Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models
From: BMC Musculoskelet Disord. 2009 Jun 19;10(1):73. [Epub ahead of print]
In the literature there is a discussion on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long term or short term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain.
Perceived stress was a risk factor for present pain, for developing pain and for number of years with pain. High work/study demands was associated with present pain; and with number of years with pain when the demands negatively affect home life. Computer use pattern (number of times/week with a computer session [greater than or equal to] 4h, without break) was a risk factor for developing pain, but also associated with present pain and number of years with pain. Among life style factors smoking was found to be associated to present pain. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study, but was smallest for the outcome ongoing pain compared to present pain and developing pain.
Pain was more prevalent among women than men for all outcome measurements, except for ongoing pain where result were indistinct. Perceived stress was a risk factor regarding developing pain, and was both a short term and a long term risk factor. Moreover, the results showed that high work/study demands were a short term and long term risk factor for neck pain. Computer use pattern was a risk factor for developing pain, but also both a short and a long term risk factor. The above findings, regarding type of factor and direction of association, are consistent with a systematic review concerning neck pain and with results in more recent studies. Smoking was a risk factor for pain at present. Less certain results regarding possible risk factors were that smoking was, in the simple model, associated with number of years with pain. High home life demands were, in the simple models, associated with pain at present and with number of years with pain. Asthma was, in the simple models, associated with developing pain and number of years with pain. In an earlier study, association between asthma and low back pain was shown. Results for ongoing pain were more uncertain, possibly due to the lower number of observations as only those reporting a period of pain in the baseline questionnaire were included. For ongoing pain perceived stress was a risk factor in the simple model, but only close to statistical significance in the multiple model. In the simple model gender was associated with ongoing pain, but in the multiple model the result was inconclusive.
The most consistent risk factors were perceived stress, high work/study demands and computer use pattern. In the frame work of the balance theory this could be interpreted as factors measuring some aspects of lack of balance between load and recourses or possibility for recovery. Computer use pattern to some degree measures the constant low intensity physical exposure of computer work without breaks for recovery. High work/study demands when negatively affecting home life could represent demands too high to allow for sufficient recovery after work. Perceived stress could be interpreted as the persons own perception of imbalance between loads and resources. This interpretation of the most important risk factors suggests that the preventive as well as the curative work, related to musculoskeletal neck pain, should focus on the balance between load and resources/recovery.
By the use of different regression models the different aspects of the neck pain pattern could be addressed and the risk factors impact on the pain pattern was identified. Short term risk factors were perceived stress, high work/study demands and computer use pattern (break pattern). Those were also long term risk factors. For developing pain perceived stress and computer use pattern were risk factors.
