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Signs, symptoms, and disability related to the musculo-skeletal system: studies of home care personnel and patients with fibromyalgia
Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Low back pain (LBP) and neck/shoulder pain are the major reasons for sickness absence and disability pensions in Sweden. The working situation of home care personnel in Sweden frequently requires heavy lifting and forward bending and workers report high prevalences of work-related musculo-skeletal pain and high frequencies of work accidents, especially lower back injuries. Most back pain patients are treated with non-surgical methods such as physical therapy, which includes manipulation, training of posture and co-ordination, lifting techniques, etc. There is limited scientific evidence with respect to clinical signs used in physical medicine. The clinical relevance of these signs with respect to symptoms and disability is unclear.

In Nyköping, Sweden, 607 home care personnel women were examined regarding pain prevalence and intensity in 9 body regions, other common symptoms, and disability. A clinical examination (conducted by 3 physiotherapists) investigated the following conditions: posture and sagittal spinal mobility (using kyphometer); joint laxity (Beighton score); segmental mobility and segmental pain from T10 down to L5-S1; and tender point (TP) palpation on 60 sites including the 18 ACR-criteria spots. In addition, a reliability study of 150 subjects was performed by two of the physiotherapists.

The 7-day prevalence of LBP was 48%. The reliability of manually investigated segmental mobility and pain was good, especially in L4-S 1 (kappa ≈o. 7). There was a positive correlation between segmental and total sagittal mobility (kyphometry) indicating criterion validity of the former. Sagittal hypomobility, segmental pain, hyper- and hypomobility, and tender point score correlated positively to pain intensity and many disability parameters. Neck-shoulder pain was more often combined with pain in other body regions and more strongly correlated to tender point score. The prevalence of fibromyalgia (FS) was 2%. There are many causes of FS. Central sensitisation is very likely essential and psychological factors and stress are discussed.

The personality profile of 33 female FS patients (FS-group) and 31 female controls (C-group) with local but not widespread pain was investigated, using MMPI and the Defence Mechanism Technique modified (DMTm). We found no sigos of serious personality abermtions in either group. A higher vulnerability for threatening experiences was found in the FS-group. Both symptoms and TP-score correlated positively to disability in both groups. The results of MMPI and DMTm indicate that cognitive coping strategies are suitable for FS patients. Because symptoms and sigos correlated to disability, the overall conclusion was that a multidisciplinary approach is appropriate in future investigations of pain problems.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 69 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 718
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28057Local ID: 12820ISBN: 91-7373-160-9 (print)OAI: oai:DiVA.org:liu-28057DiVA: diva2:248608
Public defence
2002-03-01, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-17Bibliographically approved
List of papers
1. The relationships between spinal sagittal configuration, joint mobility, general low back mobility and segmental mobility in female homecare personnel
Open this publication in new window or tab >>The relationships between spinal sagittal configuration, joint mobility, general low back mobility and segmental mobility in female homecare personnel
1999 (English)In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 31, no 4, 197-206 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate joint mobility, segmental and general spinal mobility and their interrelationship in 607 women working as homecare personnel. Joint mobility (mainly peripheral) was estimated using the "Beighton" score. Spinal posture and mobility were measured by Debrunner's kyphometer. Passive segmental mobility and pain provocation were estimated manually. Reliability tests between two physiotherapists of segmental mobility and pain provocation (n = 150 subjects) were performed. Positive correlations were found between joint mobility, sagittal thoraco-lumbar mobility and segmental mobility. Hyperlordosis (>39 degrees) was associated with greater lumbar mobility. The reliability of manual segmental mobility and segmental pain provocation was good, especially in the lowest back segments (kappa approximately 0.7). Joint mobility, general mobility and segmental spinal mobility intercorrelated. Segmental mobility manually estimated showed intertester reliability. The good positive correlation between sagittal lumbar mobility and manually tested segmental mobility indicates criterion validity for the latter.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81489 (URN)10.1080/003655099444362 (DOI)10599896 (PubMedID)
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2017-12-07Bibliographically approved
2. Correlations between joint and spinal mobility, spinal sagittal configuration, segmental mobility, segmental pain, symptoms and disabilities in female homecare personnel
Open this publication in new window or tab >>Correlations between joint and spinal mobility, spinal sagittal configuration, segmental mobility, segmental pain, symptoms and disabilities in female homecare personnel
2000 (English)In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, Vol. 32, no 3, 124-133 p.Article in journal (Refereed) Published
Abstract [en]

The aim of a study comprising 607 women working as homecare personnel was to investigate general spinal, joint and segmental mobility, different symptoms (pain and strain) and their relation to various aspects of disability. Joint mobility (mainly peripheral) was estimated using the 'Beighton' score and spinal posture and mobility were measured by kyphometer. Passive segmental mobility and pain provocation were estimated manually. Pain intensity and strain during work and leisure were estimated using visual analogue scales for defined anatomical regions. Disability was rated using defined items and two indices. The 7-day prevalence of low back pain was 48%. Peripheral joint mobility, spinal sagittal posture and thoracic sagittal mobility showed low correlations with disability. Lumbar sagittal hypomobility was associated with higher disability. Manually estimated segmental mobility and segmental pain provocation of L4-L5 and L5-S1 correlated with disability; hypo- and hypermobility or positive pain provocation tests at these levels showed higher disability than normal mobility and negative pain provocation tests, respectively. Cluster analysis revealed that the combination of positive pain provocation tests and low lumbar sagittal mobility was associated with particularly high disability levels. In conclusion, positive pain provocation tests were clearly associated with high disability levels.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27775 (URN)11028797 (PubMedID)12522 (Local ID)12522 (Archive number)12522 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-17Bibliographically approved
3. Tender point scores and their relations to signs of mobility, symptoms, and disability in female home care personnel and the prevalence of fibromyalgia syndrome
Open this publication in new window or tab >>Tender point scores and their relations to signs of mobility, symptoms, and disability in female home care personnel and the prevalence of fibromyalgia syndrome
2002 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 29, no 3, 603-613 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: In this study of female home care personnel employed in a municipality (n = 643; participation rate 94%) we investigated (1) the prevalence of tender points and fibromyalgia (FM); (2) the relationships between tender point score and other signs and symptoms; (3) if subgroups based on the tender point score differed with respect to signs, symptoms, disability, and health related quality of life; and (4) signs that showed the strongest intercorrelations with disability and health.

METHODS: The following variables were registered: (1) Signs: joint mobility, spinal posture and mobility, tender points, and segmental mobility and pain provocation at L4-S1 levels of the low back. (2) Symptoms: pain and pain intensity and other symptoms. (3) Disability (i.e., self-rated reduced capacity for everyday activities and employment) and health: 3 indices and sick leave.

RESULTS: The tender point score correlated with the number of pain regions and the pain intensities, and the amount of other symptoms, sick leave, and disability. Tender point score was the strongest regressor of the investigated signs in regression of the 2 disability indices. Segmental pain showed the strongest correlation with tender point score. Three subgroups identified by tender point score showed significant differences in segmental pain, prevalence and intensity of different symptoms, disability, and health related quality of life. The prevalence of FM was 2.0%.

CONCLUSION: Tender point score together with different symptoms showed relatively strong correlations with disability. A relatively high prevalence of FM was found in occupationally active female home care personnel.

Keyword
fibromyalgia, home care, musculoskeletal, pain, tender point, women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-48946 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-09-17Bibliographically approved
4. Personality characteristics of women with fibromyalgia and of women with chronic neck, shoulder, or low back complaints in terms of Minnesota Multiphasic Personality Inventory and defense mechanism technique modified
Open this publication in new window or tab >>Personality characteristics of women with fibromyalgia and of women with chronic neck, shoulder, or low back complaints in terms of Minnesota Multiphasic Personality Inventory and defense mechanism technique modified
Show others...
2002 (English)In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 10, no 3, 33-55 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare personality features of fibro-myalgia patients with those of a disease control group with regional pain.

Methods: A group of 33 women with fibromyalgia [FMS-group] was compared on the Minnesota Multiphasic Personality Inventory [MMPI] and the Defense Mechanism Technique modified [DMTm] with 31 women [C-group] without this diagnosis who had localized chronic pain in their neck, shoulder, and/or low back areas and were very similar in chronological age, intelligence, and basic personality patterns.

Results: As hypothesized the FMS-group scored higher than the C-group on the MMPI-scales of Hypochondriasis, Depression, and Hysteria. They also scored higher on Admission of symptoms, Psych-asthenia, Anxiety, Schizophrenia, Social introversion, and a number of nonclinical subscales. The differences were not found to be due to differences in pain intensity. The only statistically significant difference in DMTm between the groups was that of FMS patients more often reporting the projected self to be positive and/or to be afraid, suggesting them to be more vulnerable than the comparison group to threatening experiences. Significant relationships between the disability level and the number of tender points, group membership, pain intensity, and various of the MMPI scales were found.

Conclusions: There were no signs on the MMPI of serious psychological disturbances in either group, and at the “deeper” psychological level, assessed in DMTm, there were no marked differences between the two groups, a proneness to somaticize psychological pain being found in both groups. Both the MMPI and the DMTm results were interpreted as suggesting that a cognitive coping strategy program be considered for rehabilitation. The fact that both different symptoms and signs had importance when regressing disability might indicate that univariate approaches is not sufficient when investigating factors of importance for disability.

Keyword
Defense Mechanism Technique modified, Disability, Fibromyalgia, Minnesota Multiphasic Personality Inventory, Pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46803 (URN)10.1300/J094v10n03_03 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2013-09-05Bibliographically approved

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