Abstract
This project was initiated because of previous difficulties in assessing whether repetitive work with low use of force causes painful conditions in the hands, elbows, shoulders and neck, and whether it increases the risk of change of occupation or early retirement. There is reasonably good evidence that forceful work in combination with repetitive movements can be the cause of specific and non-specific disorders of the upper extremities. However, there is a lack of studies on repetitive work with low use of force and the studies have often been based on self-reported exposures or on smaller studies with a few different occupations which can lead to some methodological disadvantages. This project investigated combinations of technical measurements of wrist and neck movements and both expert and self-assessed exposures in job exposure matrices in many different occupations in large populations and the development of specific and non-specific disorders. This approach has clear methodological advantages in determining a possible causal link. One of the data sources of the non-specific disorders was the PensionDanmark Health Scheme (PDHS), which has not previously been used for research into causes of disorders of the upper extremities. The combination of different data sources of information made it possible to adjust for relevant confounders.
Methods: We based our project on four cohorts. In a cohort of hairdressers who responded to a questionnaire in 2009 (n = 1,303), we examined the relationship between self-reported work intensity (number of cuts in hair per week) and treatments due to pain in the neck and shoulders in the PDHS in the first study. Also, the association between treatment for pain and risk of leaving the profession was investigated in a large cohort of all hairdressers in the PDHS (n = 11,162) which were linked to Danish registers for employment and benefits. In the second study, the relationships between wrist force and repetitive movements on the risk of treatments due to pain in the upper extremities were studied among 17 different occupations with access to treatments by physiotherapists and chiropractors in the PDHS (n = 202,747). Finally, the third study investigated the associations between neck movements and positions at work and risk of cervical disc herniation among all Danes who had worked within 29 different occupations over a period from 1981 to 2016 (n=852,625).
Results: In the first study, no association was found between work intensity for hairdressers and treatments due to neck and shoulder pain. The results may have been affected by a healthy-worker effect, but no sensitivity analyses showed other results. We found that the hairdressers who had received treatments in the PDHS within the last year left their profession to a significantly lesser extent, possibly as a direct effect of the treatments but other factors such as health behaviour could also explain this finding. In the second study, the analyses showed a clear dose-response relationship between the use of wrist force and treatment for pain in the upper extremities. We found a weak association between repetitive movements of the wrist and pain in the upper extremities, which disappeared after adjustment for use of force. The results were generally not significant among women, as only a few occupations with many women were covered in the PDHS. In the third study, we found no association between neck movements and postures at work and development of cervical disc herniation. Primarily increasing age, female sex, and previous lumbar disc herniation increased the risk of cervical disc herniation.
Conclusions: The above results indicated that repetitive movements of the wrists with low use of force either measured in a job exposure matrix or among a homogeneous occupational group such as hairdressers did not increase the risk of developing pain in the upper musculoskeletal system. This could mean that future interventions to prevent this should focus on reducing the use of force and to a lesser extent the purely repetitive exposures. Similarly, results indicated that the causes of cervical disc herniation are mainly non-modifiable factors such as age, sex and previous lumbar disc herniation. Also, the use of the PDHS for treatment of pain may protect against leaving the trade as a hairdresser. However, we do need to investigate this association in other occupations.
Methods: We based our project on four cohorts. In a cohort of hairdressers who responded to a questionnaire in 2009 (n = 1,303), we examined the relationship between self-reported work intensity (number of cuts in hair per week) and treatments due to pain in the neck and shoulders in the PDHS in the first study. Also, the association between treatment for pain and risk of leaving the profession was investigated in a large cohort of all hairdressers in the PDHS (n = 11,162) which were linked to Danish registers for employment and benefits. In the second study, the relationships between wrist force and repetitive movements on the risk of treatments due to pain in the upper extremities were studied among 17 different occupations with access to treatments by physiotherapists and chiropractors in the PDHS (n = 202,747). Finally, the third study investigated the associations between neck movements and positions at work and risk of cervical disc herniation among all Danes who had worked within 29 different occupations over a period from 1981 to 2016 (n=852,625).
Results: In the first study, no association was found between work intensity for hairdressers and treatments due to neck and shoulder pain. The results may have been affected by a healthy-worker effect, but no sensitivity analyses showed other results. We found that the hairdressers who had received treatments in the PDHS within the last year left their profession to a significantly lesser extent, possibly as a direct effect of the treatments but other factors such as health behaviour could also explain this finding. In the second study, the analyses showed a clear dose-response relationship between the use of wrist force and treatment for pain in the upper extremities. We found a weak association between repetitive movements of the wrist and pain in the upper extremities, which disappeared after adjustment for use of force. The results were generally not significant among women, as only a few occupations with many women were covered in the PDHS. In the third study, we found no association between neck movements and postures at work and development of cervical disc herniation. Primarily increasing age, female sex, and previous lumbar disc herniation increased the risk of cervical disc herniation.
Conclusions: The above results indicated that repetitive movements of the wrists with low use of force either measured in a job exposure matrix or among a homogeneous occupational group such as hairdressers did not increase the risk of developing pain in the upper musculoskeletal system. This could mean that future interventions to prevent this should focus on reducing the use of force and to a lesser extent the purely repetitive exposures. Similarly, results indicated that the causes of cervical disc herniation are mainly non-modifiable factors such as age, sex and previous lumbar disc herniation. Also, the use of the PDHS for treatment of pain may protect against leaving the trade as a hairdresser. However, we do need to investigate this association in other occupations.
Originalsprog | Engelsk |
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ISBN (Trykt) | 978-87-93510-87-6 |
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Status | Udgivet - 16 dec. 2021 |
Emneord
- Sundhedsvidenskab