Prevalence and risk factors of thumb pain in Italian manual therapists: An observational cross-sectional study.

Work-related musculoskeletal disorders (WMSDs) affect physical therapists with loss of health status and social costs. MSD is a relevant problem in upper limb extremities, especially when associated with manual techniques.



The study aims to investigate the prevalence and risk factors associated with thumb pain in Italian physiotherapists who perform manual therapy.



A self-administered questionnaire was sent by email, exploring demographics, thumb mobility, job, thumb pain, manual techniques, aggravating factors, management strategies and consequences of thumb pain.



The survey was sent to 523 manual therapists, 219 of which fully completed it. 49.3% of respondents experienced thumb pain at least once in the previous 12 months and 70.8% at least once in their lifetime. Statistically significant associations suggest that within 12 months manual therapists with more than 5 years of experience are less likely to report thumb pain (6-10 years of work: OR = 0.408, 95% CI: 0.215-0.775; 11-20 years of work: OR = 0.346, 95% CI: 0.139-0.859), whereas those who performs trigger point pressure release (OR = 1.832, 95% CI: 1.005-3.340), trigger point ischemic compression (OR = 2.999, 95% CI: 1.184-7.597) and fascial neuro-connective manipulation (OR = 3.086, 95% CI: 1.346-7.077) are more likely to experience it. In terms of lifetime prevalence, female manual therapists and those who perform trigger point ischemic compression are more likely to suffer from thumb pain (females: OR = 2.569, 95% CI: 1.339-4.930; trigger point ischemic compression: OR = 2.878, 95% CI: 1.319-6.281).



Special attention should be paid to prevention during manual skills training, since inexperience exposes manual therapist to a higher risk of developing thumb pain.

Related papers:

title: Prevention of musculoskeletal disorders in workers: classification and health surveillance – statements of the Scientific Committee on Musculoskeletal Disorders of the International Commission on Occupational Health
abstract: The underlying purpose of this commentary and position paper is to achieve evidence-based recommendations on prevention of work-related musculoskeletal disorders (MSDs). Such prevention can take different forms (primary, secondary and tertiary), occur at different levels (i.e. in a clinical setting, at the workplace, at national level) and involve several types of activities. Members of the Scientific Committee (SC) on MSDs of the International Commission on Occupational Health (ICOH) and other interested scientists and members of the public recently discussed the scientific and clinical future of prevention of (work-related) MSDs during five round-table sessions at two ICOH conferences (in Cape Town, South Africa, in 2009, and in Angers, France, in 2010). Approximately 50 researchers participated in each of the sessions. More specifically, the sessions aimed to discuss new developments since 1996 in measures and classification systems used both in research and in practice, and agree on future needs in the field.The discussion focused on three questions: At what degree of severity does musculoskeletal ill health, and do health problems related to MSDs, in an individual worker or in a group of workers justify preventive action in occupational health? What reliable and valid instruments do we have in research to distinguish ‘normal musculoskeletal symptoms’ from ‘serious musculoskeletal symptoms’ in workers? What measures or classification system of musculoskeletal health will we need in the near future to address musculoskeletal health and related work ability?Four new, agreed-upon statements were extrapolated from the discussions: 1. Musculoskeletal discomfort that is at risk of worsening with work activities, and that affects work ability or quality of life, needs to be identified. 2. We need to know our options of actions before identifying workers at risk (providing evidence-based medicine and applying the principle of best practice). 3. Classification systems and measures must include aspects such as the severity, frequency, and intensity of pain, as well as measures of impairment of functioning, which can help in prevention, treatment and prognosis. 4. We need to be aware of economic and/or socio-cultural consequences of classification systems and measures.

title: Work-related musculoskeletal disorders among physical therapists.
abstract: Increasing evidence suggests that musculoskeletal disorders are common in workers in the United States health care industry. Physical therapists, who commonly treat patients with these disorders, are also at risk for work-related musculoskeletal disorders (WMD) in the upper limbs and low back. The purpose of this study was to determine the prevalence of WMD during a 12-month period and the job factors that may be associated with these disorders in physical therapists.



A four-page questionnaire was mailed to physical therapists (N = 1,160) who attended The University of Iowa between 1943 and 1993. Nine hundred twenty-eight questionnaires were returned (80% response rate) from physical therapists in 46 states.



Based on a literature review and pilot study of physical therapists, a survey instrument was constructed consisting of a symptom survey, a job-factor survey, and various demographic information.



The highest prevalences of WMD among physical therapists were in the following anatomical areas: low back (45%), wrist/hand (29.6%), upper back (28.7%), and neck (24.7%). The job factor rated most likely to contribute to job-related musculoskeletal disorders was "lifting or transferring dependent patients." The prevalence of WMD in physical therapists also was affected by work setting, practice specialty, age of patient, and gender of therapist.



Specific strategies should be developed to reduce WMD in the practice of physical therapy.

title: Cause, prevalence, and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants.
abstract: Physical therapists (PTs) and physical therapist assistants (PTAs) are susceptible to occupational musculoskeletal injuries. The purpose of this study was to examine the reported causes and prevalence of occupational musculoskeletal injuries to PTs and PTAs during a 2-year period.



A questionnaire was mailed to 500 PTs and 500 PTAs randomly selected from the American Physical Therapy Association 1996 active membership list. Six hundred sixty-seven questionnaires were returned, giving a response rate of 67%.



Based on a literature review and a pilot study, an occupational injury questionnaire was constructed and mailed. Self-reports of injuries were obtained.



Thirty-two percent of the PTs and 35% of the PTAs reported sustaining a musculoskeletal injury. The highest prevalence of injury was to the low back (62% of injured PTs and 56% of injured PTAs). The PTs reported the upper back and the wrist and hand as having the second highest prevalence (23%). The PTAs reported the upper back as having the second highest prevalence (28%). The PTs and PTAs reported making changes in their work habits of improved body mechanics, increased use of other personnel, and frequent change of work position. The majority of PTs and PTAs reported they did not limit patient contact time or area of practice after sustaining an injury.



Although PTs and PTAs are recognized to be knowledgeable in prevention and treatment of musculoskeletal injuries, they are susceptible to sustaining occupational musculoskeletal injuries because of performing labor-intensive tasks.

title: Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses.
abstract: Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury.



As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed.



An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury.



Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms.



Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.

title: Occupational injuries of physiotherapists in North and Central Queensland.
abstract: The National Occupational Health and Safety Commission of Australia has identified musculoskeletal injuries in the health industry as a key area of concern. There is little data available on injuries to physiotherapists. This study aimed to investigate the nature, prevalence, job risk factors and consequences of occupational injuries, with particular focus on musculoskeletal injuries, experienced by physiotherapists in North and Central Queensland. A work-related musculoskeletal injury was defined as pain lasting more than three days that the respondent felt was cause by their work as a physiotherapist. Fifty-five per cent of respondents had experienced a work-related injury and 40% had experienced injury in the previous year. The most injured body areas were the low back, hands and neck. Over half (56%) of the initial episodes of injury occurred within five years of graduation. The job risk factors of most concern to injured respondents were sustained demanding postures, manual therapy techniques, repetition, working while injured and excessive workloads. Injured respondents chose to work while injured and not to take time off on workers' compensation or have surgery. Following injury, 38 of respondents changed work settings. Most injured physiotherapists modified their techniques to continue working. Further research is needed to develop effective preventative strategies.

title: Low back pain and other work-related musculoskeletal problems among physiotherapists.
abstract: This technical note reports the findings of a self-administered questionnaire regarding low back pain (LBP) and other musculoskeletal problems completed by 113 physiotherapists (15% of the active physiotherapists in the Republic of Slovenia). The study revealed that the overall incidence among the sample population of physiotherapists is 73.7% and the most prominent factor appears to be the age of the respondents. The only triggering factor for LBP within the physiotherapy profession appears to be handling of dependent patients.

title: Work-related musculoskeletal disorders affecting members of the Chartered Society of Physiotherapy ☆
abstract: To estimate the prevalence of work-related musculoskeletal disorders from a snapshot sample of members of the Chartered Society of Physiotherapy (CSP); the trade union, educational and professional body for physiotherapists, physiotherapy assistants and physiotherapy students in the UK. The distribution of musculoskeletal disorders against different variables, including age of therapist, years in practice and clinical specialty, was also investigated. We set out to highlight the job tasks that injured physiotherapists associated with their complaint and to identify any preventive strategies that injured physiotherapists adopted to prevent re-injury.  A self-administered questionnaire was posted to a randomly selected sample taken from the membership database of the CSP.  Ten percent ( n =3661) of registered physiotherapists, physiotherapy assistants and physiotherapy students on clinical placement. Main instrument Questionnaire based on the Standardised Nordic Questionnaire.  Reported career prevalence of work-related musculoskeletal disorders in members of the CSP was 68%. Previous 12-month prevalence was 58%, and 42% reported musculoskeletal symptoms in the last 12 months that lasted for more than 3 days. The low back was the body area identified by 44% of injured respondents as their most significant injury. Nearly one-third (32%) of injured respondents first experienced their worst injury within 5 years of graduation. A greater number of respondents (59%) were aged 30 years or under when their most serious injury occurred. Injured respondents rated ‘performing the same tasks over and over', ‘working in the same position for long periods' and ‘treating a large number of patients in 1 day' as the three most influential job risk factors contributing to injury.  Younger physiotherapists and newly qualified graduates appear to be most in need of intervention services aimed at reducing injury rates. Official action is undermined by injured physiotherapists seeking informal treatment from colleagues rather than reporting injury to their manager, helping to keep work-related injury a hidden problem. Physiotherapists should be encouraged to report workplace injury, and barriers to official reporting should be identified.

title: Work-related musculoskeletal disorders among Nigerian Physiotherapists
abstract: BackgroundPhysiotherapists are known to be prone to Work- related musculoskeletal disorders (WRMDs) but its prevalence among physiotherapists in Nigeria has not been reported. This study investigated the prevalence and work factors of WRMDs among physiotherapists in Nigeria.MethodsA cross- sectional survey was administered to physiotherapists in different parts of Nigeria using a 2- part questionnaire with items adopted from questionnaires used for similar studies around the world. Two hundred and seventeen copies of the questionnaire were distributed for self administration but 126 physiotherapists returned completed surveys for a 58.1% response. The data were analyzed using SPPS version 10 at alpha level of 0.05. Descriptive statistics of frequency and percentages and inferential statistics of x2 were used as appropriate for data analysis.ResultsReported 12- month prevalence of WRMDs among Nigerian physiotherapists was 91.3%. Prevalence of WRMDs was significantly higher in female physiotherapists (p = 0.007) and those with lower body mass index (p = 0.045). The low back (69.8%) was the most commonly affected body part, followed by the neck (34.1%). Fifty percent of the physiotherapists first experienced their WRMDs within five years of graduation and the highest prevalence (61.7%) was found among physiotherapists younger than 30 years. Treating large number of patients in a day was cited by most (83.5%) of the respondents as the most important work factor for their WRMDs. The most commonly adopted coping strategy identified was for the therapists to modify their position and/or the patient's position (64.3%). Majority of the respondents (87.0%) did not leave the profession but 62.6% changed and/or modified their treatment because of their WRMDs.ConclusionThe prevalence of WRMDs among physiotherapists in Nigeria is higher than most values reported for their counterparts around the world. The coping strategies and work factors of WRMDs among Nigerian physiotherapists are mostly similar to those of their counterparts elsewhere.

title: Prevalence, risk factors and preventive strategies in work-related musculoskeletal disorders among Israeli physical therapists.
abstract: Although physical therapists (PTs) have extensive knowledge of body mechanisms and injury prevention, work-related musculoskeletal disorders (WRMD) are quite common in this population. The purposes of this study were: to determine the prevalence and impact of WRMD among Israeli PTs; to investigate WRMD risk factors and to identify preventive strategies used by PTs; and to compare the risk of injuries in two professional settings: rehabilitation centres (RCs) and outpatient clinics (OPCs).



A validated, modified Cromie questionnaire, translated into Hebrew, was distributed to the PTs at their workplaces. The relationship between WRMD symptoms and professional settings was analysed by Pearson chi-square. The risk models were developed by logistic regression. One hundred and twelve PTs working in OPCs and RCs who defined themselves as healthy individuals were the subjects of this study.



Lifetime prevalence of WRMD was 83%. The highest prevalence of WRMD was in the lower back area (80%). Rehabilitation treatment was associated with an increased risk of lower back (odds ratio [OR] = 1.05) and shoulder symptoms (OR = 1.04); manual treatment was associated with an increased risk of wrist/thumb symptoms (OR = 1.11).



Work in RCs was associated with an increased prevalence of lower back/shoulder symptoms, whereas work in OPCs was associated with an increased prevalence of thumb/wrist symptoms. PT's used different strategies to reduce risk of WRMD, including altering practice technique. The respondents recommended administrative and ergonomic changes in the workplace.



Workplace-specific interventions to reduce WRMD in PTs should be developed and tested in future studies.

title: Work-related injuries among physiotherapists in public hospitals—a Southeast Asian picture
abstract: A cross-sectional study was conducted to measure the prevalence of work-related injuries among physiotherapists in Malaysia and to explore the influence of factors such as gender, body mass index, years of work experience and clinical placement areas on the occurrence of work-related musculoskeletal disorders.  Self-administered questionnaires adapted from the Nordic Musculoskeletal Questionnaire were sent to 105 physiotherapists at three main public hospitals in Kuala Lumpur, Malaysia. The questionnaire had 12 items that covered demographic information, areas of musculoskeletal problems and physiotherapy techniques that could contribute to work-related musculoskeletal disorders. The data obtained were analyzed using the Statistical Package for Social Science version 14 software.  The overall prevalence of work-related injuries during the past 12 months was 71.6%. Female therapists reported a significantly higher prevalence of work-related musculoskeletal disorders than the male therapists (73.0%, p<0.001). Significant differences were observed between the proportion of therapists who had work-related musculoskeletal disorders and those who did not for the group with a body mass index (BMI) >25 (χ2 = 9.0, p = 0.003) and the group with a BMI of 18–25 (χ2 = 7.8, p = 0.006). Manual therapy (58.6%) and lifting/transfer tasks (41.3%) were the two physiotherapy techniques that most often contributed to work-related musculoskeletal disorders.  Work-related injuries are significantly higher among the physiotherapists in Malaysia compared with many other countries. Female therapists reported a higher incidence of work-related musculoskeletal disorders in this study, and work-related musculoskeletal disorders were more common among therapists working in the pediatric specialty. This study contributes to the understanding of work-related disorders among physiotherapists from a southeast Asian perspective where the profession is in its development stage.

title: Work-related musculoskeletal disorders in female Swedish physical therapists with more than 15 years of job experience: Prevalence and associations with work exposures
abstract: The objective of this study was to determine the prevalence of and risk factors for work-related musculoskeletal disorders (WRMDs) in female physiotherapists with more than 15 years of job experience. A self-administered postal questionnaire was sent to 203 female physiotherapists with more than 15 years of job experience. Unconditional logistic regression was used to study the association between job exposures and the risk for WRMDs. The questionnaire was returned by 131 physiotherapists (64.5%). Of 99 subjects who answered specific questions about WRMDs, 52 (53.5%) were affected by WRMDs in at least one body part. Regions most affected were the hand/wrist (n=31; 58.5%) and the lower back (n=30; 56.5%). For hand/wrist pain, associations were found with: orthopedic manual therapy techniques (adjusted odds ratio [OR]=3.90; 95% confidence interval [CI]=1.2–13.1); working in awkward or cramped positions (OR=4.96; 95% CI=1.3–18.7); and high psychological job demands (OR=4.34; 95% CI=1.2–15.0). For lower back pain, associations were found with: working in awkward or cramped positions (adjusted OR=6.37; 95% CI=1.6–24.7); and kneeling or squatting (adjusted OR=4.76; 95% CI=1.4–15.9). More than half of the respondents reported WRMDs. General physical and psychosocial work-related exposures, as well as specific therapy tasks, were strongly associated with WRMDs. Larger, longitudinal studies are needed to determine the direction of causality.

title: The prevalence of occupational injuries among hand therapists in Australia and New Zealand.
abstract: Little research has been dedicated to the prevalence of occupational injury among hand therapists (occupational therapists and physiotherapists). This study investigates the prevalence of occupational injuries and pain in hand therapists in Australia and New Zealand. Another aim of the study was to identify risk factors and prevention strategies. A questionnaire was distributed to 155 therapists in Australia and New Zealand. One hundred and ten questionnaires were returned and analyzed. Results indicated a significant prevalence of primarily hand and upper limb injuries in hand therapists. There were 148 injuries discussed by 73 participants. Of these, 75% were described as work-related injuries. Forty percent of participants described two or more current injuries or pain sites. The most commonly reported occupational injury or pain was around the metacarpophalangeal or carpometacarpal thumb joint. Analysis of data showed no characteristics of participants that particularly put them at risk. There was no statistically significant difference in the incidence of injury in relation to hours of work, handedness, time since graduation, age, or sex. Participants identified possible causes of occupational injury and pain and prevention strategies. Further studies need to assess correlation between anthropometric measures and the prevalence of occupational injury. Studies also need to investigate specific prevention strategies.

title: Work-related activities associated with injury in occupational and physical therapists.
abstract: The purpose of this study was to examine work activities associated with work-related injury (WRI) in occupational and physical therapy.



1,158 occupational and physical therapists in Wisconsin responded to a mailed survey, from a total of 3,297 OTs and PTs randomly selected from the State licensure list.



The study used a cross-sectional, survey design. Participants reported information about WRI they sustained between 2004 and 2006, including the activities they were performing when injured. Investigators analyzed 248 injury incidents using qualitative and quantitative analysis.



Data were examined across OT and PT practice in general, and also by practice area. Manual therapy and transfers/lifts were associated with 54% of all injuries. Other activities associated with injury were distinct to practice area, for example: floor work in pediatrics; functional activities in acute care; patient falls in skilled nursing facilities; and motor vehicle activities in home care.



Injury prevention activities must address transfers and manual therapy, but also must examine setting-specific activities influenced by environment and patient population.

title: Prevalence of thumb pain in physical therapists practicing spinal manipulative therapy.
abstract: Thumb pain is a common complaint of physical therapists. The purpose of this study was to investigate the prevalence, presentation, and techniques associated with aggravation of thumb pain in physical therapists practicing spinal manipulative therapy and the management strategies used to deal with pain. A survey was sent to members of Musculoskeletal Physiotherapy Australia. Data were collected from subjects who had completed postgraduate study in manipulative physical therapy. Of the 155 subjects who responded, 83% complained of pain in their thumbs aggravated by performing manipulative therapy techniques in the preceding year (2000). The most common presentation of pain included mild pain (3.8/10) at the metacarpophalangeal joint, with multiple, short-lived episodes. Techniques most commonly responsible for aggravation of symptoms were unilateral (87%) and central posteroanterior glides (85%). Most subjects (74%) changed their choice of treatment technique to alleviate symptoms. Suggestions are made about the safe alignment of the thumb during performance of spinal manipulative therapy techniques.

title: The prevalence of thumb problems in Australian physiotherapists is high: an observational study.
abstract: What is the lifetime and current prevalence of thumb problems in Australian physiotherapists and what are the factors associated with thumb problems?



Survey of a random cross-section of physiotherapists.



1562(approximately 10% of the total) registered Australian physiotherapists.



General questions covered demographic information, area of practice, hours worked per week, and years worked as a physiotherapist. Specific questions about thumb problems covered thumb affected, symptoms, onset of symptoms, treatment sought, relevance of work-related factors, and joint hypermobility.



1102 (71%) questionnaires were returned and 961 (68%) completed. The lifetime prevalence of thumb problems was 65% and the current prevalence was 41%. Factors that were significantly associated with thumb problems included: working in orthopaedic outpatients (OR 3.2, 95% CI 1.8 to 5.8); using manual therapy (OR 2.3 to 3.4, 95% CI 1.7 to 5.1), trigger point therapy (OR 2.3, 95% CI 1.7 to 3.0) and massage (OR 2.1, 95% CI 1.6 to 2.8); having thumb joint hypermobility (OR 2.2 to 2.6, 95% CI 1.4 to 4.5); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (OR 4.2, 95% CI 2.9 to 5.9). Of those respondents who reported thumb problems, 19% had changed their area of practice and 4% had left the profession as a result of their thumb problems.



The prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers.

title: Factors related to thumb pain in physiotherapists.
abstract: The aim of this study was to determine whether differences exist between physiotherapists with work-related thumb pain and physiotherapists without thumb pain. Twenty-four physiotherapists with work-related thumb pain (Pain Group) and 20 physiotherapists without thumb or wrist pain (Non-pain Group), who were working at least 20 hours per week in an outpatient musculoskeletal setting, were compared on a number of attributes: generalised joint laxity, hand and thumb strength, height, weight, working environment, hand position and force applied during mobilisation, mobility at individual thumb joints, extent of osteoarthritis at the thumb and radial-sided wrist joints, and demographic data including age, gender and years of experience. All physiotherapists in the Pain Group reported their thumb pain was related to and initially caused by the performance of manual techniques, and 88% had altered their manual techniques because of pain in the thumb. There was extreme variability in hand position and force applied during mobilisation, and a slightly high prevalence of osteoarthritis (22.7%) considering the mean age of the total sample (38.6 years). Statistically significant differences between groups included increased right carpometacarpal joint laxity (6.4%, 95% CI 0.19 to 12.6), decreased right tip pinch strength (0.84 kg, 95% CI 0.01 to 1.68), and lower body mass index (2.0, 95% CI 0.11 to 3.9) for the Pain Group. Other factors were not statistically different between groups. These results indicate that work-related thumb pain affects physiotherapists ability to administer manual treatments, and suggest that decreased stability and strength of the thumb may be associated with work-related thumb pain.

title: Modest Association of Joint Hypermobility With Disabling and Limiting Musculoskeletal Pain: Results From a Large‐Scale General Population–Based Survey
abstract: To determine the population prevalence of joint hypermobility (JH) and to test the hypothesis that JH would be associated with reporting musculoskeletal pain.

title: Readiness for work injury management and prevention: important attributes for early graduate occupational therapists and physiotherapists.
abstract: Early graduate occupational therapists (OTs) and physiotherapists (PTs) are routinely employed in work injury management and prevention in Australia. However, our understanding is limited about employer requirements for early graduates entering the field, and how commencing practitioners manage transition to practice. In addition, employers have expressed concerns anecdotally about the preparedness of early graduates for work injury management and prevention. However, evidence is limited about early gradutate preparedness for the field.



The study aimed to develop a detailed qualitative account of the perceptions of employers and early graduates on the attributes required of early graduates in work injury management and prevention, and processes for effective transition to practice in this field.



A purposive sample of 12 employers and 12 early graduates in work injury management and prevention participated in semi-structured interviews. Questions to employers focused on recruitment, supervision and readiness for practice. Questions to early graduates focused on challenges in transition and effective learning methods. Transcripts were analysed by Leximancer™ and supported by manual coding and synthesis.



Four themes with findings were, 1) 'Job and workplace requirements'; skills required by employers and support needed for early graduates, 2) 'Learning for work injury management and prevention'; options for early graduate development and learning methods early graduates found effective, 3) 'Employer expectations of early graduates in transition to work injury management and prevention', responses to transition; and 4) 'Early graduate perceptions on transition to work injury management and prevention'; early graduates responses to transition.



Findings for employers and early graduates were similar to those expected in other areas of practice for OTs and PTs. Work injury management and prevention skills were not expected of early graduates by employers. Employers and early graduates shared similar views that clinical education in work injury management and prevention was useful to early graduates entering this field. Physiotherapy employers considered PT early graduates not yet ready for work injury management and prevention.

title: Teaching ergonomics to undergraduate physical therapy students: new methodologies and impressions of a Brazilian experience.
abstract: Being ergonomics a scientific discipline based on knowledge of several areas, it is important to use education methodologies that promote critical thinking and reflective during the educational process. The article discusses the importance of interdisciplinarity in undergraduate courses in health care in particular in disciplines that address the ergonomics issue. The aspects of the introduction of new education methodologies, as well as case studies in undergraduate courses in Brazil, are discussed in this study. Based on the literature review conducted, some proposals for action in the interdisciplinary teaching of ergonomics in Physiotherapy courses are presented.

title: Homeostatic Mechanisms in Articular Cartilage and Role of Inflammation in Osteoarthritis
abstract: Osteoarthritis (OA) is a whole joint disease, in which thinning and disappearance of cartilage is a critical determinant in OA progression. The rupture of cartilage homeostasis whatever its cause (aging, genetic predisposition, trauma or metabolic disorder) induces profound phenotypic modifications of chondrocytes, which then promote the synthesis of a subset of factors that induce cartilage damage and target other joint tissues. Interestingly, among these factors are numerous components of the inflammatory pathways. Chondrocytes produce cytokines, chemokines, alarmins, prostanoids, and adipokines and express numerous cell surface receptors for cytokines and chemokines, as well as Toll-like receptors. These receptors activate intracellular signaling pathways involved in inflammatory and stress responses of chondrocytes in OA joints. This review focuses on mechanisms responsible for the maintenance of cartilage homeostasis and highlights the role of inflammatory processes in OA progression.

title: Cellular senescence and the senescent secretory phenotype in age-related chronic diseases
abstract: Possible mechanisms in cellular senescence and the senescence-associated secretory phenotype (SASP) that drive and promote chronic inflammation in multiple age-related chronic diseases are considered.  A series of studies about the SASP indicate that senescent cells may be involved in the development of chronic inflammatory diseases associated with aging.  Aging is a complex biological process accompanied by a state of chronic, low-grade, ‘sterile’ inflammation, which is a major contributor to the development of many age-related chronic disorders including atherosclerosis, osteoarthritis, Alzheimer's disease, type 2 diabetes, cancers, and others. It appears that cellular senescence plays a role in causing inflammation through the SASP. A better understanding of the contribution of senescent cells to the pathologies of chronic inflammatory disorders could have potentially profound diagnostic and therapeutic implications.

title: Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders in Massage Practitioners
abstract: Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors.  We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression.  Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0–4.5 with 95% confidence interval (CI) 1.5–13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3–8.1), and ≤7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9–3.2, 95% CI=1.2–8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3–7.8) and 3.6 (95% CI=1.4–9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height.  WMSDs were prevalent among massage practitioners.

title: A survey of musculoskeletal injuries amongst Canadian massage therapists.
abstract: A survey was administered to registered massage therapists (RMT) across Canada to determine the prevalence of musculoskeletal pain and discomfort to the low back, shoulders, neck, wrist and thumbs associated with therapeutic treatments. A total of 502 RMT responded to the survey. Despite the majority of the respondents indicating they received proper training in therapy postures and self-care, there was a high prevalence of pain reporting to all areas of the upper extremity. The highest reporting of pain and discomfort was reported in the wrist and thumb, followed by the low back, neck and shoulders, respectively. There were no significant gender differences in pain/discomfort reporting except for the neck. The results of this survey indicate a high prevalence of musculoskeletal pain and discomfort associated with delivering massage therapy treatments. Therapists must focus on proper technique posture and adhere to a regime of self-care to reduce the risks of pain and injury. Further research is needed to determine the effects of neuromuscular fatigue and technique accommodation as it relates to pain risk.

title: Validity of self-reported physical work load in epidemiologic studies on musculoskeletal disorders.
abstract: This study assessed the validity of self-reported physical work load by questionnaire and logbook against task analysis and observation. It also investigated factors (job type and low-back or neck pain) affecting the self-assessment of physical work load and compared the assessments between the questionnaire and the logbook.



A self-administered questionnaire including 10 questions (ordinal scales) on physical work load and musculoskeletal symptoms was filled out by 2756 men in the forest industry. From this population, 36 men were selected for task analysis and observation. Logbooks including 10 continuous variables were analyzed for 386 men.



The Spearman rank correlation coefficients between the self-assessments and observations for the frequency of manual handling, duration of trunk flexion, neck rotation, hand above shoulder level, and squatting or kneeling ranged between 0.42 and 0.55. The correlation coefficients for the questionnaire items were higher in general, and the accuracy better, for those with no low-back pain than for those with pain. The duration of trunk flexion, neck flexion and hand above shoulder level was overestimated in the questionnaires and less so in the logbooks.



Self-administered questionnaires may help to classify groups with heterogeneous occupational tasks according to some work-load factors. The accuracy of the assessments is not good for studying quantitative exposure-effect relationships, however. The logbook method might give more valid information. The perception of musculoskeletal pain may bias the self-assessment of work load.

title: Back pain among workers in the United States: national estimates and workers at high risk.
abstract: Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.