Balance dysfunction and falls in people with lower limb arthritis: factors contributing to risk and effectiveness of exercise interventions

Chronic musculoskeletal conditions in the lower extremities, particularly arthritis, and the chronic pain associated with them, are independent risk factors for falls, with approximately 50% of people with arthritis reporting one or more falls. Despite this, few studies have specifically addressed balance dysfunction, falls risk and falls incidence in people with arthritis. This review aimed to identify potential factors contributing to the increased risk of falls in people with lower limb osteoarthritis or rheumatoid arthritis and to summarise the evidence base for effective exercise interventions targeted to reduce their risk of falls. A systematic search of the literature was conducted in February 2010 and included the following databases: MEDLINE (Ovid), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Cochrane Library and PsycINFO. Only three studies that investigated exercise programmes for people with lower limb arthritis met all inclusion criteria, but none used falls as an outcome measure. To broaden the review, systematic reviews that assessed the effectiveness of exercise interventions for fall prevention in older people were also included. The presence of any form of lower limb arthritis and the associated consequences including pain, balance impairment, reduced muscle strength and reduced function are all associated with increased risk of falling. Due to the link between musculoskeletal pain and the increased risk of falls, further research needs to investigate which type of exercise programme will be effective in reducing the risk of falls in populations with arthritis in the lower limbs.     

Effectiveness of water-based exercise in people living with Parkinson’s disease: a systematic review

This systematic review summarizes the relatively scant literature concerning the effectiveness of water-based exercise (WBE) interventions in people with Parkinson’s disease (PD). Databases MEDLINE, EMBASE, PEDro, Scopus, and SportDiscus were searched from the earliest available date to December 2011. Studies had to meet the following selection criteria: (1) the target population was patients with PD; (2) the effects of a WBE intervention (as the primary intervention) were tested; (3) the abstract of the research was available in English. Selected studies were subject to unmasked quality assessment by applying a methodological scoring with a possible maximum score of 15 points. Twelve studies met the inclusion criteria, although only three of them achieved a methodological quality score above 10 points. Collectively, the data showed that WBE has some beneficial short-term effects on the impact that PD has on the patients (mainly on their motor symptoms and on their functional mobility), as well as on their quality of life. This review provides evidence that WBE is safe for patients with PD, but there is a lack of hard evidence regarding its beneficial effects. Further randomized and controlled trials with larger sample sizes are required.     

Effects of Pilates method in physical fitness on older adults. A systematic review

Pilates method is employed for physical and mental conditioning. Elderly people could be benefited from a patterned and regulated conditioning work based on Pilates method. We performed a systematic review to assess the evidence on the effects of Pilates method in physical fitness on older adults. Our search included the following databases: MEDLINE-PubMed, Scopus and CINAHL Plus with Full Text via EBSCO and SPORTDiscus databases (up to April 2014). A summary of the results was performed using a best evidence synthesis and was reported according to the systematic review method proposed by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodology quality of selected studies. Seventeen experimental studies were included in this review. Fourteen were randomized controlled trials (RCT) and three clinical controlled trials (CCT). Quality scores according to PEDro indicate low quality of the included studies (range 1–6, mean 3.8?±?1.2). The most studied components related to physical fitness were neuromotor fitness (n?=?11), muscle strength (n?=?8), cardiorespiratory endurance (n?=?4), body composition (n?=?4) and flexibility (n?=?4). Results indicate that Pilates method seems to present positive effects in neuromotor fitness, especially in static and dynamic balance. Related to the other components of physical fitness (cardiorespiratory endurance, muscle strength, body composition and flexibility), contradictory results were observed. The Pilates method indicates to be an appropriate exercise modality in order to improve balance on older adults. Nevertheless, more intervention research is needed to build a solid knowledge base about the health benefits of Pilates method on older people, especially regarding the other components of physical fitness.     

Can balance exercise programmes improve balance and related physical performance measures in people with dementia? A systematic review

This review presents the physical performance outcomes of randomised trials investigating exercise programmes that included balance exercise for older people with dementia. A systematic literature search through five computerised bibliographic databases until February 2009 was carried out. Of 1,038 potentially relevant published articles, only seven met the inclusion criteria and were extracted. Findings from the review for a total of 632 participants showed that almost all of the included studies addressed exercise or physical activities as the main intervention; however, only two of the studies focused on balance exercise. The effect size values varied from no effect (0.00) to a large effect (3.29) of the interventions for a range of physical performance outcome measures. Findings also suggest that it is feasible to conduct exercise programmes with older people with dementia. However, further studies with more specific exercise designed to improve balance performance in order to prevent falls are required for older people with dementia.     

Prevalence of discomfort/pain complaints and related factors in dental professionals of the public health service in Araucária, Paraná state, Brazil

This poster presents a study about the influence of gender related factors, age, body weight, time of service in the profession and practice of physical exercise on the prevalence of discomfort/pain complaints in dental professionals. The scope of this study was limited to 123 subjects, 84.24% of professionals in the public dental clinics, who answered the multidimensional analytical work questionnaire. The data suggest that the lack postural awareness can contribute to the maintenance of painful conditions and also the low commitment to self-care can perpetuate the state of musculoskeletal discomfort/pain, justifying the application of the ergonomics concepts in the workplace and systematic guidance to professionals to adopt a healthy lifestyle.     

Self-reported musculoskeletal pain and working conditions among employees in the Swedish public sector

Musculoskeletal disorders constitute a considerable public health problem, often resulting in sickness absence, particularly in public sector employees. Increased knowledge on how this is related to individual and work-related factors is required. The objective of this study was to investigate the associations between self-reported musculoskeletal pain and the following factors: physical and psychosocial work conditions, lifestyle, psychosomatic symptoms and sick leave. A comprehensive questionnaire was completed by a total of 2523 people, of which 87% were women and 13% men. The participants were employed in public hospitals, educational institutions, home care services for the elderly and domestic/catering services in a Swedish county. The response rate was 92%. Multiple logistic regression analyses showed that the high level of self-reported musculoskeletal pain was highly associated with strenuous physical and psychosocial work conditions. The physical factor with the highest odds ratio (OR) was working in a forward-bent position. High work demands was the most prominent psychosocial factor and distinctly associated with musculoskeletal pain among men. Physical work strain and other demanding working conditions, which were associated with musculoskeletal pain, were frequent among employees in home care services for the elderly and domestic/catering services. There was a strong association between long-term sick leave and high musculoskeletal pain. Furthermore, there was a strong association between a high level of musculoskeletal pain and the exhibition of psychosomatic symptoms in both women and men; this is an interaction that may intensify the total experience of illness and thus needs to be further investigated.     

The effects of exercise reminder software program on office workers' perceived pain level, work performance and quality of life

In direct proportion to current technological developments, both the computer usage in the workplaces is increased and requirement of leaving the desk for an office worker in order to photocopy a document, send or receive an e-mail is decreased. Therefore, office workers stay in the same postures accompanied by long periods of keyboard usage. In recent years, with intent to reduce the incidence of work related musculoskeletal disorders several exercise reminder software programs have been developed. The purpose of this study is to evaluate the effectiveness of the exercise reminder software program on office workers' perceived pain level, work performance and quality of life. 39 healthy office workers accepted to attend the study. Participants were randomly split in to two groups, control group (n = 19) and intervention group (n = 20). Visual Analogue Scale to evaluate the perceived pain was administered all of the participants in the beginning and at the end of the study. The intervention group used the program for 10 weeks. Findings showed that the control group VAS scores remained the same, but the intervention group VAS scores decreased in a statistically significant way (p < 0.01). Results support that such exercise reminder software programs may help to reduce perceived pain among office workers. Further long term studies with more subjects are needed to describe the effects of these programs and the mechanism under these effects.     

Exercise or physical activity and cognitive function in adults with type 2 diabetes,insulin resistance or impaired glucose tolerance: a systematic review

Background

Diabetes is an important risk factor for cognitive impairment. Although some studies suggest that physical exercise can minimize age-related cognitive declines or improve brain morphology or function, benefits in diabetes or impaired glucose tolerance are unclear. Therefore, our aim was to evaluate the efficacy of exercise or physical activity on cognition in adults with type 2 diabetes, insulin resistance or impaired glucose tolerance.

Methods

An electronic search for studies published from the earliest record until February 2017 was conducted using Medline, EMBASE, SPORTDiscus, CINAHL, and PsycINFO. Any experimental or observational study designs were included, as long as they were conducted in individuals of any age with type 2 diabetes, insulin resistance or impaired glucose tolerance, and they directly examined exercise/physical activity effects on cognitive outcomes or the relationship between changes in cognition and changes in either insulin resistance and glucose homeostasis. Study quality was assessed using the PEDro scale; data on participant and intervention characteristics and outcomes were extracted.

Results

Six studies enrolling 2289 participants met the eligibility criteria. Quality was modest and effect sizes variable and mostly small or negligible. Overall, four of the six studies (67%) reported significant benefits of greater exercise/physical activity participation for some aspects of cognition, but only 26% of cognitive outcomes were significant across all trials. Clinical improvements in insulin resistance/glucose homeostasis were related to improvements in cognitive function in three studies. Overall results were inconsistent, with benefits varying across exercise types and cognitive domains.

Conclusions

Literature does not provide evidence that physical activity or exercise interventions contribute to a better cognitive function in patients with type 2 diabetes or impaired glucose tolerance. Large-scale, long-term, robust randomized controlled trials are required to determine if exercise improves cognition in this high-risk cohort, and to investigate putative mechanistic links between cognition, body composition, metabolism, and inflammation in diabetes and related metabolic syndromes.

     

Effect of ergonomic and workstyle risk factors on work related musculoskeletal disorders among IT professionals in India

'Workstyle' can be described as a mechanism by which ergonomic and psychosocial risk factors interact to affect the development, exacerbation and/or maintenance of upper limb pain and functional limitations. Workstyle is associated with the increase in the work demand. In today's life use of computer in the workplace is very common and it causes to increase the work demand among the workers who are working with computer. As work demand increase, according to the characteristic of workstyle, risk of the development of musculoskeletal disorders also increased. This study aimed at to findout the association between ergonomics risk factors, workstyle and WRMSD. Two hundred IT professionals participated in this study. Result revealed that most prevalenet body regions were lower back (20%), Upper back (16%) and shoulder (14%). Study result says that there is a positive association between workstyle score with musculoskeletal pain (r=0.85). Also it revealed that posture and regional pain is associated (r=0.62), per day use of computer and musculoskeletal pain (r=0.46), micro breaks and pain (r=0.87) and productivity and the pain (r=0.95). This study further validates these observations and extends support for the assessment of working postures and workstyle behaviors during the design of WMSD treatment.     

Associations between psychosocial risk factors and musculoskeletal disorders: application to the IT profession in India

The exponential growth of the information technology (IT) industry in India has been accompanied with a substantial increase in the reporting of work-related musculoskeletal disorders (WMSDs). The purpose of the current study was to identify and assess the contributions of prevalent psychosocial factors on perceived WMSD outcomes among IT professionals from India. About 77 IT professionals from India completed a survey set consisting of 26 question items from the Job Content Questionnaire and 3 separate question items pertaining to WMSD outcomes (pain/discomfort and psychological stress scores). The findings suggest prevalence of existing pain (shoulder/neck and low back) in more than one-fourth of the respondents. Additionally two-thirds of the respondents had never had any ergonomics awareness training. Co-worker support and psychological work demands were found to be the strongest contributors of psychosocial risk factors towards pain/discomfort and psychological stress outcomes. Findings from this study highlight the influence of certain psychosocial traits of the Indian IT workplace on perceived WMSD outcomes. There is a need to develop and implement intervention strategies to address these factors that may help lower the risk of work-related musculoskeletal pain.     

Back pack injuries in Indian school children: risk factors and clinical presentations

The use of backpack increased substantially among the school children. Studies have shown that carrying a backpack cause to develop different symptoms of musculoskeletal disorders among the carrier of the backpack. In India there are fewer studies available in literature which explains the musculoskeletal discomfort among the school children. This study aimed at to find out the prevalence of different musculoskeletal problems among the school children. In a retrospective study data were collected for twenty two students. The main diagnostic criteria were pressure mark (redness or swelling) over neck and shoulder corresponding to the straps of the backpack, stooping posture while carrying the back pack, pain or stiffness in the neck, upper back and shoulders predominantly while carrying the back pack and absence of these symptoms during school holidays. Results revealed that pain in the upper back (40%), neck (27%) and shoulder (20%) were most prevalent body regions followed by forearm and wrist pain (7%) and low back (6%). Results further revealed that all the students participated in this study have a pressure mark over shoulder. 54.55% of the children were diagnosed with myofascial pain and rest with thoracic outlet syndrome.     

Methodological standards for randomised controlled trials of interventions for preventing recurrence of child physical abuse and neglect

Despite the significant financial and human resources invested in child protection services (CPS), it is unknown whether these services are effective in preventing recurrence of child physical abuse and neglect. This paper reviews available studies evaluating the effectiveness of these interventions and identifies methodological limitations and factors that may contribute to these limitations. We searched databases to identify randomised controlled trials published in peer‐reviewed journals in the past five decades that evaluated interventions to reduce recurrence of physical abuse and neglect. We outlined ten methodological standards that are important for rigorous testing of psychosocial interventions and applied them in critically appraising identified studies. Thirteen randomised controlled trials were reviewed. This review identified methodological limitations (e.g. small sample size, lack of standardisations, contamination) that made it difficult to draw reliable conclusions as to the effectiveness of interventions. Field‐specific factors that contributed to methodological limitations (e.g. heterogeneity of sample, multiple family problems, psychosocial nature of interventions) were identified and recommendations were provided for improvement. It was concluded that it is possible to implement high‐quality trials that are ethical and feasible in the child welfare field. Copyright © 2009 John Wiley & Sons, Ltd.     

Data entry workers perceptions and satisfaction response to the "stop and stretch" software program

Cumulative Trauma Disorder (CTD) is a collection of chronic musculoskeletal disorders caused by frequent, sustained, and repetitive movements, most notably by computer usage at the workplace. A computer based break reminder program (Stop and Stretch) has been developed and installed to prevent CTDs caused by prolonged computer usage at the workplace. We investigated users' opinions to the Stop and Stretch program at their work place. 19 computer users were recruited as the subjects of the study. We conducted a survey after all the subjects used the Stop and Stretch program for one month. Among the nineteen subjects, 52.5% or 10 noticed a difference of symptoms after using the program; 63.3% or 12 thought the program had positive effect on their productivity; 100% or all 19 thought the program was easy to follow; 100% or all 19 thought it was helpful; 94.7% or18 were satisfied with the program; and the same value would recommend the program to others. When grouped into those who had prior experience with using stretch and exercise as part of their work routine15 subjects had no prior experience; and 14 participants within that group were satisfied or very satisfied with the program; 93.3% or 14 would recommend it to co-workers; and over half of those 15 thought the program is easy to use. The study provided insight to the response to using "stretch break software" and provided indicators of satisfaction with the Stop and Stretch program and that the program had sufficient usability and acceptance within a workplace setting which might be applied in other work settings similar to these.     

Study of musculoskeletal risks of the office-based surgeries

Due to the cost and time benefits associated with patients and physicians, outpatient surgeries continue to become more and more popular over time. With the increase in the number of office-based surgical procedures, the prevalence of work-related musculoskeletal disorders (WMSDs) associated with office-based surgeries has been reported. The purpose of this pilot study is to ergonomically evaluate the risk of work-related musculoskeletal disorders of physicians/surgeons performing office-based surgery (OBS). Ergonomic assessment tools included Questionnaire, the BodyMap and the Rapid Upper Limb Assessment for measuring potential ergonomic concerns. The findings have shown that the ergonomic issues of greatest concerns were the discomforts in the neck, shoulders, arms/wrists, and back. Some additional comments were provided by the participants regarding the duration of discomfort or clarification on the frequency of their body discomfort. This study suggests that there is a considerable risk of musculoskeletal injuries of physicians/surgeons performing the OBS tasks. By properly using the ergonomic assessment techniques, valuable information on ergonomic OBS workplace design and selection could assist in the early interventions of WMSD prevention.     

Evaluating the effectiveness of ergonomics application

The effectiveness of ergonomics application is achieved in the course of this research by reviewing ergonomics literature, Internet searches and case studies of a number of work related musculoskeletal disorders (WMSD's) and other ergonomic related workplace incidence rate. The results of ergonomic intervention control measures such as engineering controls, administrative controls and personnel protective equipment were also studied. The findings in this paper may help to development model for analysing and solving ergonomic problems in the workplace. It concludes on the need for management to support ergonomics intervention programme for effective cost saving, litigation avoidance and better productivity.     

The farrier's work environment

The horse industry in Sweden has rapidly expanded in recent years. This increasing number of horses implies a greater need for more farriers. Shoeing a horse is hard physical work, and includes awkward work postures and repetitive movements. It is well known that hard physical work increases the risk of injuries and musculoskeletal problems. The risk is especially high for musculoskeletal disorders when certain movements are constantly repeated. Heavy or repeated unilateral loads lead to considerable stress on the muscles, which can lead to rupture and fatigue that can cause long term problems. A case study showed that farriers worked 75% of their work time with their backs in bent positions (often more than 70 degrees). Farriers are also exposed to risk factors in their physical environment like dust, noise and poor lighting. Risk of kicks and bites, eye injuries and burns are other factors that make their work environment hazardous. There are only a few studies available that have documented the farriers' working environment and these are not of recent date. A US study from 1984 described kicks and bites from horses, metal splinters in the eyes, heat exhaustion and problematic postures to be perceived as the greatest risks in their work. The back, knees and wrists were the most exposed body regions. There is a need for more current and in-depth studies investigating the farriers' working conditions in order to gain more knowledge of their health and work environment. The aim of the present study is to investigate the physical health and work environment of farriers. The investigation will use questionnaires, work load measurements and workplace analysis. The results will serve as a base for improvements concerning the design of the workplace, equipment, tools and aids as well as supplying recommendations about physical exercise and the correct work technique, etc. The results are planned to be incorporated in the education of farriers.     

Working environmental conditions as experienced by women working despite pain

OBJECTIVE: This study looked at female hospital cleaners and home help personnel who continued working despite problems or pain in their musculoskeletal system and where there was a risk of increase in sickness absence. The aim was to determine whether supportive intervention for these personnel at the workplace had an effect on the way that they experienced the physical and psychosocial aspects of their working environments. METHODS: The design was prospective with non-rando-mised intervention and reference groups. A selection of 55 questions about physical and psychosocial working environment from a national survey were used. Comparisons were made between intervention and reference groups and with data on a selection of the Swedish population of people in these professions. RESULTS: The results showed that in the hospital cleaners' intervention group the introduction of new cleaning materials and new cleaning methods seemed to contribute to a reduction in workload during the intervention period, which in turn gave them a better chance of taking rest breaks during working time. In the home helps' intervention group the results showed that the group had had a reduction both in workload and in more responsible tasks, and at the same time the psychosomatic stress reactions reduced after the intervention. CONCLUSIONS: The results indicate that effects on the working environmental conditions as experienced could be obtained by a general multi-component support program at the workplace, but the number of variables influenced by the program was very small. The relatively limited effects may be explained by the fact that the impact of a support program depends on how well the remedial measures fulfil the need for such measures either at the workplace, in a work group or among the individual people at the workplace. This emphasises the importance of designing effective analysis tools for judging what remedial measures are needed before the measures themselves are tried out.     

Reliability of the JobFit System Pre-Employment Functional Assessment Tool

Functional capacity testing in the pre-employment or post-offer phase of recruitment is increasing in popularity as a preventative tool for controlling sprains and strains in the workplace. The purpose of this study is to determine the reliability of the JobFit System Pre-Employment Functional Assessment (PEFA) as a whole, or in parts, as a precursor for a validity study investigating the relationship between PEFA results and workplace injury rates and severity. A group of 28 healthy male coal mine employees were videotaped whilst they participated in a generic JobFit System Pre-Employment Functional Assessment (PEFA) including tests of aerobic physical fitness, balance, postural tolerances and material handling tolerances. Twenty participants performed a second trial. The test component scores and overall PEFA scores were compared between trials (test-retest, intra-rater) and assessors (inter-rater) to determine their reliability expressed in terms of ICC. Using an ICC score of > 0.75 as good and > 0.90 as excellent, in conjunction with percentage agreement a good to excellent reliability rating was allocated to the overall PEFA score, floor to bench lift, bench to overhead lift, bilateral carry and climbing. A moderate to good rating was recorded for bench to shoulder lifts, reaching forward, reaching overhead and stooping. A poor to moderate rating was recorded for squatting, balance and fitness tests. Test-retest scores were typically lower than intra-tester and inter-tester scores. ICC scores should be interpreted with consideration of their limitations and in conjunction with the actual test results.     

A proposed model representing the relationships between user characteristics, computer exposure and musculoskeletal symptoms in children

Children's computer exposure is rapidly growing. Several studies have suggested children using computers may be at risk of developing musculoskeletal symptoms. General models and theories relating to the causality of negative musculoskeletal outcomes in adult workers demonstrated relationships between workplace factors and musculoskeletal outcomes. When examining children's computer exposure it is evident that their use is different. Even though risk factors may be similar, due to the nature of children and their computer environments, the potential risk factors and thus a proposed model of causal relationships between exposure and outcomes may differ. Objective: To develop a model of factors influencing computer exposure and musculoskeletal symptoms in children. Methods: 1351 children (or their parents for Year 1 children) in school Years 1, 6, 9 and 11 (ages ~ 6,11,14,16 years) from 10 schools in Western Australia were surveyed on a range of user characteristics, computer exposure and musculoskeletal symptoms. Results: Potential risk factors for childrens' computer exposure and musculoskeletal outcomes were multivariable. Factors such as age, gender, somatic complaints, flow, computer anxiety, computer, TV and physical activity exposure, and SES were related to computer exposure and children's reports of musculoskeletal symptoms. Significance: Developing a child-related computer exposure model to understand relationships between potential risk factors and musculoskeletal symptoms will assist academics, teachers and parents to develop a better understanding of the risk factors for children's computer exposure.