Concurrent validity of questions on arm, shoulder and neck symptoms of the RSI QuickScan

Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A Scoping Review

Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located articles, 123 were considered relevant. Within this literature, there were 43 CDS tools located. These were classified into 3 main areas: computer-based tools/questionnaires (n = 8, 19 %), treatment algorithms/models (n = 14, 33 %), and clinical prediction rules/classification systems (n = 21, 49 %). Each of these areas and the associated evidence are described. The state of evidentiary support for CDS tools is still preliminary and lacks external validation, head-to-head comparisons, or evidence of generalizability across different populations and settings. Conclusions CDS tools, especially those employing rapidly advancing computer technologies, are under development and of potential interest to health care providers, case management organizations and funders of care. Based on the results of this scoping review, we conclude that these tools, models and systems should be subjected to further validation before they can be recommended for large-scale implementation for managing patients with MSK disorders.

German version of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ): translation and validation

Background

Musculoskeletal disorders are a public health problem with significant effects on work ability. In the context of the promotion and prevention of work-related health, there is a need for valid, simple, time-saving and universally applicable methods for the assessment of musculoskeletal pain and complaints. The aim of this study was the translation of the English Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) into German and the validation of the German version.

Methods

The linguistic and cultural adaption of the CMDQ into German (D-CMDQ) followed international guidelines. The adapted pre-version was initially tested in terms of comprehensibility on 44 persons with different educational and occupational backgrounds. The questionnaire was validated further on 68 employees with the reference of an 11-point Numeric Rating Scale (Cohen’s Kappa and Spearman’s rank correlation coefficients). Finally, reliability (Cohen’s Kappa) and internal consistency (Cronbach’s alpha) were verified.

Results

The D-CMDQ meets the requirements for comprehensibility and demonstrated good validity: The values of Cohen’s Kappa and Spearman’s rank correlation coefficient obtained substantial to excellent agreement, with one exception. The Kappa values for the test-retest reliability were mainly in the moderate to substantial range whilst taking the prevalence effect into account. The internal consistency was proven satisfactory.

Conclusions

The D-CMDQ meets the psychometric requirements for questionnaires. A clear one-sided presentation of body areas enables the time-saving assessment of musculoskeletal complaints and their effects on work ability. As a result, a broad application in the German-speaking world for different occupational groups seems possible, whether performing physical, manually repetitive or sedentary work.

Are pushing and pulling work-related risk factors for upper extremity symptoms? A systematic review of observational studies

Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of) upper arm, elbow, forearm, wrist or hand symptoms.