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Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.

Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]). Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units. State Health Research Advisory Council, Department of Health, Government of Western Australia.

ObjectiveJob rotation is an organisational strategy widely used on assembly lines in manufacturing industries to mitigate workers' exposure so as to prevent musculoskeletal disorders. This study aimed to evaluate the effectiveness of job rotation for reducing working hours lost due to sick leave resulting from musculoskeletal diseases.MethodsThe design consisted of a 1-year cluster randomised controlled trial with a blinded assessor. Production sectors of the textile industry were randomised to intervention and control groups. Both groups received ergonomic training. The intervention group performed a job rotation programme. The primary outcome measure was number of working hours lost due to sick leave as a result of musculoskeletal disease (ICD-10). The secondary outcome measures were musculoskeletal symptoms (Yes/No), risk factors for musculoskeletal diseases (0–10), psychosocial factors and fatigue (0–100), general health (0–100), and productivity (0–10). All secondary outcomes were measured at baseline and 12-month follow-up.ResultsAt the 12-month follow-up, both groups showed an increase in the number of working hours lost due to sick leave for musculoskeletal disease. There was no significant difference between the job rotation intervention group (mean deviation −5.6 hours, 95% CI −25.0 to 13.8) at the 12-month follow-up and the control group. There were no significant differences between groups for the secondary outcomes (p>0.05).ConclusionsThe job rotation programme was not effective in reducing the number of working hours lost due to sick leave, decreasing the prevalence of musculoskeletal symptoms, or improving perception of musculoskeletal pain and workplace risk factors, psychosocial risk factors and productivity.Trial registration number NCT01979731.

There is a lack of accurate information on the prevalence and causes of musculoskeletal impairment (MSI) in low income countries. The WHO prevalence estimate does not help plan services for specific national income levels or countries. The aim of this study was to find the prevalence, impact, causes and factors associated with musculoskeletal impairment in Malawi. We wished to undertake a national cluster randomized survey of musculoskeletal impairment in Malawi, one of the UN Least Developed Countries (LDC), that involved a reliable sampling methodology with a case definition and diagnostic criteria that could clearly be related to the classification system used in the WHO International Classification of Functioning, Disability and Health (ICF). A sample size of 1,481 households was calculated using data from the latest national census and an expected prevalence based on similar surveys conducted in Rwanda and Cameroon. We randomly selected clusters across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the distribution of the population. In the field, randomization of households in a cluster was based on a ground bottle spin. All household members present were screened, and all MSI cases identified were examined in more detail by medical students under supervision, using a standardized interview and examination protocol. Data collection was carried out from 1st July to 30th August 2016. Extrapolation was done based on study size compared to the population of Malawi. MSI severity was classified using the parameters for the percentage of function outlined in the WHO International Classification of Functioning (ICF). A loss of function of 5-24% was mild, 25-49% was moderate and 50-90% was severe. The Malawian version of the EQ-5D-3L questionnaire was used, and EQ-5D index scores were calculated using population values from Zimbabwe, as a population value set for Malawi is not currently available. Chi-square test was used to test categorical variables. Odds ratio (OR) was calculated with a linear regression model adjusted for age, gender, location and education. A total of 8,801 individuals were enumerated in 1,481 households. Of the 8,548 participants that were screened and examined (response rate of 97.1%), 810 cases of MSI were diagnosed of which 18% (108) had mild, 54% (329) had moderate and 28% (167) had severe MSI as classified by ICF. There was an overall prevalence of MSI of 9.5% (CI 8.9-10.1). The prevalence of MSI increased with age, and was similar in men (9.3%) and women (9.6%). People without formal education were more likely to have MSI [13.3% (CI 11.8-14.8)] compared to those with formal education levels [8.9% (CI 8.1-9.7), p<0.001] for primary school and [5.9% (4.6-7.2), p<0.001] for secondary school. Overall, 33.2% of MSIs were due to congenital causes, 25.6% were neurological in origin, 19.2% due to acquired non-traumatic non-infective causes, 16.8% due to trauma and 5.2% due to infection. Extrapolation of these findings indicated that there are approximately one million cases of MSI in Malawi that need further treatment. MSI had a profound impact on quality of life. Analysis of disaggregated quality of life measures using EQ-5D showed clear correlation with the ICF class. A large proportion of patients with moderate and severe MSI were confined to bed, unable to wash or undress or unable to perform usual daily activities. This study has uncovered a high prevalence of MSI in Malawi and its profound impact on a large proportion of the population. These findings suggest that MSI places a considerable strain on social and financial structures in this low-income country. The Quality of Life of those with severe MSI is considerably affected. The huge burden of musculoskeletal impairment in Malawi is mostly unattended, revealing an urgent need to scale up surgical and rehabilitation services in the country.

Background Musculoskeletal disorders (MSDs) are one of the most common occupational diseases and the main cause of disability worldwide. Work-related musculoskeletal disorders (WMSDs) are one of the common health risks and the most important cause of absenteeism due to disability in various industries, including the petrochemical industry, in developed and developing countries. These disorders have important social economic, and significant financial consequences due to direct and hidden costs. Health behaviors play a role in both creating and preventing musculoskeletal disorders in employees. Therefore, by identifying the influencing factors on these behaviors, it is possible to strengthen and improve the preventive behaviors of musculoskeletal disorders through educational intervention programs. This study aims to assess the behavioral risk of work-related musculoskeletal disorders, and design and implement an educational intervention to teach effective behaviors in the prevention of musculoskeletal disorders in petrochemical industry workers. Methods This study is a mixed-method study implemented in four stages involving the qualitative study, the design and evaluation of an instrument, the design of an experimental randomized clinical trial, and the psychometric evaluation of the instrument and the evaluation of the program. The research community consists of employees working in the petrochemical industry. The volume of samples in the qualitative study with the purposeful sampling method, in the instrument design stage based on the available sampling method, and also in the experimental study, the samples are employees suffering from work-related musculoskeletal disorders, who were selected based on a simple random method from among the employees of the petrochemical industry. Then they will be divided into intervention and control groups. The instruments of this research include a demographic questionnaire, a researcher-made questionnaire for measuring behavior, and two auxiliary instruments including the visual analog scale (VAS) and the Quebec Disability Scale. Evaluation is done in 4 stages: pre-test, immediately, 3, and 6 months after the intervention of both groups. The obtained data will be analyzed using SPSS software. Discussion Musculoskeletal disorders related (WMSDs) to work can harm employees’ health in various industries, including the petrochemical industry. This study attempts to evaluate the behavioral risk of work-related musculoskeletal disorders among petrochemical industry workers and design and implement an appropriate educational intervention program. Trial registration Iranian Registry of Clinical Trial (IRCT20240321061346N1). Registered on 2024–04-10. Ethics Status: Ethics code: IR.MODARES.REC.1402.251.

Objective This study aimed to estimate the proportion and number of incident upper-extremity musculoskeletal disorders (UEMSD) cases attributable to occupational risk factors in a working population. Methods Between 2002-2005, occupational physicians randomly selected 3710 workers, aged 20-59, from the Pays de la Loire (PdL) region. All participants underwent a standardized clinical examination. Between 2007-2010, 1611 workers were re-examined. This study included 1246 workers who were free of six main clinically diagnosed UEMSD at baseline but were diagnosed with at least one of these UEMSD at follow-up [59% of men, mean age: 38 (standard deviation 8.6) years]. Relative risks and population-attributable fractions (PAF) were calculated using Cox multivariable models with equal follow-up time and robust variance. The total number of incident UEMSD in the PdL region was estimated after adjustment of the sample weights using 2007 census data. The estimated number of potentially avoidable UEMSD was calculated by multiplying PAF by the total number of incident UEMSD in PdL. Results At follow-up, 139 new cases of UEMSD (11% of the study sample) were diagnosed. This represented an estimated 129 320 incident cases in the PdL in 2007. Following adjustment for personal factors, 26 381 (20.4% of all incident UEMSD) were attributable to high physical exertion, 16 682 (12.9%) to low social support, and 8535 (6.6%) to working with arms above shoulder level. Conclusions A large number and important proportion of incident UEMSD may be preventable by reducing work exposures to physical exertion and working with arms above shoulder level as well as improving social support from co-workers/supervisors.

Objectives This study is to evaluate the efficacy of participatory ergonomic (PE) intervention on musculoskeletal disorders (MSDs) and work ability among young dental professionals in China. Methods A cluster randomized controlled trail was conducted during 2015–2016. Twenty‐nine departments from five hospitals in the South of China were randomized into intervention (14 departments) and control (15 departments), with individuals of 125 and 138 dental professionals, respectively. Main participatory ergonomic interventions involved work posture, repetitive motions, tool usage, work break relaxation and work time re‐arrangement with total 235 ergonomic changes in the trail. Individual ergonomic risk exposure was assessed by investigator's observation using quick exposure check (QEC). Work ability index (WAI) and MSDs were collected by questionnaires at baseline, and every 3 months during the 1‐year follow‐up. Results Follow‐up rate was 91% and 96% for the intervention and control group, respectively. Significant reductions in ergonomic risk exposure and MSD prevalence on six anatomic sites were found in the PE group during the different follow‐up stages. WAI scores improved by 1.1 (95% CI 0.43, 1.89) after the 9‐month intervention. Compared to the control, the PE participants significantly reduced MSDs on neck (OR = 2.93, 95% CI: 1.25, 4.03) and wrists/hands (OR = 2.33, 95% CI: 1.08, 4.21), marginally increased WAI scores by 0.53 (95% CI: −0.02, 1.56) due to the interventions. Conclusion PE intervention is effective in reducing ergonomic risk exposure and MSDs on neck and wrists/hands among young dental professionals. PE ought to be offered in the early dental career for preventing MSDs.

Children are increasingly spending more time sedentary at school and during leisure time. This study examined the effects of a standing desk intervention in a classroom on children’s standing and sitting time at school, sedentary and physical activity levels throughout the day (waking hours), and musculoskeletal discomfort. A within-subjects crossover study design was used. Participants used either a standing desk or traditional seated desk for 21 days before swapping desks for another 21 days. Accelerometry and musculoskeletal discomfort data were collected during the last seven days of each 21-day period. Mixed models were used to analyse accelerometry data. Zero-inflated regression models and logistic regression models were used to analyse discomfort data. Forty-seven male students (aged 10–11 years) participated in the study. Standing time was 21 min/school day higher (p < 0.001) and sitting time was 24 min/school day lower (p = 0.003) when standing desks were used. No significant differences were found in sedentary and physical activity time during waking hours between the standing desk and seated desk conditions. Students were less likely to report musculoskeletal discomfort in the neck, shoulder, elbows and lower back when using standing desks (OR 0.52–0.74). Standing desks significantly increased classroom standing time and decreased musculoskeletal discomfort reports but had no overall effect on daily physical activity levels. Schools should consider moving towards classrooms enabling a variety of postures to potentially improve the long-term health of children.

Background Work-related musculoskeletal disorders are one of the main occupational health hazards affecting dental practitioners. This study was conducted to assess the prevalence of Work-related Musculoskeletal Disorder (WMSD) amongst dental students. Possible correlations with the working environment and ergonomics taught in Malaysian dental schools were also sought. Methods Five dental schools in Malaysia participated in this cross-sectional study. A validated self-administered questionnaire was used to establish the point prevalence of WMSD in the dental students based on various body regions. The questionnaire also collected data regarding the working environment, clinical practice and the taught ergonomics of the students during their training years. Results Out of five hundred and sixty eight dental students who participated in the study, 410 were in their clinical years whilst 158 were students in their non- clinical years. Ninety three percent of the clinical year students reported symptoms of WMSD in one or more body regions. Female students reported a significantly higher numbers of symptoms compared to male students. The neck (82%) and lower back (64%) were reported to have the highest prevalence of WMSD. Discomfort in the neck region was found to be associated with self-reported frequency of bending of the neck. A majority of students (92%) reported minimum participation in workshops related to ergonomics in dentistry and 77% were unfamiliar with treatment and remedies available in the case of WMSD. Conclusions There was more WMSD seen in dental students who had started their clinical years. Neck and lower back are more injury prone areas and are at increased risk of developing musculoskeletal disorders. Theory and practice of ergonomics should be incorporated into the dental undergraduate curriculum.

Background. Musculoskeletal disorders (MSDs) are considered one of the most common health issues in working population and have a high social and economic impact. This study is aimed at determining the MSD patterns and associated risk factors among higher education academicians in Saudi Arabia. Methods. A cross-sectional study was conducted among higher education academicians, randomly selected from different universities within Saudi Arabia. A sample of 207 academicians participated in the present study from different faculties such as nursing, applied medical sciences, pharmacy, dentistry, computer science, science, and engineering for a period of 1 year. The Nordic Musculoskeletal Questionnaire (NMQ-E) was used to assess the MSD patterns and prevalence for the different parts of the body regions, and the Dutch Musculoskeletal Questionnaire (DMQ) was used to determine the physical risk factors associated with the working conditions in the higher academic occupations. Descriptive statistics and the Pearson chi-squared test were used for data analysis. Results. The overall prevalence rate was 42.5%, and the pattern of body parts involved was almost similar on both study variables, i.e., descending from the lower back (31.9%), followed by the neck (26.1%), knees (21.3%), shoulder (16.9%), upper back (13%), ankle and foot (10.1%), wrist and hand (7.2%), and elbow (6.3%), and the least common observed region was the hip and thigh (2.4%). The physical risk factors and its association with the body regions based on DMQ related to workload, period of use, and repetitive movements were observed in the wrist and hand (43%), followed by the neck (42%) and trunk (21%). Conclusion. The study demonstrated that the MSDs are lower among the higher academic occupations. However, the most common MSDs observed in this group of subjects are the back, neck, and knee pain, and it is found that some of the lifetime physical activities also have a significant association with these involved body regions.