Social and psychological factors influenced the course of arm, neck and shoulder complaints

doi:10.1016/j.jclinepi.2006.11.012

Journal of Clinical Epidemiology

Volume 60, Issue 8, August 2007, Pages 839-848

https://doi.org/10.1016/j.jclinepi.2006.11.012 Get rights and content

Abstract

Objective

To investigate the clinical course and prognostic factors of complaints of arm, neck, and shoulder.

Study Design and Setting

A prospective cohort study in physical therapy practice. Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and/or upper extremities. Participants filled in questionnaires at baseline, 3 months, and 6 months. The main outcome measure was the persistence of complaints over 6-month follow-up. Possible predictors like social and psychological factors, physical factors, and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements.

Results

Of the 624 participants at baseline 543 (87%) returned at least one follow-up questionnaire. At 6-month follow-up, 40% had persisting pain and discomfort. Somatization, kinesiophobia, catastrophizing, and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population. In those with paid work (77%), catastrophizing, low decision authority at work, and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months.

Conclusion

40% of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course.

Introduction

Different terms are used in the literature to describe pain and discomfort in the neck and upper extremities, for example repetitive strain injury, occupational overuse syndrome, cumulative trauma disorder, or work-related upper extremity disorders [1], [2], [3]. In the literature, the use of this terminology is not consistent. Moreover, this terminology is confusing because it suggests a single common pathway, whereas currently experts are of the opinion that this is not the case [4]. Therefore, we use the less loaded term “pain and discomfort in the neck and upper extremities” to describe all musculoskeletal complaints in the neck and upper extremities not caused by acute trauma or specific systemic diseases.

The pain and discomfort can partly originate from the work environment and performance of work, but sport and other recreational activities can also contribute to the development of these complaints [1]. Activities associated with pain and discomfort in the neck and upper extremities are repetitive or forceful motions, static, or awkward postures and activities being accompanied by vibrations or activities in extreme temperatures [1], [2], [5]. Nowadays, besides physical factors, other characteristics are also recognized as important risk factors. Especially perceived stress at work, but also general distress and other pain (comorbidity) are consistently related to pain and discomfort in the neck and upper extremities [6]. Physical, psychosocial, and personal factors probably all play a role, but the way they interact with each other is not exactly known [6].

The pain and discomfort can consist of clumsiness, stiffness, tingling, loss of coordination, loss of physical strength, skin discoloration, and temperature differences located in the neck, upper back, shoulder, arm, elbow, wrist, hand, and/or fingers [7].

According to the “Criteria Document for evaluation of the work-relatedness of upper extremity disorders” [3] pain and discomfort in the neck and upper extremities can be divided into specific and nonspecific complaints: specific complaints have defined diagnostic criteria (e.g., carpal tunnel syndrome) whereas nonspecific complaints do not [3].

There is literature, which demonstrates, that neck and upper extremity complaints originating from work cause increased compensation and health care costs [1], [8]. The reported rates of pain and discomfort in the neck and upper extremities tripled between 1986 and 1993 in the USA; in 1990 these complaints accounted for more than 60% of occupational illnesses [1]. Large increases in incidence have also been reported in other countries [1]. In the Netherlands, the 12-month prevalence of chronic or regular pain and discomfort in neck and upper extremities partly or totally due to work increased slightly from 26% in the year 2000 to 28% in the year 2002 [9].

Given these prevalence's, it is not only of importance to study risk factors for development but also to study the course of such complaints and their prognostic factors. Such information is important for patient education and management, but can also be used to develop and study interventions for these complaints, especially when modifiable prognostic factors can be identified. However, insight into the clinical course of these complaints and the factors related to outcome at follow-up is scarce [10]. Therefore, this study investigated the course of pain and discomfort in neck and upper extremities and evaluated prognostic factors, which can influence its course.

Section snippets

Design and setting

From four provinces in the western part of the Netherlands, physiotherapists from physical therapy practices active in primary care or occupational health care were invited to participate. Consecutive patients were then recruited in this prospective cohort study with a follow-up period of 6 months.

Participants

New consulters with pain and discomfort in neck and upper extremities (neck, upper back, shoulder, upper arm, elbow, forearm, wrist, and hand) aged 18–65 years were recruited by the participating

Participants

The physical therapists invited consecutive patients with pain and discomfort in the neck and upper extremities for participation in our study. This resulted in 748 participants. Of these, 710 met the inclusion criteria, and 624 participants gave informed consent and filled in the baseline questionnaire. Of the 624 participants in the total population, 511 (81.9%) returned the questionnaire at 3 months, 474 (76%) returned the questionnaire at 6 months, and 543 (87%) returned one of these two

Discussion

In this large study on prognostic factors in pain and discomfort in the neck and upper extremities somatization, kinesiophobia, and catastrophizing were predictive factors for the persistence of complaints in the total population over 6-month follow-up. In the working population, catastrophizing and a lack of decision authority at work were associated with the persistence of complaints over 6 months. The factor somatization was not significant enough, although borderline (P = 0.06), to stay in

Acknowledgments

The authors thank all the physical therapists and participants for their cooperation in this study and Roos Bernsen (Department of Community Medicine, United Arab Emirates University, Al Ain) for her help and support with the statistical analyses.

Funding for this research was provided by CvZ (College voor Zorgverzekeringen, The Netherlands).

References (33)

A. Yassi
Repetitive strain injuries
Lancet
(1997)
P.W. Buckle et al.
The nature of work-related neck and upper limb musculoskeletal disorders
Appl Ergon
(2002)
J.W. Vlaeyen et al.
Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance
Pain
(1995)
A.K. Rosenstiel et al.
The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment
Pain
(1983)
P. Spinhoven et al.
Pain coping strategies in a Dutch population of chronic low back pain patients
Pain
(1989)
R. Severeijns et al.
Pain catastrophizing and consequences of musculoskeletal pain: a prospective study in the Dutch community
J Pain
(2005)
K.E. Walker-Bone et al.
Criteria for assessing pain and nonarticular soft-tissue rheumatic disorders of the neck and upper limb
Semin Arthritis Rheum
(2003)
B.A. Silverstein et al.
Work-related musculoskeletal disorders: comparison of data sources for surveillance
Am J Ind Med
(1997)
Sluiter JK, Rest KM, Frings-Dresen MHW. Criteria document for evaluation of the work-relatedness of upper extremity...
T.J. Armstrong et al.
A conceptual model for work-related neck and upper-limb musculoskeletal disorders
Scand J Work Environ Health
(1993)

P.M. Bongers et al.

Repetitive strain injury (RSI): occurrence, etiology, therapy and prevention

Ned Tijdschr Geneeskd

(2002)

P.M. Bongers et al.

Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II)

J Occup Rehabil

(2006)

G. Piligian et al.

Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity

Am J Ind Med

(2000)

J. Heinrich et al.

RSI-complaints in the Dutch working population. Trends, risk factors, and explanations

Tijdschr Soc Gezondheidsz

(2005)

Bongers PM. “Make work of RSI”. Inaugural lecture. VUmc, 2003. [In...

L. Goubert et al.

The Tampa Scale for Kinesiophobia: psychometric characteristics and norms

Gedrag Gezond

(2000)

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Original ArticleSocial and psychological factors influenced the course of arm, neck and shoulder complaints

Abstract

Objective

Study Design and Setting

Results

Conclusion

Introduction

Section snippets

Design and setting

Participants

Participants

Discussion

Acknowledgments

Lancet

Appl Ergon

Pain

Pain

Pain

J Pain

Semin Arthritis Rheum

Work-related musculoskeletal disorders: comparison of data sources for surveillance

Am J Ind Med

A conceptual model for work-related neck and upper-limb musculoskeletal disorders

Scand J Work Environ Health

Repetitive strain injury (RSI): occurrence, etiology, therapy and prevention

Ned Tijdschr Geneeskd

Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II)

J Occup Rehabil

Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity

Am J Ind Med

RSI-complaints in the Dutch working population. Trends, risk factors, and explanations

Tijdschr Soc Gezondheidsz

The Tampa Scale for Kinesiophobia: psychometric characteristics and norms

Gedrag Gezond

Original Article
Social and psychological factors influenced the course of arm, neck and shoulder complaints