Introduction: The objective of this cross-sectional study is to describe the prevalence and severity of self-reported musculoskeletal disorders (MSDs) in firefighters and how these vary by demographics and length of service (LOS). Methods: A cohort of 294 active-duty firefighters completed a body diagram to indicate the location and pain intensity of their MSK complaints. Where painful sites were indicated, they completed the relevant region-specific self-report disability measure – Neck Disability Index (NDI), Roland Morris Disability Questionnaire (RMDQ), Lower Extremity Functional Scale (LEFS), or the Short Form of Disabilities of the Arm, Shoulder and Hand (QuickDASH) – to quantify severity. Prevalence was determined from the body diagrams and severity from the site-specific self-report questionnaires. Differences in MSK severity based on demographics or LOS were determined using ANOVA. Results: The 294 active-duty firefighters had a mean age of 42.6 (SD 9.7) years and mean duration of service of 15.1 (SD 10.1) years. The prevalence of neck, back, upper-limb, and lower-limb complaints was 20%, 33%, 44%, and 45% respectively. Firefighters 42 years or older reported significantly more severe lower-extremity disability (median (IQR) LEFS: 71 (65, 77) vs. 75 (69.5, 78.5), p=0.03) and more severe back disability (median (IQR) RMDQ: 2 (1, 3) vs. 1 (0, 2), p=0.04). Firefighters with 15 years or more of firefighting service reported significantly more severe lower extremity disability (median (IQR) LEFS: 71 (64, 77) vs. 76 (70, 79), p=0.0005). Firefighters reporting >1 MSDs were significantly older than firefighters reporting no MSD ( F(5,285)=3.3, p=0.002). Discussion: The rate of MSDs is high in firefighters, and their severity is elevated with greater age and LOS, suggesting cumulative exposures/injuries and highlighting the need for ongoing assessment of the musculoskeletal system and interventions to reduce injury throughout firefighters' careers.
Background:Neck pain is common, but few studies have used qualitative methods to describe it.Purpose:To describe the quality, distribution and behavior of neck pain.Methods:Sixteen people (15 females; mean age = 33 years (range = 20-69)) with neck pain >3 months were interviewed using a semi-structured guide. Interview data were recorded and transcribed verbatim. Descriptive content analysis was performed by two authors. Participants then completed an electronic descriptive pain tool, placing icons (word and icon descriptors to describe quality) on anatomic diagrams to identify location of pain, and intensity ratings at each location. This data was triangulated with interviews.Results:Aching pain and stiffness in the posterior neck and shoulder region were the most common pain complaints. All patients reported more than one pain quality. Associated headache was common (11/16 people); but varied in location and pain quality; 13/16 reported upper extremity symptoms. Neuropathic characteristics (burning) or sensory disturbance (numbness/tingling) occurred in some patients, but were less common. Activities that involved lifting/carrying and psychological stress were factors reported as exacerbating pain. Physical activity was valued as essential to function, but also instigated exacerbations. Concordance between the structured pain tool and interviews enhanced trustworthiness of our results. Integrating qualitative findings with a previous classification system derived a 7-axis neck pain classification: source/context, sample subgroup, distribution, duration, episode pattern, pain/symptom severity, disability/participation restriction.Conclusions:Qualitative assessment and classification should consider the multiple dimensions of neck pain.
Background: Neck Pain (NP) is a common musculoskeletal disorder and the literature provides conflicting evidence about its management.Objective:To describe the methodology used to conduct an overview of reviews (OvR) and to characterize the distribution and risk of bias profiles across the evidence for all areas of NP management.Methods:Standard systematic review (SR) methodology was employed. MEDLINE, CINAHL, EMBASE, ILC, Cochrane CENTRAL, and LILACS were searched from 2000 to March 2012; Narrative and SR and clinical practice guidelines (CPG) evaluating the efficacy of treatment (benefits and harms), diagnosis/classification, prognosis, and outcomes were eligible. For treatment, articles were limited to SRs from 2005 forward. Risk of bias of SR was assessed with the AMSTAR; the AGREE II was used to critically appraise the CPGs.Results:From 2476 articles, 508 were eligible for full text screening. A total of 341 articles were included. Treatment (n=117) had the greatest yield. Other clinical areas had less literature (diagnosis=54, prognosis=16, outcomes=27, harms=16). There were no SR for classification and narrative reviews were problematic for this topic. There was great overlap across different databases within each clinical area except for those for outcome measures. Risk of bias assessment using the AMSTAR of eligible SRs showed a similar trend across different clinical areas.Conclusion:A summary of methods used to review the literature in five clinical areas of NP management have been described. The challenges of selecting and synthesizing eligible articles in an OvR required customized solutions across different areas of clinical focus.
Firefighters’ perceptions of mental health can inform management. This qualitative study explored Canadian career firefighters’ experiences, needs, and research priorities with respect to mental health. Thirty-nine career firefighters (33 men, 6 women) of different ranks and geographic locales were interviewed using a semi-structured interview guide. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis within an interpretive description approach. Firefighters reported that critical incidents and chronic job stressors contributed to mental health symptoms that led to burnout, compassion fatigue, and mental and physical injury. They were concerned with family impacts, like lack of full openness, reduced financial stability, and risk of divorce; and work impacts, like interpersonal conflict, lack of support to fellow firefighters, task avoidance, and absenteeism. A broad array of barriers and facilitators were found in firefighter work, culture, programs, social supports, health care, and societal factors. Variability in access to help, the changing fire service, and the complexity of knowing what to do to achieve mental health were evident across themes. Firefighters identified the need for research in four areas: awareness and monitoring, understanding etiology of mental health, better prevention and treatment, and access to care. Across domains of inquiry, context “two sides to the coin”, and uncertainty were overarching themes.
BackgroundOwing to the fact that firefighters have unique health risks, access to firefighter-specific internet-based health information is a potential mechanism for achieving better health and work outcomes.ObjectiveThe objective of our study was to identify the amount and nature of health information resources available on Canadian firefighter-specific websites and the extent to which resources are consistent across websites as a surrogate indicator of diffusion of information.MethodsA search of health resources on firefighter websites (union and employer) for all Canadian provinces, major cities and a subset of smaller cities, and the International Association of Fire Fighters (IAFF) website was conducted on Google (July 2017). Content was identified and classified based on the type of resource, health focus, and location. The quantity and nature of the resources were summarized using descriptive statistics.ResultsAmong all (N=313) websites reviewed, 41 websites had health information with a cumulative total of 128 resources that addressed firefighter mental (59/128, 46.1%), physical (43/128, 33.6%), and work health (26/128, 20.3%). The highest density of information was found on international and national websites (13 resources per website) and the least on local websites (1 resource per 7 websites). Three provinces (Ontario, Québec, and British Columbia) hosted 81% (65/80) of the provincial, territorial and local resources. General mental health (20/59, 34%), posttraumatic stress disorder (14/59, 24%), and suicide (14/59, 24%) were the most prevalent topics within the mental health resources, whereas half (21/43, 49%) of all physical health resources were on cancer. No resources from Northern Canada were found. Musculoskeletal health was not mentioned in any of the resources identified. There was minimal cross-linking of resources across sites (only 4 resources were duplicated across sites), and there was no clear indication of how the content was vetted or evaluated for quality.ConclusionsThere was wide variation in the amount and type of information available on different firefighter websites with limited diffusion of information across jurisdictions. Quality evaluation and coordination of resources should be considered to enhance firefighters’ access to quality health information to meet their specific needs. Mental health and cancer information aligned with high rates of these health problems in firefighters, whereas the lack of information on musculoskeletal health was discordant with their high rate of work injury claims for these problems.
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