[Physical activity and health-related lifestyle in the Spanish population living with musculoskeletal disease]. / Actividad física y estilo de vida relacionado con la salud en la población española con enfermedad musculoesquelética.

INTRODUCTION: Background: physical activity is a health-related behavior that is associated with increased well-being in people living with musculoskeletal disease. Objective: we assessed the association of different health and lifestyle factors with physical activity in the Spanish population living with musculoskeletal disease. Method: we used data from the 2014 European Health Survey for Spain. The population was classified according to their musculoskeletal disease (including osteoarthritis, back pain, osteoporosis, or several of these diseases) diagnostic status. The survey collected data on habitual physical activity and other health-related behaviors (diet, alcohol and tobacco consumption, among others) and other health indicators (self-perceived health status, perceived pain, mental health, physical limitations, among others). We used multivariate logistic regression models to analyze the relationship between the different variables studied in the population living with musculoskeletal disease. Results: physical activity is associated with daily fruit and vegetable intake, regardless of age and sex, and with daily fish consumption in women aged 45 years and older. Tobacco smoking is higher in inactive women and men, while weekly consumption of alcohol is associated with more physical activity (except in women aged 15-44 years). Conclusions: physical activity is a behavior associated with a better health status and healthier lifestyle in the Spanish population living with musculoskeletal disease.

INTRODUCCIÓN: Introducción: la actividad física es una conducta relacionada con la salud que se asocia a un mayor bienestar de la población que padece enfermedades musculoesqueléticas. Objetivo: el objetivo es evaluar la asociación de diferentes factores de salud y estilo de vida con la actividad física en el tiempo libre de la población española que padece enfermedades musculoesqueléticas. Métodos: hemos utilizado datos de la Encuesta Europea de Salud en España de 2014. La población se clasificó en función del diagnóstico médico o no de enfermedad musculoesquelética (artrosis, dolor de espalda, osteoporosis o varias de estas enfermedades). La encuesta recoge datos sobre la actividad física y otras conductas relacionadas con la salud (alimentación, consumo de alcohol y tabaco, entre otras) y otros indicadores de salud (estado de salud percibido, dolor percibido, salud mental, limitaciones físicas, entre otros). Hemos empleado modelos de regresión logística multivariante para analizar la relación entre las diferentes variables estudiadas en la población con diagnóstico de enfermedad musculoesquelética. Resultados: la actividad física se asocia a la ingesta diaria de fruta y verdura, independientemente de la edad y el sexo, y al consumo diario de pescado en las mujeres mayores de 45 años. El consumo de tabaco es mayor en las mujeres y los hombres inactivos, mientras que el consumo semanal de alcohol se asocia a una mayor actividad física (excepto en las mujeres de entre 15 y 44 años). Conclusiones: la actividad física habitual es una conducta que se asocia a un mejor estado de salud y un estilo de vida más saludable en la población española con enfermedad musculoesquelética.

The Role of Ultrasound Therapy in the Management of Musculoskeletal Soft Tissue Pain.

Ultrasound is an invaluable physical modality widely used for diagnosis and therapy in humans and animals. It is noninvasive, atraumatic, and may be used repeatedly. As a therapeutic tool, ultrasound has been in use for some 6 decades. Therapeutic ultrasound (TUS) is used for the treatment of musculoskeletal disorders, including acute soft tissue injuries, overuse syndromes, as well as chronic orthopedic and rheumatologic conditions. The aim of this review was to investigate the clinical effectiveness of TUS in musculoskeletal acute and chronic pain, mainly through the control of inflammation and the promotion of soft tissue injury healing. Based on the evidence presented, TUS is clinically effective in some musculoskeletal soft tissue pain conditions, but due to conflicting results in some studies, no specific positive recommendations can be made, nor does it permit exclusion of TUS from clinical practice. In phonophoresis, TUS plays a significant role, without reported adverse effects. There is scope for improving the evidence base with better designed studies.

Cross-Cultural Adaptation and Validation of the Simplified Chinese Version of the Lower Extremity Functional Scale.

PURPOSE: The purpose of this study was to cross-culturally adapt and validate the Simplified Chinese version of the Lower Extremity Functional Scale (SC-LEFS). METHODS: The original English version of the Lower Extremity Functional Scale was translated and cross-culturally adapted into Simplified Chinese according to international guidelines. The SC-LEFS and 36-Item Short-Form Health Survey were administered to 213 patients with lower extremity musculoskeletal disorders. Psychometric properties including internal consistency, test-retest reliability, content validity, and construct validity were tested. RESULTS: There were no floor or ceiling effects for the SC-LEFS. The scale had high values for internal consistency (Cronbach α = 0.97) and test-retest reliability (intraclass correlation coefficient = 0.97). Corrected item-total correlations for every item ranged from 0.67 to 0.89. And the item-level content validity index (I-CVI) for each item ranged from 0.78 to 1.00. Principal component analysis revealed a one-factor structure. Nine of ten prior hypotheses were confirmed, which further supports good construct validity within the SC-LEFS. CONCLUSION: The SC-LEFS has high internal consistency, good test-retest reliability and content validity, convergent construct validity, and a one-factor structure. Thus, it could be regarded as a reliable and valid tool to assess activity limitations in Chinese patients with lower extremity musculoskeletal disorders.

An Assessment of International Classification of Diseases, 10th Revision, Clinical Modification, Codes Used to Describe Common Pediatric Orthopedic Conditions.

The diagnosis coding system for health care providers that is used in the United States recently converted from the International Classification of Diseases, 9th Revision (ICD-9), to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The authors are unaware of any studies specifically evaluating the utility and specificity of ICD-10-CM codes in the pediatric orthopedic literature. The authors chose 20 diagnoses that are commonly seen in general pediatric orthopedic practice. The study had two goals: (1) to evaluate the adequacy of these codes to describe the diagnoses and (2) to offer advice on the most appropriate code to use when the ideal code does not exist. A list of 20 diagnoses that are commonly seen in general pediatric orthopedic practice were chosen by 2 fellowship-trained pediatric orthopedic surgeons. Each author independently evaluated the appropriate ICD-10-CM code for each diagnosis. The authors came to a consensus regarding whether the codes were adequate and agreed on an appropriate alternate code when the ideal one did not exist. One common condition had no code (accessory navicular), necessitating the recommendation of a nonspecific code. Other seemingly dissimilar conditions were described by the same code (acetabular dysplasia/femoral anteversion, Osgood-Schlatter disease/Blount's disease). Numerous codes lacked specificity, and the option of laterality was not uniform. Compared with the ICD-9, the ICD-10-CM allows more diagnostic options for these 20 common pediatric orthopedic conditions. The authors identified several areas for improvement. Involvement of subspecialty societies could guide future endeavors to improve this new coding system. [Orthopedics. 2020;43(2):e87-e90.].

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review.

OBJECTIVES: Physicians often refer patients with musculoskeletal conditions to physical therapy. However, it is unclear to what extent physical therapists' treatment choices align with the evidence. The aim of this systematic review was to determine what percentage of physical therapy treatment choices for musculoskeletal conditions agree with management recommendations in evidence-based guidelines and systematic reviews. DESIGN: Systematic review. SETTING: We performed searches in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine, Scopus and Web of Science combining terms synonymous with 'practice patterns' and 'physical therapy' from the earliest record to April 2018. PARTICIPANTS: Studies that quantified physical therapy treatment choices for musculoskeletal conditions through surveys of physical therapists, audits of clinical notes and other methods (eg, audits of billing codes, clinical observation) were eligible for inclusion. PRIMARY AND SECONDARY OUTCOMES: Using medians and IQRs, we summarised the percentage of physical therapists who chose treatments that were recommended, not recommended and had no recommendation, and summarised the percentage of physical therapy treatments provided for various musculoskeletal conditions within the categories of recommended, not recommended and no recommendation. Results were stratified by condition and how treatment choices were assessed (surveys of physical therapists vs audits of clinical notes). RESULTS: We included 94 studies. For musculoskeletal conditions, the median percentage of physical therapists who chose recommended treatments was 54% (n=23 studies; surveys completed by physical therapists) and the median percentage of patients that received recommended physical therapy-delivered treatments was 63% (n=8 studies; audits of clinical notes). For treatments not recommended, these percentages were 43% (n=37; surveys) and 27% (n=20; audits). For treatments with no recommendation, these percentages were 81% (n=37; surveys) and 45% (n=31; audits). CONCLUSIONS: Many physical therapists seem not to follow evidence-based guidelines when managing musculoskeletal conditions. There is considerable scope to increase use of recommended treatments and reduce use of treatments that are not recommended. PROSPERO REGISTRATION NUMBER: CRD42018094979.

Characteristics of musculoskeletal disorders and satisfaction with in-house physical therapy clinics in office workers.

BACKGROUND: Musculoskeletal disorders are not properly managed in office workers because of their busy work life. In-house physical therapy is a good way to manage the musculoskeletal disorders in office workers. Despite the numerous advantages of in-house physical therapy, the establishment and research of in-house physical therapy were insufficient. OBJECTIVE: The purpose this study was to determine the characteristics of musculoskeletal disorders in office workers and to investigate their satisfaction with in-house physical therapy clinics and the associated factors. METHODS: In this study, 664 office workers who used in-house physical therapy clinics were surveyed for characteristics of musculoskeletal disorders and satisfaction with in-house physical therapy clinics. RESULTS: Of these office workers, the most common causes of damage were nontraumatic (36.8%) and the most common lesion sites were the neck (30.3%) and lower back (25.6%). In the empirical characteristics of in-house physical therapy clinics, basic thermoelectric treatments were the most common (46.8%). The satisfaction with in-house physical therapy clinic was generally high. In addition, the cause of damage and treatment contents affected treatment-related and functional return-related satisfaction. CONCLUSION: In-house physical therapy, including therapeutic exercises and self-management education, is a good system to manage musculoskeletal disorders in office workers.

Gender differences in prevalence of musculoskeletal disorders and physiological stress among the brick field workers of West Bengal, India.

BACKGROUND: The manual brick field industry is one of the most important and oldest industries in India, where millions of male and female workers make their livelihood. OBJECTIVE: To estimate the different ergonomic risk factors associated with brick making, identify potential gender differences and the prevalence of Work-related musculoskeletal disorders (WMSDs), physiological and psychological stress among the brickfield workers. METHODS: Brickfield workers - 152 male and 148 female were randomly selected from the 12 brickfields. The Modified Nordic Questionnaire was applied to assess the discomfort reported among both groups of brickfield workers. Objective measurement of physiological parameters and lung function values were also recorded. RESULTS: From this study, it was revealed that there is significantly higher discomfort reported in hands, lower back and knees among female brick molders than male brick molders. The physiological parameters did not show any significant change between male brickfield workers and female brickfield workers. The mean values of FVC, FEV1 and PEFR for females were lower than those for male brickfield workers. CONCLUSION: This study concludes that female brickfield workers reported more discomfort than male brickfield workers; perhaps in part due to their additional domestic work responsibilities.

Association of derived patterns of musculoskeletal disorders with psychological problems: a latent class analysis.

BACKGROUND: Musculoskeletal symptoms often occur in more than one anatomical site. The present study aimed to define specific patterns of multisite musculoskeletal disorders and examine how these patterns are related to common psychological problems. METHODS: Using the data from an interview-based health survey of 358 samples of the industrial manufacturing male employees, we derived major patterns of musculoskeletal complaints using latent class analysis and investigated its association with psychological problems score extracted from depression, anxiety, and stress measured by Depression/Anxiety/Stress Scale (DASS-21). Musculoskeletal disorders were assessed by Nordic Musculoskeletal Questionnaire (NMQ). The statistical analysis was carried out by Mplus 8. RESULTS: Complaints in the lower back (42.1%) and neck (30.7%) had the highest prevalence, and in the hip (15.0%) and ankle (12.2%) the lowest. Three major patterns of musculoskeletal disorders were extracted using latent class analysis. Class 1 (12.9%) was characterized by a high rate of complaints in upper musculoskeletal sites, such as the neck, shoulder, and joints; class 2 (38.2%) was identified by a higher rate of complaints in the lower and upper back; and class 3 (48.9%) was marked by low rates of complaints in all musculoskeletal sites. After adjustment for confounding variables and specifying class 3 as the reference, it turned out that there was a statistically significant association between the psychological problems score and the chance of being in class 1 (OR = 2.47, 95% CI 1.66-3.68), but not a significant association with the chance of being in class 2 (OR = 1.51, 95% CI 0.83-2.72). CONCLUSION: Musculoskeletal disorders can be summarized in the latent class-derived patterns in the adult study population and provide additional prognostics. Common psychological problems are significantly associated with the type of musculoskeletal disorder patterns. The findings in this study could be useful for dealing with prevention and treatment programs.

Automated semantic labeling of pediatric musculoskeletal radiographs using deep learning.

BACKGROUND: An automated method for identifying the anatomical region of an image independent of metadata labels could improve radiologist workflow (e.g., automated hanging protocols) and help facilitate the automated curation of large medical imaging data sets for machine learning purposes. Deep learning is a potential tool for this purpose. OBJECTIVE: To develop and test the performance of deep convolutional neural networks (DCNN) for the automated classification of pediatric musculoskeletal radiographs by anatomical area. MATERIALS AND METHODS: We utilized a database of 250 pediatric bone radiographs (50 each of the shoulder, elbow, hand, pelvis and knee) to train 5 DCNNs, one to detect each anatomical region amongst the others, based on ResNet-18 pretrained on ImageNet (transfer learning). For each DCNN, the radiographs were randomly split into training (64%), validation (12%) and test (24%) data sets. The training and validation data sets were augmented 30 times using standard preprocessing methods. We also tested our DCNNs on a separate test set of 100 radiographs from a single institution. Receiver operating characteristics (ROC) with area under the curve (AUC) were used to evaluate DCNN performances. RESULTS: All five DCNN trained for classification of the radiographs into anatomical region achieved ROC AUC of 1, respectively, for both test sets. Classification of the test radiographs occurred at a rate of 33 radiographs per s. CONCLUSION: DCNNs trained on a small set of images with 30 times augmentation through standard processing techniques are able to automatically classify pediatric musculoskeletal radiographs into anatomical region with near-perfect to perfect accuracy at superhuman speeds. This concept may apply to other body parts and radiographic views with the potential to create an all-encompassing semantic-labeling DCNN.

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity.

OBJECTIVE: There are currently no algorithms for early stratification of pediatric musculoskeletal infection (MSKI) severity that are applicable to all types of tissue involvement. In this study, the authors sought to develop a clinical prediction algorithm that accurately stratifies infection severity based on clinical and laboratory data at presentation to the emergency department. METHODS: An IRB-approved retrospective review was conducted to identify patients aged 0 to 18 who presented to the pediatric emergency department at a tertiary care children's hospital with concern for acute MSKI over a 5-year period (2008 to 2013). Qualifying records were reviewed to obtain clinical and laboratory data and to classify in-hospital outcomes using a 3-tiered severity stratification system. Ordinal regression was used to estimate risk for each outcome. Candidate predictors included age, temperature, respiratory rate, heart rate, C-reactive protein (CRP), and peripheral white blood cell count. We fit fully specified (all predictors) and reduced models (retaining predictors with a P-value ≤0.2). Discriminatory power of the models was assessed using the concordance (c)-index. RESULTS: Of the 273 identified children, 191 (70%) met inclusion criteria. Median age was 5.8 years. Outcomes included 47 (25%) children with inflammation only, 41 (21%) with local infection, and 103 (54%) with disseminated infection. Both the full and reduced models accurately demonstrated excellent performance (full model c-index 0.83; 95% confidence interval, 0.79-0.88; reduced model 0.83; 95% confidence interval, 0.78-0.87). Model fit was also similar, indicating preference for the reduced model. Variables in this model included CRP, pulse, temperature, and an interaction term for pulse and temperature. The odds of a more severe outcome increased by 30% for every 10 U increase in CRP. CONCLUSIONS: Clinical and laboratory data obtained in the emergency department may be used to accurately differentiate pediatric MSKI severity. The predictive algorithm in this study stratifies pediatric MSKI severity at presentation irrespective of tissue involvement and anatomic diagnosis. Prospective studies are needed to validate model performance and clinical utility. LEVEL OF EVIDENCE: Level II-prognostic study.

Effects of Antibiotic Timing on Culture Results and Clinical Outcomes in Pediatric Musculoskeletal Infection.

INTRODUCTION: Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Therefore, investigating the effects of antibiotic timing may lead to improved clinical practice guidelines for treating children with MSI. METHODS: An IRB-approved retrospective review was conducted that identified 113 patients aged 0 to 18 who presented to the pediatric emergency room at a tertiary care children's hospital with MSI from 2008 to 2013. Demographic data, culture results, severity markers, and intervention timing were obtained from the medical record. Logistic regression and Cox survival analysis were performed to determine the relationship of antibiotic timing with culture sensitivity and time to discharge. RESULTS: No difference was seen in culture sensitivity antibiotic administration in either the local (55% culture before antibiotics vs. 89% after antibiotics) or disseminated group (76% before vs. 79% after), which persisted when further accounting for disease severity with C-reactive protein. However, later administration of antibiotics in the local infection group correlated with a decreased likelihood of discharge (3.91 d when cultured before antibiotics vs. 2.93 d when cultured after antibiotics; hazard ratio, 0.53; P<0.05). In patients with disseminated infection, antibiotic administration was not shown to correlate with any difference in time to discharge (hazard ratio, 1.08). CONCLUSIONS: The authors were surprised to find that tissue culture sensitivities were not decreased by antibiotic administration in either local or disseminated MSI, suggesting that antibiotic administration should not be delayed to obtain tissue cultures. The correlation of earlier antibiotic administration with shorter length of stay in children with local MSI led the authors to conclude that antibiotics should be initiated as quickly as possible. Further study is necessary to confirm these findings and establish clinical practice guidelines. LEVEL OF EVIDENCE: Level III-retrospective cohort.

Automatic Disease Annotation From Radiology Reports Using Artificial Intelligence Implemented by a Recurrent Neural Network.

OBJECTIVE: Radiology reports are rich resources for biomedical researchers. Before utilization of radiology reports, experts must manually review these reports to identify the categories. In fact, automatically categorizing electronic medical record (EMR) text with key annotation is difficult because it has a free-text format. To address these problems, we developed an automated system for disease annotation. MATERIALS AND METHODS: Reports of musculoskeletal radiography examinations performed from January 1, 2016, through December 31, 2016, were exported from the database of Hanyang University Medical Center. After sentences not written in English and sentences containing typos were excluded, 3032 sentences were included. We built a system that uses a recurrent neural network (RNN) to automatically identify fracture and nonfracture cases as a preliminary study. We trained and tested the system using orthopedic surgeon-classified reports. We evaluated the system for the number of layers in the following two ways: the word error rate of the output sentences and performance as a binary classifier using standard evaluation metrics including accuracy, precision, recall, and F1 score. RESULTS: The word error rate using Levenshtein distance showed the best performance in the three-layer model at 1.03%. The three-layer model also showed the highest overall performance with the highest precision (0.967), recall (0.967), accuracy (0.982), and F1 score (0.967). CONCLUSION: Our results indicate that the RNN-based system has the ability to classify important findings in radiology reports with a high F1 score. We expect that our system can be used in cohort construction such as for retrospective studies because it is efficient for analyzing a large amount of data.

Scoping review of priority setting of research topics for musculoskeletal conditions.

OBJECTIVE: Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified. DESIGN: Scoping review. SETTING AND POPULATION: Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included. METHODS AND ANALYSIS: We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted. RESULTS: Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities. CONCLUSIONS: While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value. PROSPERO REGISTRATION NUMBER: CRD42017059250.

Automatic Musculoskeletal and Neurological Disorder Diagnosis With Relative Joint Displacement From Human Gait.

Musculoskeletal and neurological disorders are common devastating companions of ageing, leading to a reduction in quality of life and increased mortality. Gait analysis is a popular method for diagnosing these disorders. However, manually analyzing the motion data is a labor-intensive task, and the quality of the results depends on the experience of the doctors. In this paper, we propose an automatic framework for classifying musculoskeletal and neurological disorders among older people based on 3D motion data. We also propose two new features to capture the relationship between joints across frames, known as 3D Relative Joint Displacement (3DRJDP) and 6D Symmetric Relative Joint Displacement (6DSymRJDP), such that the relative movement between joints can be analyzed. To optimize the classification performance, we adapt feature selection methods to choose an optimal feature set from the raw feature input. Experimental results show that we achieve a classification accuracy of 84.29% using the proposed relative joint features, outperforming existing features that focus on the movement of individual joints. Considering the limited open motion database for gait analysis focusing on such disorders, we construct a comprehensive, openly accessible 3D full-body motion database from 45 subjects.

The Economic Burden of Musculoskeletal Disease in Children and Adolescents in the United States.

BACKGROUND: Musculoskeletal conditions are among the most common and costly conditions suffered by Americans. In 2011, there was an estimated $213 billion in annual cost of direct treatment for and lost wages due to musculoskeletal disease in the United States. Data on economic burden, however, comes mostly from the adult population, with significantly less information regarding the burden of these conditions in young patients available. The purpose of this report is to provide data on the economic burden of musculoskeletal diseases in children and adolescents in the United States. METHODS: Eleven diagnosis categories were identified, with health care visits and hospitalization data derived from ICD-9-CM codes for each of the conditions searched. The largest database utilized was the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID). Total visits came from the KID, HCUP NEDS (emergency department), NCHS NHAMCS OP (outpatient), and NCHS NAMCS (physician office) databases. The National Health Interview Survey (NHIS) child sample was additionally searched to obtain patient/parent-reported data. RESULTS: In 2012, more than 19 million children and adolescents received treatment in medical centers, physicians' offices, and hospitals for a musculoskeletal-related condition. The most common reason for treatment (68%) was traumatic injury, followed by a pain syndrome (13%) and deformity (9%). Total hospital charges in 2012 for children and adolescents with a primary musculoskeletal-related diagnosis totaled $7.6 billion. Trauma (43%) and deformity (38%) were the major contributors to total hospital charges. CONCLUSIONS: Although we found that hospital-related charges for musculoskeletal diseases for children and adolescents in 2012 totaled $7.6 billion, this number underestimates the total cost for all pediatric musculoskeletal conditions. Musculoskeletal conditions accounted for 5.4% of hospital charges in the pediatric population. However, only 1.4% of pediatric research funding is designated to musculoskeletal research. Going forward, the data in this report may be used to further research and to stimulate development of better methods with which to measure the direct and indirect costs of musculoskeletal conditions in children. LEVEL OF EVIDENCE: Level IV-economic and decision analysis.

Three-Dimensional Analysis of Hemimetameric Segmental Shift in Congenital Scoliosis.

STUDY DESIGN: This is a retrospective cohort study. BACKGROUND: Hemimetameric segmental shift (HMMS) is defined as a hemivertebral deformation in which 2 or more hemivertebrae exist on both sides of the spine and are separated by at least 1 normal vertebra. Reports of HMMS are rare and based on simple anterior x-ray images. No reports have used 3-dimensional computed tomography (3D-CT) to analyze both the anterior and posterior elements. The objective of this study was to analyze the morphology and clinical features of HMMS 3 dimensionally. METHODS: HMMS was confirmed in 32 (6.6%, 16 males and 16 females) of 483 patients diagnosed with congenital scoliosis at the study institution between 1998 and 2013. The average age at the first visit was 6 years and 3 months. 3D-CT imaging was performed for 30 patients older than 2 years (average age: 9 y and 8 mo) and used to classify cases according to posterior elements. RESULTS: With regard to the number of hemivertebrae present, 21 patients had 2 hemivertebrae, 7 patients had 3 hemivertebrae, and 2 patients had 4 hemivertebrae. Patients with 2 hemivertebrae predominantly had hemivertebrae in the thoracolumbar spine. Patients were classified into 2 categories: malformation existing at an equal level in anterior and posterior sides (unison HMMS) and malformation existing at nonequal levels (discordant HMMS). Nine patients had unison HMMS and all of them had 2 hemivertebrae (average: 4.6 vertebrae). Twenty-one patients had discordant HMMS, with 12 having 2 hemivertebrae, 7 having 3 hemivertebrae, and 2 having 4 hemivertebrae. CONCLUSIONS: Through 3D-CT analysis, HMMS was categorized as unison or discordant. Discordant HMMS was observed in 21 of 30 (70%) patients and in all patients with >3 hemivertebrae. Diagnosing HMMS, whether unison or discordant, is clinically important and should be done with careful analysis of bone models and/or radiologic images to determine the correct spinal levels. LEVEL OF EVIDENCE: Level IV-diagnostic study.

The psychometric properties of the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions.

PURPOSE: The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions. MATERIALS AND METHODS: One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren's syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test-retest reliability. RESULTS: The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach's α > 0.90); concurrent validity was strong (Health Assessment Questionnaire: rs = 0.60-0.92; Short-Form Health Survey v2 Physical Function: rs = -0.61 to -0.91) and test-retest reliability excellent (Intra-Class Correlation Coefficient(2,1) = 0.77-0.96). CONCLUSION: The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions. Implications for rehabilitation The Evaluation of Daily Activity Questionnaire evaluates users' ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren's syndrome). Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist. The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility. The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

Factor associated with self-reported work-related musculoskeletal disorders in Brazilian adults.

OBJECTIVE: To describe the prevalence of work-related musculoskeletal disorder (WMSD) and analyze the factors associated with this outcome in the Brazilian population. METHODS: In this cross-sectional, population-based study, we use data from the National Survey on Health (PNS) of 2013. The sample was composed of 60,202 Brazilians aged 18 years or older. The outcome variable was the occurrence of self-reported WMSD. Sociodemographic and occupational characteristics, personal resources, and health conditions were investigated as explanatory variables. Analyses were performed with the software Stata 12.0 and considered the weighting imposed by the sampling design of the study. Then, univariate and multivariate binary logistic models were carried out, considering a significance level of 5%. RESULTS: The results obtained indicated that the prevalence of WMSD in the Brazilian population was of 2.5%, ranging from 0.2% (Acre) to 4.2% (Santa Catarina). The factors associated with a greater chance of occurrence of WMSD were: female sex (OR = 2.33; 95%CI 1.72-3.15); be temporarily away from work (OR = 2.44; 95%CI 1.41-4.23); be exposed to noise at the workplace (OR = 2.16; 95%CI 1.68-2.77); seniority equal to or greater than 4.5 years at the current job (OR = 1.37; 95%CI 1.09-1.72); participate in volunteer work (OR = 1.65; 95%CI 1.25-2.17); report medical diagnosis of arthritis or rheumatism (OR = 2.40; 95%CI 1.68-3.44); and depression (OR = 2.48; 95%CI 1.86-3.31). On the other hand, factors associated with less chance of WMSD were: not having a partner (OR = 0.73; 95%CI 0.37-0.71) and working in an open environment (OR = 0.51; 95%CI 0.37-0.71). CONCLUSIONS: The associated factors and the prevalence found indicate regional and gender differences. Special attention to comorbidities and environmental noise monitoring would benefit the health of workers in the Country.

OBJETIVO: Descrever a prevalência de distúrbio osteomuscular relacionado ao trabalho (Dort) e analisar os fatores associados com esse desfecho na população brasileira. MÉTODOS: Neste estudo transversal, de base populacional, utilizamos dados da Pesquisa Nacional de Saúde (PNS) de 2013. A amostra foi composta por 60.202 brasileiros com 18 anos ou mais de idade. A variável desfecho foi a ocorrência de Dort autorreferida. Como variáveis explicativas, foram investigadas características sociodemográficas, ocupacionais, recursos pessoais e condições de saúde. As análises foram realizadas com o software Stata 12.0 e levaram em consideração as ponderações impostas pelo delineamento amostral do estudo. Foi realizado, então, um modelo logístico binário uni e multivariado, considerando o nível de significância de 5%. RESULTADOS: Os resultados obtidos indicaram que a prevalência de Dort na população brasileira foi de 2,5%, variando de 0,2% (Acre) a 4,2% (Santa Catarina). Os fatores associados à maior chance de ocorrência de Dort foram: sexo feminino (OR = 2,33; IC95% 1,72-3,15); estar afastado temporariamente do trabalho (OR = 2,44; IC95% 1,41-4,23); estar exposto a ruído no local de trabalho (OR = 2,16; IC95% 1,68-2,77); antiguidade igual ou superior a 4,5 anos no trabalho atual (OR = 1,37; IC95% 1,09-1,72); participar de trabalho voluntário (OR = 1,65; IC95% 1,25-2,17); relatar diagnóstico médico de artrite ou reumatismo (OR = 2,40; IC95% 1,68-3,44) e de depressão (OR = 2,48; IC95% 1,86-3,31). Por outro lado, foram associados à menor chance de diagnóstico de Dort: não ter parceiro (OR = 0,73; IC95% 0,37-0,71) e trabalhar em ambiente aberto (OR = 0,51; IC95% 0,37-0,71). CONCLUSÕES: Os fatores associados e a prevalência encontrada indicam diferenças regionais e de gênero. Especial atenção às comorbidades e monitoramento do ruído ambiental beneficiariam a saúde dos trabalhadores no país.