An epidemiologic approach to disorders in the neck and shoulders

Sammanfattning: Complaints about pain in the locomotor system represent a commonly occuning health problem among working people all over the world. In this context, a series of studies were employed to determine if work organization and psychosocial conditions at work, in addition to physical work load, contribute to the development of disorders in the neck and shoulders. The potentially health-promoting effect of early and active rehabilitation of those already suffering from disorders in the neck and shoulders was also evaluated.A first psychophysiological study showed that various stress conditions during monotonous work had limited effects on muscle tension. The interindividual variability in muscle reactions to stress was large, but the results indicate that some individuals may react with a sustained, low-level muscle activity that is associated with pain.A cross-sectional study of a sample of a normal working population and a case-control study of patients with disorders in the neck and shoulders revealed a set of work-related core determinants, which appear to be essential component causes for the development of symptoms and signs. Prevalence ratios (PR) were calculated for determinants of early symptoms in the cross-sectional study, and odds ratios (OR) were estimated in the case-control study for determinants of disorders of the neck and shoulders. Repetitive movements demanding precision (PR 1.2 and OR 7.5, respectively), high work pace (PR 1.2 and OR 3.5, respectively), low quality work content (low decision latitude and lqw skill discretion; PR 1.3 and OR 2.6, respectively), and uncertainty about how to perform and-manage the tasks (work-role ambiguity; PR 1.2 and OR 16.5, respectively) were associated with both development of early symptoms, and disorders in the neck and shoulders. The results also show that being a woman (PR 1.3 and OR 11.4, respectively) and I or an immigrant (PR 1.3 and OR 4.9, respectively) imposes a higher risk for developing signs and symptoms in the neck and shoulders, possibly due to selective job-assignment.A controlled, two-year follow-up of cohorts of subjects with early and active rehabilitation versus traditional, less active treatment of neck~shoulder disorders respectively, did not support the hypothesis that active rehabilitation, as compared to traditional treatment methods, promotedbetter health, unless work conditions were changed. People who remained on the same job after rehabilitation, independent of type of treatment, had a less positive prognosis (relative risk 3.6) than those who had a changed work situation.Further analysis of which factors retained people in long-term sick-leave suggested that work conditions are more important than personality and other individual characteristics in determining the amount of time that will elapse before individuals will resume work after a sickleave. There was no gender-difference in this respect.