain for the lower extremities. CONCLUSIONS: Our findings show that musculoskeletal pain and resultant limitations in work ability are common in SAF marines. Low frequency of physical training emerged independently associated with back pain limiting work ability. This suggests that marines performing physical training 1 day per week or less are suitable candidates for further medical evaluation and secondary preventive actions. While also associated, body height and computer work need further exploration as underlying mechanisms for back pain limiting work ability. Further prospective studies are necessary to clarify the direction of causality.


Assuntos
Avaliação da Deficiência , Inquéritos Epidemiológicos , Militares , Dor Musculoesquelética/epidemiologia , Doenças Profissionais/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Dor Musculoesquelética/reabilitação , Doenças Profissionais/reabilitação , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Suécia/epidemiologia , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-27900113

RESUMO

BACKGROUND: Elevated neck pain prevalence among skydivers is associated with exposure to repeated parachute opening shock (POS). A study is planned to evaluate a preventive free fall acrobatics intervention, but prior assessment of the protocol is necessary given the complex and safety-critical study environment. AIM: To validate an intervention protocol to reduce POS neck loads. METHODS: A protocol was developed based on observational data and theoretical calculations. Six experts rated each component of the protocol on a four-point Likert scale, regarding relevance, simplicity/feasibility and safety, and responded to open-ended questions. Two iterations were made, each followed by consensus panel protocol revisions. The content validity index (CVI) was used to quantify ratings. A measure of universal agreement (CVI/UA) was computed as the proportion of components that achieved a rating ≥3 by all raters. For safety, a high-sensitivity CVI/UA was computed with a rating of no <4 (highest score) as acceptable. RESULTS: CVI/UA for relevance increased from 0.80 in the first assessment to 1.00 in the second; for simplicity from 0.50 to 0.63; and for safety from 0.70 to 1.00. High-sensitivity CVI/UA for safety increased from 0.10 to 0.75. Responses to open-ended questions included safety concerns for free fall stability, altitude awareness and concerns over comprehensibility. CONCLUSIONS: The proposed protocol has been improved in assessed relevance, simplicity and safety, and is considered validated for the start of the empirical trial. To what degree complex interventions should be preceded by open prevalidation is discussed.

20.
Aviat Space Environ Med ; 84(10): 1034-40, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24261055

RESUMO

INTRODUCTION: Sport parachuting from aircraft (skydiving) is a major aerial activity in which parachutists are subject to decelerating forces during parachute opening shock (POS), possibly as much as 3-5 G. While traumatic incidents related to POS have been reported, epidemiological data on musculoskeletal pain among skydivers is absent in the literature. The aim was therefore to examine the prevalence of self-rated musculoskeletal pain related to POS in a skydiver population and elicit related risk factors. METHODS: There were 658 Swedish sport skydivers who completed a structured web-based questionnaire (70% response rate; email invitation) validated for use in skydivers. The questionnaire concerned individual and skydiving-related risk indicators, and musculoskeletal pain experiences. Multiple regression analysis was used to estimate the relationship between risk indicators and musculoskeletal pain related to POS. RESULTS: The 12-mo prevalence of musculoskeletal pain related to POS was highest for the neck region, 25% (95% CI = 21.4-28.2). Other upper-body regions were as follows: shoulder 16% thoracic spine 10%, and lower back 18%. A high number of parachute jumps in the last 12 mo, i.e., 30-90 jumps (RR = 1.7, 95% CI = 1.1-2.7), > 90 jumps (RR = 2.1, 95% CI = 1.3-3.4), and a high main parachute wing-loading, i.e., > 1.4 lb/ft2 (RR = 1.7, 95% CI = 1.1-2.6) were independent risk factors. CONCLUSIONS: Neck pain related to POS was common among skydivers. A high number of parachute jumps the last 12 mo and high wing-loading emerged as risk factors, suggesting that highly active skydivers using small canopies may be at risk. Studies on biomechanics under POS are suggested.


Assuntos
Aviação , Dor Musculoesquelética/epidemiologia , Esportes , Adolescente , Adulto , Dor nas Costas/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Cervicalgia/epidemiologia , Prevalência , Fatores de Risco , Dor de Ombro/epidemiologia , Inquéritos e Questionários , Suécia/epidemiologia , Adulto Jovem
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