Global Prevalence of Musculoskeletal Disorders Among Physiotherapists: a Systematic Review and Meta-Analysis

BMC Musculoskeletal Disorders | By Philippe Gorce & Julien Jacquier-Bret

Background
Musculoskeletal disorders (MSD) are one of the most important problems among physiotherapists worldwide. However, there is no meta-analysis of the MSD prevalence in all body areas among physiotherapists.

Objectives
The purpose was to investigate and estimate the worldwide prevalence of MSD among physiotherapists using a systematic review-, meta-analysis and meta-regression.

Methods
The systematic review, meta-analysis and meta-regression were performed in 2022 using the PRISMA guidelines.

Data sources
The search was performed on PubMed/Medline, ScienceDirect, Google Scholar, Medeley and Science.gov databases.

Study appraisal
The quality appraisal of the included articles was assessed using the critical appraisal tool for cross-sectional studies AXIS.

Results
A total of 722 articles were found. After screening and comparison with the inclusion criteria, 26 studies were retained. Based on the random-effects model, the worldwide MSD prevalence in neck, upper back, mid back, lower back, shoulders, elbows, wrists/hands, thumb, hips/thighs, knees/legs, and ankles/feet was 26.4% (CI 95%: 21.0–31.9%), 17.7% (CI 95%: 13.2–22.2%), 14.9% (CI 95%: 7.7–22.1%), 40.1% (CI 95%: 32.2–48.0%), 20.8% (CI 95%: 16.5–25.1), 7.0% (CI 95%: 5.2–8.9), 18.1% (CI 95%: 14.7–21.5%), 35.4% (CI 95%: 23.0–47.8), 7.0% (CI 95%: 5.2–8.8), 13.0% (CI 95%: 10.3–15.8), and 5% (CI 95%: 4.0–6.9) respectively. The neck and shoulder prevalence of four continents were close to the world prevalence. No effect of continent was found on MSD prevalence. The heterogeneity of the results obtained in the meta-analysis and meta-regression was discussed.

Conclusions
Based on the random effects model, the results of the worldwide meta-analysis showed that lower back pain, thumb, neck and shoulder were the area most at risk for MSD and were therefore those to be monitored as a priority. Recommendations were proposed for future reviews and meta-analyses.

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APTA Home Health / NAHC Webinar – Stay Alert for High-Alert Medications in Home Health: Anticoagulants and Insulin

Thursday, April 27, 2023 | 2:00- 3:00 PM EDT

 APTA Home Health is collaborating with the National Association for Home Care & Hospice (NAHC) for this nation-wide free webinar. The presenter, Melissa Bednarek, PT, DPT, PhD will define high-alert medications and focus specifically on anticoagulants and insulin.  The indications, mechanism of action, side effects and clinical implications for each medication class will be discussed.

Learning Objectives: 

1. Define high-alert medication and list included medication classes.
2. Describe the indications, mechanism of action, common side effects and implications for a home health patient taking anticoagulants.
3. Describe the indications, mechanism of action, common side effects and implications for a home health patient taking insulin.

Speaker: Melissa Bednarek, PT, DPT, PhD

Price: FREE

Register

To Ice or Not to Ice? Icing Can Promote Muscle Regeneration After Mild Injury

By Kobe University

Applying ice to a muscle injury is a widespread first-aid treatment, but exactly what effect does this have on the muscle regeneration and does it really help? Cumulative research by a multi-institutional Japanese research collaboration reveals that "to ice or not to ice" may depend on the degree of muscle injury.

In their latest research, the group consisting of Associate Professor Arakawa Takamitsu and Master's student Nagata Itsuki (from Kobe University's Graduate School of Health Sciences), and Assistant Professor Kawashima Masato (Kawasaki University of Medical Welfare) and colleagues have shown that applying ice to muscle damage in a small percentage of muscle fibers in rats promotes muscle regeneration. This is believed to be the first study in the world to show benefits of icing on muscle repair. In conjunction with their previous study on serious muscle injuries, it is hoped that these results can be used as a basis for more accurate guidelines on whether or not to ice such injuries.

These research findings were first reported in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology on March 6, 2023.

Research Background

"RICE treatment" is a common approach for treating the acute phase of sports injuries. This acronym stands for Rest, Ice, Compression and Elevation and it is also often used in physical education in schools and even clinical settings. There are a variety of subsequent steps that can be taken to treat the injury afterwards, yet opinions vary as to whether or not icing should be applied. However, there is a lack of evidence on the benefits of icing.

The current research team has conducted many experiments to investigate the effectiveness of icing, which led them to publish their previous findings. However, no previous animal experiments have indicated that icing promotes muscle regeneration.

In this study, the researchers focused on altering the severity of the muscle injury in the experiments. The reasoning behind this was that the majority of sports-related muscle injuries are limited; in other words less than 10% of the overall number of muscle fibers (myofibers) are damaged and necrotized. However, all animal experiments up until now had looked at more serious injuries where over 20% of the myofibers were damaged.

Thus, the team devised an animal model for mild muscle injuries, and experimented with applying ice after injury using a similar method as before.

Research Findings

After the animal was anesthetized, the muscle was exposed and clamped between forceps to induce injury. In their previous experiments, the researchers attached a 500g weight to the forceps, which induced an injury that affected 20% of the total number of fibers in the muscle. In the present study, they tried attaching a 250g weight to the forceps and demonstrated that this could be used to consistently injure 4% of the fibers (Figure 1). This is similar to the degree of injury that often occurs after sports activities such as vigorous exercise or long-distance marathon running.

Icing was carried out by placing polyethylene bags of ice on surface of the skin over three 30-minute sessions per day, with each session being 1.5 hours apart. This was continued until two days after injury for a total of nine icing sessions (i.e. immediately after injury = three sessions, one day after injury = three sessions, two days after injury = three sessions). The icing method was the same as in the previously reported study.

Observations of muscles that were regenerating in the icing group and no-icing group two weeks after injury revealed significant differences in the size of regenerating fibers in cross-sections. In other words, this demonstrated the possibility that

Macrophages are immune cells that orchestrate the reparative process of injured muscle. Pro-inflammatory macrophages accumulate in the damaged site soon after injury occurs, however they express an inducible nitric oxide synthase (iNOS), which has a disadvantageous side-effect of expanding the injury's size. The results of this team's experiments revealed that icing after mild muscle injury reduces the accumulation of iNOS-expressing pro-inflammatory macrophages. By causing this phenomenon, icing prevents the expansion of muscle injury size.

In other words, icing attenuates the recruitment of pro-inflammatory macrophages in the injury site. This was also reported in their previous study, demonstrating that this is an effect caused by icing regardless of whether the muscle injury is serious or mild. In the previous study, icing was found to delay the regeneration of muscle after a serious injury that destroyed many fibers because the pro-inflammatory macrophages were unable to sufficiently phagocytose the injured muscle. In contrast to this, the current study shows that icing has a positive effect when the muscle injury is mild because it prevents the secondary expansion of the muscle injury caused by the pro-inflammatory macrophages. It suggests that this particular effect of icing is connected to the promotion of muscle regeneration.

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CDC: Adults Need Only One Updated COVID Booster Shot, for Now

McKnight’s Home Care | By Alicia Lasek

The Centers for Disease Control and Prevention does not recommend more than one updated COVID-19 booster shot at this time for adults who have completed their primary series of vaccinations, according to guidance information updated this week.

The Food and Drug Administration in August authorized omicron-targeting vaccines made by Pfizer-BioNTech and Moderna as preferred COVID booster shots. Unlike the original monovalent vaccines, these vaccines are bivalent, protecting against both the original virus that causes COVID-19 and omicron variants BA.4 and BA.5.

In February, the CDC’s independent vaccine advisers decided that current evidence did not support more than one yearly dose of the newer, bivalent vaccines, including for older adults and other groups vulnerable to severe disease. That decision was largely based on a lack of existing data on the efficacy of multiple doses. But the CDC itself did not confirm a stance on the issue at the time.

The new CDC guidance appears a FAQ webpage directed at the public, as reported by the San Francisco Chronicle Tuesday. The CDC answers the hypothetical question of whether one should receive more than a single, updated booster by stating, “No. Currently, CDC recommends one updated COVID-19 booster dose” for everyone aged 5 years and older, and for certain younger children.

“If you have completed your updated booster dose, you are currently up to date. There is not a recommendation to get another updated booster dose,” it added in another post update March 2. In addition, the Food and Drug Administration has not authorized more than one shot.

Health officials appear to be leaning toward an emphasis on preventing severe disease as a priority over preventing infections, the Chronicle noted.

“The bottom line is that there is some waning of protection for those who got boosters more than six months ago and haven’t had an intervening infection,” Bob Wachter, MD,  chair of medicine at the University of California, San Francisco, told the news outlet. “[T]he level of protection versus severe infection continues to be fairly high, good enough that people who aren’t at super high risk are probably fine waiting until a new booster comes out in the fall.”

Clinically fragile adults, such as some elderly adults and many nursing home residents remain high risk of severe outcomes from COVID-19.  

In the meantime, the World Health Organization’s vaccination advisory group also has adjusted its COVID-19 vaccination guidance. It now recommends that countries prioritize at-risk older adults and frontline healthcare workers, among other high-risk groups — for both initial shots and boosters. With immunity levels high from infections and vaccinations, there is no longer an urgent need to prioritize healthy younger adults and children for the shots, it announced Tuesday.