Abstract
Work-related neck, shoulder and upper limb disorders are a subset of work-related musculoskeletal disorders (WRMD's) which affect the locomotor system. These conditions often result in pain, impairment and disability with associated economic cost. Disorders of indeterminate clinical diagnosis or non-specific musculoskeletal disorders make up the bulk of these conditions, are common in working populations and can significantly influence quality of life. Early assessment and management of these disorders is essential to enhance appropriate care and prevent long term disability. Valid and reliable measures of 'early effects' are required for active work place surveillance and screening of these disorders. Aims and objectives The primary aim of this study is to assess the utility of a number of functional physical examination screening tests for the identification of mild to moderate work-related neck, shoulder and upper limb disorders in working female computer users Methods A self selected convenience sample of 63 female computer workers completed a Nordic based self report questionnaire which included functional outcome measures and underwent a screening examination consisting of 60 examination tests. These tests examined posture, movement patterns, balance, nerve irritability, muscle length, strength and endurance and joint dysfunction of the cervicothoracic, shoulder, elbow/forearm, hand wrist and finger regions. The lumbopelvic region and lower limb were also screened. Participants were classified as a case or non-case of work-related morbidity by 12 month self report frequency and duration of neck shoulder symptoms. Self reported case status was used as the 'gold standard' for case definition. Sensitivity, specificity, predictive value and likelihood ratios were determined for each screening test. Results A high prevalence of self reported neck shoulder symptoms was identified. The examination tests generally demonstrated high sensitivity (>80%) and positive predictive values, poorer specificity (<80%) and low likelihood ratios (<4) with some exceptions. A number of the examination tests selected appear to have potential to be used as a component of a screening examination protocol for the early identification of WRMD's affecting the neck shoulder and upper limb in the study population. The nature of self report and a small non stratified sample limit the extrapolation of these findings to other populations. Conclusion The high prevalence of self reported WRMD's suggests methods are needed for the early detection of these conditions. Evaluation of functional capacity by some of the clinical examination tests examined in this study may provide an additional approach to ergonomic and questionnaire only based methods for the early detection of these common conditions. The identified tests could be incorporated into currently used surveillance and screening approaches to these disorders in working populations. Based upon the results of this study a theoretical model incorporating the current models of development of WMSD's and approaches to classification and assessment is proposed.