Epidemiological Patterns of Work-Related Musculoskeletal Disorders among Healthcare Workers in Five Reference Hospitals in the City of Douala, Cameroon

Introduction: Work-related musculoskeletal disorders (WRMSDs) are a public health problem and have forced many workers to quit their jobs prematurely. This study investigated the prevalence and risk factors of WRMSDs among Healthcare workers in five reference hospitals in the City of Douala-Cameroon. Methods: A cross-sectional study was conducted in 2022 among 561 healthcare workers working in five reference hospitals in the city of Douala, Cameroon. Participants were selected using a convenient sampling technique. Data were collected with structured questionnaires;data on the demographics and risk factors were collected using a well-designed questionnaire, while estimation of the prevalence of WRMSDs was done using the Modified Nordic questionnaire. Results: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was 83.4% (468/561). The prevalence per professional groups was as follows: 88.8% (71) for Medical Laboratory Scientists (MLS), 81.9% (289) for nurses, 21 (80.8%) for Physiotherapists (PTs) and 78.8% (41) for Medical Doctors (MDs). There was a significant difference (p = 0.001) in the prevalence of WRMSDs with respect to place of work where healthcare workers from HLD recorded the highest prevalence 89.9%, while Healthcare workers from NBDH were 2.91 times at risk (AOR = 2.91;95% CI: 1.32 - 6.41;p = 0.001) to develop WRMSDs than healthcare workers in the other hospitals. With respect to body region, the highest prevalence of WRMSDs was recorded on the lower back, 58.8% with the lowest at the elbows 11.2%. The age group 30 to 39 years was significantly associated with WRMSDs at level of the shoulder (p = 0.002), upper back (p = 0.019), elbows (p Conclusion: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was high. The prevalence of WRMSDs is highest among MLS and nurses and the most affected body parts are;lower back, neck and upper back. Working on the same posture, stressful job, and repetitive tasks were the major risk factors associated to WRMSDs among healthcare workers in Douala hospitals.

Prevalence and factors of work-related musculoskeletal disorders among hand surgeons

BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers,thus subjecting these surgeons to the risk of musculoskeletal(MSK)injuries during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among hand surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail.The collected data were analyzed using descriptive statistics,one-way analysis of variance,and Fisher’s exact test.P values of<0.05 were considered statistically significant.RESULTS Of the 578 respondents,60.4%reported that they had sustained a work-related MSK injury,of which the most common diagnoses were lateral elbow epicondylitis(18.7%),low back pain(17.1%)and carpal tunnel syndrome(15.6%).Among those that reported an injury,73.1%required treatment and 29.2%needed time off work as a direct result of their injury.The number of work-related injuries incurred by a surgeon increased significantly with increasing age(P<0.003),increasing years in practice(P<0.001)and higher case load(P<0.05).CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence.These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries,thus minimizing the financial and psychological burden on these surgeons and the healthcare system.

The Application of NIOSH Lifting Equation to Prevent Musculoskeletal Disorder Risks

The objective of the study was to reduce musculoskeletal disorder risks by applying the NIOSH lifting equation variables include the horizontal location, the vertical location, the vertical travel distance, the asymmetric, the lifting frequency and the coupling classification. The 17 specific samples from 4W and ZECP division were selected by the weight of box 15.4 - 28.7 pounds. The standardized Nordic questionnaire for the analysis of musculoskeletal symptoms with pain scale from 0 (no pain) to 10 (worst pain) was used to self-report feeling. The ergonomics redesigns trained for the workers included: 1) brought the load closer to the worker by training;2) raised the height of objects placed to reduce the vertical distance between the origin and destination of the lift;and 3) moved the origin and destination of lift closer together to reduce the angel twist. The new procedures were trained to all participated workers. The result found that the lifting index was safer (<1.0). For successful outcome, be supposed to monitoring is careful the data about a problem of the worker health, give the carefulness in case of specially exceed environment more than the LI advises and should do training continuously.

Work-related musculoskeletal injuries among upper extremity surgeons:A web-based survey

BACKGROUND Work-related injuries have gained recent attention,especially in the orthopaedic literature.As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers,these surgeons can be at increased risk of acquiring workrelated musculoskeletal(MSK)disorders during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail.The collected data were analyzed using descriptive statistics,one-way analysis of variance,and Fisher's exact test.P values of<0.05 were considered statistically significant.RESULTS Of the 142 respondents,90.8% were males and the majority were younger than 55 years old(65.5%).A work-related MSK injury was reported by 89.4% of respondents,of which the most common diagnoses were low back pain(26.1%)and lateral elbow epicondylitis(18.3%).Among those that reported an injury,82.7%required treatment and 26% required time off work as a direct result of their injury.The need to undergo treatment due to the injury was associated with increased number of injuries(P<0.01).Moreover,surgeons were more likely to require time off work when they had been in practice for>21 years(P<0.05).CONCLUSION A high proportion of surgeons in our survey reported MSK injuries,with more than one quarter of surgeons reported requiring time off work due to an MSK injury.The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care.Awareness of operative ergonomics,irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.

Survey of Prevalence and Risk Factors Associated with Upper Extremity Musculoskeletal Disorders by Repetitive Job Activities Methods in Baker of Iran

Aim: The first purpose is to survey the cumulative trauma disorder (CTD) prevalence in 4 zones of neck, shoulder, hand/wrist and back, and the second purpose is to survey the risk factors producing upper limb musculoskeletal disorders by using OCRA index method. In this analytic-descriptive and cross-sectional study, incorporation of four data collection methods was contained;observing and interviewing methods, using questionnaire and check list, were utilized. Randomly, 384 samples for CTD prevalence and 423 samples for OCRA index exposure survey were collected by cluster ratio sampling. In this study, findings indicated that CTD prevalence was high in studied bakery workers and most disorder and pain were reported in back, knees and hand/wrist. Through different tasks, most percentage of neck CTD (7.1%) and shoulder CTD (27.8%) was related to selling and baker tasks respectively, and most percentage of hand/wrist CTD (33/3%) and back CTD (38.1%) was related to bread baker task. There was a significant correlation between shoulder, hand/wrist and back CTD with bakery and task type, and effect of job background on CTD preva-lence was improved in the above four zones. The rather high prevalence of CTD in the young pop-ulation with average age of 30 years which have a few work experiences and the results of per-formed risk assessment can be taken account of serious warning, if it is not considered.

Influence of Metabolic Syndrome versus Musculoskeletal Disorders on Saudi Health-Related Quality of Life

Aim: This work aimed to study the influence of two chronic health conditions, metabolic syndrome (MetS) and musculoskeletal disorders (MSDs), on the health-related quality of life (HRQoL) of Saudis. Method: The Medical Outcomes Study Short Form-36 (SF-36) health status questionnaire was used to measure the HRQoL and compare the mean scores of the questionnaire subscales and physical and mental component summaries (PCS and MCS) of 33 patients with MetS, 18 patients with MSDs, and 30 apparently healthy (AH) subjects. Regression analysis was used to measure the prediction power of the study group, age and gender of the participants in estimating the HRQoL. Results: Results showed that the mean scores of the physical subscales, the PCS, the mental subscales and MCS were arranged in descending order from AH subjects, patients with MetS, to patients with MSDs. The mean scores difference among the 3 study groups were statistically significant with the only exception for the general mental health (GMH) subscale (P = 0.404). The study group and age accounted for 41.8% of the variability of PCS while the study group accounted for 19.6% of the variability in the MCS. The resulted equation to estimate the PCS score was as follows: PCS = 113.18 - 12.85 (Group: 0 for AH, 1 for MetS, and 2 for MSDs) - 0.67 age. On the other hand the resulted equation to estimate the MCS score was as follows: MCS = 76.203 - 10.426 (Group: 0 for AH, 1 for MetS, and 2 for MSDs). Conclusion: Patients with MetS and patients with MSDs had lower HRQoL than AH subjects. All the physical and mental dimensions of HRQoL are negatively influenced with MetS and with MSDs with the only exception for the GMH subscale. The physical and mental burden of MSDs is more dominant. The study group and age can be used to predict the PCS while the study group can be used to predict the MCS.

High Prevalence of Musculoskeletal Disorders and Self-Medication among Street Vendors in Bangui, Central African Republic (CAR)

Introduction: Musculoskeletal disorders (MSDs) are a set of peri-articular conditions that result mainly in pain and functional discomfort. They represent a major occupational health problem in all areas of activity. The objective of this work was to determine the prevalence of MSDs among street vendors in the city of Bangui in the Central African Republic (CAR). Methods: A cross-sectional study was conducted from September 01 to October 31, 2021 in Bangui, the capital of CAR. The study population consisted of street vendors which were included at the entrance of 4 large markets of Bangui after giving informed consent. The sample size, calculated according to the Schwartz formula, was 384. Sociodemographic data (age, gender, level of education, marital status), professional data (the duration of sale in hours, the distance traveled per day);and health data (the health problems suffered by itinerant sellers and the means of dealing with them) were collected using a pre-established self-questionnaire. This collected data was processed using Microsoft Excel 2013 and Epi-Info version 7 software. Results: Among 384 street vendors included, women represented a quarter (24.9%). The average age was 27 years;the 25-34 age group was the most represented (50%). About two-thirds (64.8%) sold for at least 12 hours and traveled more than 10 km (69.3%) per day. The main health problems reported by street vendors were musculoskeletal disorders (95.8%). Their locations concerned the upper limbs shoulder 65.36% (251), elbow 24.22% (93). Non-ergonomic postures that stress the back and joints all day long, causing pain are risk factors for MSDs. These MSDs were treated by self-medication with non-steroidal anti-inflammatory drugs (22.0%), mainly sold on the street. Conclusion: MSDs dominated the health problems of street vendors. These problems raise the need for recognition and support for these workers to optimize their performance while preserving their health through awareness and good management of MSDs whose chronicity generates a disability.

Musculoskeletal disorders in oil palm fruit bunches harvesting in Malaysia

Malaysia is the biggest crude palm oil exporter to the world market for the last 16 years. However this achievement is still be overshadowed by the harvesting method which is conventional and labor intensive. An attempt to use mechanization into the harvesting system, in particular the cutting process of tall palm trees, has been unsuccessful. At the beginning of the oil palm＇s fruit bearing fife, i.e. 3 to 4 years of age, fi＇uit bunches are still accessible. For these palms, a chisel is used to cut the fiuit bunches. Growth is such 8-10 years, and the trees have already reached substantial height. In these cases a sickle mountedon flexible telescopic aluminum tube （pole） is used. This, however, exposes plantation worker to the risk of musculoskeletal discomfort and injury. This paper examines the problems by assessing the task posture and tool, and their implications for operators, using questionnaire survey and videotape analysis techniques. The result prevails that there is evidence to associate the problems of musculoskeletal disorders among the operators.

Hepatomusculoskeletal disorders:Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

Chronic liver disease can affect many body systems including the musculoskeletal system.The pathogenetic crosstalk between the liver and organs such as the brain and the kidneys has already been described with compound terms merging the organs affected by the pathology,such as the hepatorenal syndrome.Nevertheless,the musculoskeletal manifestations of chronic liver disease have not been coined with such a term to date.Because of this shortage,documenting the musculoskeletal implications of chronic liver disease in both research and clinical practice is challenging.To fill this gap,the authors propose the term hepatomusculoskeletal disorders,a compound term of Greek origin that encompasses all the body structures involved in the aforementioned pathologic crosstalk.

A Study on the Prevalence of Musculoskeletal Disorders among Ageing Workforce of Indian Construction Industry

Ageing work force is one of the leading causes behind the depletion in the growth rate of the labor force in construction industries.Construction industry is a paramount source of employment worldwide after agricul­tural industry explicitly in urban areas.Manual material handling in con­struction industries causes musculoskeletal disorders affecting both upper and lower extremities of the body.Studies on lower limb problems due to dynamic work like handling of heavy loads in construction industries are scanty.To analyze the level of exertion,ergonomics risk factors and the prevalence of work-related lower limb disorders among the young and elderly construction workforce.20 male construction workers in the age group of i)20 to 30 years(golden age group);ii)50 years and above were selected from a local construction site in Mumbai.Demographic data like age,height,weight,BMI,body fat,waist hip ratio and risk assessment by questionnaires study comprising QEC,NMQ,VAS,and LEFS were collected.Compared to the golden age group,the elderly subjects were found to feel more discomfort in their lower back,knee and calf regions of lower limb due to immoderate forces and motions tolerated by their lower limbs during their daily work.Muscle pliability and proper coor­dination diminishes with age and it is appearing to be the most probable reason behind the pain experienced in their lower limbs might be due to improper techniques and postures.For elderly workers,age related limita­tions become an additional factor to maintain their normal work-life.

Understanding the eff ect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens

BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ systems.The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised.This article aims to review the pathophysiology and toxic eff ects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.METHODS:Medical literature published from 1970 until 2022 was identifi ed utilizing MEDLINE/PubMed and the Cochrane Library.In addition to the databases,references were obtained through the use of reference lists of published articles identifi ed by the aforementioned databases.The initial search terms included opioids,inhalants,hallucinogens,cannabis,stimulants,and bone health.There were no methodological limitations in relation to the initial acquisition and analysis of data.RESULTS:A total of 55 research articles were included in this review.Cannabis,stimulants,opioids,and inhalants impact bone maintenance,specifically osteoblast and osteoclast activity,as well as impede hormone production.These substances inhibit bone remodeling and development,manifesting as lower bone mineral density and increased fracture risk in chronic users.CONCLUSION:Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease,further research is warranted to evaluate the clinical effects of long-term substance use.The evaluation of such effects will aid in establishing appropriate pain regimens,as well as appropriate screening and treatment plans for recreational drug users.

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.

Handlers’ Musculoskeletal Disorders in an Airline Operating Company in Conakry (Guinea)

Introduction: Musculoskeletal disorders are disorders of the musculoskeletal system related to work. The objective of this study was to musculoskeletal disorders among SOGEAC handlers. Methodology: This was a descriptive and analytic cross-sectional study over 6 months from November 2021 to April 2022. Results: We collected 110 handlers during the study. All of our population had postural constraints and were men. The average age of workers was 39.2 years. 93 handlers or 84.5% did manual handling, and 79% or 71.8% were baggage handlers. Regarding training, 88.2% or 97 handlers were trained, and 89.1% did alternating work. The standing posture was the most adopted with 89.1% followed by the kneeling position with 66.4%. 89.1% carried weights at work. 80 handlers or 73% had developed musculoskeletal disorders and the lumbar seat was found at 70%. The analysis of factors that may influence the occurrence of musculoskeletal disorders did not find any statistically significant relation. Conclusion: Our study shows that musculoskeletal disorders are an occupational health problem and recommends better compliance with occupational safety and health instructions.

A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees

Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

Frequency of Comorbid Musculoskeletal Problems in Patients with Parkinson’s Disease: What and When?

Background: Musculoskeletal problems, deteriorating posture and pain are common complaints/comorbidities in Parkinson’s disease (PD). The aim of this study was to investigate the frequency of comorbid musculoskeletal problems in PD, and their relationship with disease stage and severity. Methods: The study was approved by the local ethical committee of Duzce University numbered with 2018/52 on date 26.03.2018. Patients with PD (pwPD) underwent a detailed examination to investigate the possible comorbidity of musculoskeletal findings in the orthopedics and traumatology clinic. Socio-demographic features, disease characteristics, motor and non-motor scores were recorded. Results: Thirty-seven pwPD were enrolled in the study. Mean age was 68.75 ± 10.75 years. Comorbid musculoskeletal problems were rotator cuff syndrome (27%), knee osteoarthritis (24.3%), meniscus (13.5%), lumber disc herniation (10.8%), kyphosis (8.1%), myotendinous diseases (16.3%). Rotator-cuff disease and knee osteoarthritis were most common comorbidities, especially in the “mild” and “moderate” stages of pwPD. Conclusion: Since most of the pwPD, especially the ones that have musculoskeletal complaints prior to the diagnosis of PD, present to the orthopedics and traumatology clinics or physiotherapists, it is mandatory to enhance the awareness of the orthopedic surgeons, and physiotherapy specialist in order to keep PD in mind.

Is burnout a mediating factor between sharps injury and workrelated factors or musculoskeletal pain?

BACKGROUND Burnout,musculoskeletal pain,and sharps injuries(SIs)affect medical workers.AIM To establish a model between SIs,burnout,and the risk factors to assess the extent to which burnout affects SIs.METHODS This questionnaire was used for an observational and cross-sectional study,which was based on members at a hospital affiliated with a medical university in Taichung,Taiwan,in 2020.The valid responses constituted 68.5%(1734 of 2531).The items were drawn from the Nordic Musculoskeletal Questionnaire and Copenhagen burnout inventory and concerned work experience,occupational category,presence of chronic diseases,sleep duration,overtime work,and work schedule.Factor analysis,chi-square test,Fisher exact test,Multiple linear,logistic regression and Sobel test were conducted.The present analyses were performed using SAS Enterprise Guide 6.1 software(SAS Institute Inc.,Cary,NC,United States),and significance was set at P<0.05.RESULTS Personal and work-related burnout ranks, sex, work experience ranks, occupationalgroups, drinking in the past month, sleep duration per day, presence ofchronic diseases, overtime work ranks, and work schedule were associated withSIs. Frequent upper limb and lower limb pain (pain occurring every day or once aweek) determined to be related to SIs. High personal burnout (> Q3) and highwork-related burnout (> Q3) mediated the relationship between SIs and frequentlower limb pain. Similarly, frequent lower limb pain mediated the relationship ofSIs with high personal and high work-related burnout. High personal and highwork-related burnout mediated the relationships of SIs with overtime work andirregular shift work. The mediating model provides strong evidence of anassociation between mental health and SIs.CONCLUSIONBurnout was determined to contribute to SIs occurrence;specifically, it mediatedthe relationships of SIs with frequent musculoskeletal pain, overtime work, andirregular shift work.

Fostering tissue engineering and regenerative medicine to treat musculoskeletal disorders in bone and muscle

The musculoskeletal system,which is vital for movement,support,and protection,can be impaired by disorders such as osteoporosis,osteoarthritis,and muscular dystrophy.This review focuses on the advances in tissue engineering and regenerative medicine,specifically aimed at alleviating these disorders.It explores the roles of cell therapy,particularly Mesenchymal Stem Cells(MSCs)and Adipose-Derived Stem Cells(ADSCs),biomaterials,and biomolecules/external stimulations in fostering bone and muscle regeneration.The current research underscores the potential of MSCs and ADSCs despite the persistent challenges of cell scarcity,inconsistent outcomes,and safety concerns.Moreover,integrating exogenous materials such as scaffolds and external stimuli like electrical stimulation and growth factors shows promise in enhancing musculoskeletal regeneration.This review emphasizes the need for comprehensive studies and adopting innovative techniques together to refine and advance these multi-therapeutic strategies,ultimately benefiting patients with musculoskeletal disorders.

A Pragmatic Observational Feasibility Study on Integrated Treatment for Musculoskeletal Disorders：Design and Protocol

Background：Musculoskeletal disorders（MSD） comprise a wide range of conditions,associated with an enormous pain and impaired mobility,and are affecting people＇s lives and work.Management of musculoskeletal disorders typically involves a multidisciplinary team approach.Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies,though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service（NHS） setting.Objective：To determine the feasibility of all aspects of a pragmatic observational study designed：（1） to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK;（2） to determine the acceptability of the study design and research process to patients;（3） to explore patients＇ expectation and experience of receiving integrated treatments.Methods：This is an observational feasibility study,with 1-year recruitment and 1-year follow-up,conducted in Royal London Hospital for Integrated Medicine,University College London Hospital Trust,UK.All eligible patients with MSDs newly referred to the hospital were included in the study.Interventions are integrated packages of care（conventional and complementary） as currently provided in the hospital.SF-36 Health Survey,short form Brief Pain Inventory,Visual Analogue Scale,and modified Client Service Receipt Inventory will be assessed at 4/5 time points.Semi-structured interview/focus group will be carried out before treatment,and 1 year after commence of treatment.Discussion：We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital.It will inform the design of a future trial including recruitment,retention,suitability of the outcome measures and patients experiences.

Effects of self-administered exercises based on Tuina techniques on musculoskeletal disorders of professional orchestra musicians: a randomized controlled trial

BACKGROUND： Musicians are frequently affected by playing-related musculoskeletal disorders （PRMD）. Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing. OBJECTIVE： To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale （NVS）. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： We performed a prospective, controlled single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental （n = 39） and the control （n = 30） groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks. MAIN OUTCOME MEASURES： Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points. RESULTS： In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20. CONCLUSION： The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

Immediate effects of Tuina techniques on working-related musculoskeletal disorder of professional orchestra musicians

BACKGROUND：Musicians are a prone group to suffer from working-related musculoskeletal disorder（WRMD）.Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their effi ciency is sometimes disappointing.OBJECTIVE：The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal.DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS：We performed a prospective,controlled,single-blinded,randomized study.Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group（n=39）and the control group（n=30）.During an individual interview,Chinese diagnosis took place and treatment points were chosen.Real acupoints were treated by Tuina techniques into the experimental group and non-specifi c skin points were treated into the control group.Pain was measured by verbal numerical scale before and immediately after intervention.RESULTS：After one treatment session,pain was reduced in 91.8%of the cases for the experimental group and 7.9%for the control group.CONCLUSION：Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal,further investigations with stronger measurements,double-blinding designs and bigger simple sizes are needed.