Towards harmonisation of case definitions for eight work-related musculoskeletal disorders - an international multi-disciplinary Delphi study

Abstract

Background International consensus is needed on case definitions of work-related musculoskeletal disorders and diseases (MSDs) for use in epidemiological research. We aim to: 1) study what information is needed for the case definition of work-related low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral and medial elbow tendinopathy, and knee and hip osteoarthritis, and to 2) seek consensus among occupational health professionals/researchers regarding the case definitions of these work-related MSDs. Methods A two-round Delphi study was conducted with occupational health professionals/researchers from 24 countries. Definition of work-related MSDs were composed of a case definition with work exposures. Round 1 included 32 case definitions and round 2, 60 case definitions. After two rounds, consensus required 75% of the panellists to rate a case definition including work exposures ≥7 points on a 9-point rating scale (completely disagree/completely agree). Results Fifty-eight panellists completed both rounds (response rate 90%). Forty-five (70%) panellists thought that for LBP a case definition can be based on symptoms only. Consensus was only reached for work-related medial elbow tendinopathy, while the lowest agreement was found for knee osteoarthritis. Where consensus was not reached, this was – except for LBP - related to physical examination and imaging rather than disagreement on key symptoms. Conclusion Consensus on case definitions was reached only for work-related medial elbow tendinopathy. Epidemiological research would benefit from harmonized case definitions for all MSDs including imaging and physical examination for LRS, SAPS, CTS, lateral elbow tendinopathy and hip and knee osteoarthritis.

What have we learned about risk assessment and interventions to prevent work-related musculoskeletal disorders and support work participation?

“…Also, non-physical factors like work-rest schedules and psychosocial demands were defined. As a follow-up, a systematic literature review and an international Delphi study were performed to arrive at case definitions for similar and other prevalent work-related MSD, namely work-related low-back pain, lumbosacral radicular syndrome, subacromial pain syndrome, carpal tunnel syndrome, lateral and medial elbow tendinopathy, and knee and hip osteoarthritis ( 14 , 15 ). Importantly, these case definitions allowed linkage of commonly recognized clinical MSD to newly identified work-related risk factors ( 16 – 18 ).…”

A Health-Impact Assessment of an Ergonomic Measure to Reduce the Risk of Work-Related Lower Back Pain, Lumbosacral Radicular Syndrome and Knee Osteoarthritis among Floor Layers in The Netherlands

“…To answer the research question, we calculated the Population Attributable Fraction and the Potential Impact Fraction. To do so, we used the data from the studies by Visser et al [11][12][13][14][15][16][17][18] that described the exposure to the physical work demands of bending of the trunk and kneeling. These two papers described, in total, four working techniques: The first paper described workplace assessments among sand-cement-bound screed floor and among anhydrite-bound screed floor layers [11].…”

“…To gain insight into the efficacy of preventive measures to reduce the number of floor layers with such diseases or disorders, insight into the proportional reduction of the number of these diseases or disorders is needed for floor layers that are not or are less exposed to the physical demands of this type of work [12,13]. In recent years, several systematic reviews have assessed to what extent physical demands at work contribute to these multifactorial musculoskeletal diseases and disorders, such as lower back pain [14], lumbosacral radiculopathy syndrome [15] and knee osteoarthritis [16].…”

Musculoskeletal disorders among dental students: a survey from Saudi Arabia

“…Many case-definitions exist for WMSDs leading to variations in the prevalence and in the evaluation of risk factors. However, majority of WMSDs cases are diagnosed based on clinical signs and symptoms, physical examination, and imaging in addition to investigating work-related criteria [ 6 ].…”