Balogh I, Orbaek P, Winkel J, Nordander C, Ohlsson K, Ektor-Andersen J
Department of Occupational and Environmental Medicine, Lund University, Lund University Hospital, Sweden.
Scand J Work Environ Health. 2001 Feb;27(1):41-8. doi: 10.5271/sjweh.585.
This study attempts to construct valid indices for mechanical exposure of the shoulder-neck region with relation to the development of shoulder-neck pain in a 1-year perspective study of a general population.
A comprehensive questionnaire was presented to 14 556 subjects aged 45 or 65 years and repeated after 12 months. Twenty-four questions concerning positions, movements, and manual materials handling were registered on a 3-point impact scale. Musculoskeletal problems were reported on a slightly modified version of the Standardized Nordic Questionnaire for the Analysis of Musculoskeletal Symptoms. Test-retest stability after 2 weeks was calculated for 232 consecutive participants. Based on mechanistic theories, 4 exposure indices were formed. Another 5 constructs were obtained by factor analysis.
All the indices showed good test-retest stability, and 5 of them had very good internal consistency. Due to overlaps between the indices, 2 indices stood out as having unique properties. One of them concerned mainly postures and the other dealt primarily with measured lifting. However, the latter was not related to the shoulder-neck pain outcome when adjusted for the posture index. The posture index showed an exposure-effect relationship with the outcome. The job titles implied a large degree of exposure misclassification.
The posture index is recommended as a mechanical exposure index for analyses of interaction with other possible determinants of shoulder-neck pain (ie, psychosocial factors). The use of such an index instead of job titles in large population studies will reduce the risk of misclassification.
在一项针对普通人群的为期1年的前瞻性研究中，本研究试图构建与肩颈疼痛发展相关的肩颈区域机械暴露有效指标。
向14556名年龄在45或65岁的受试者发放一份综合问卷，并在12个月后再次发放。关于姿势、动作和手工搬运材料的24个问题以3分影响量表进行记录。肌肉骨骼问题通过对标准化北欧肌肉骨骼症状分析问卷的略微修改版本进行报告。对232名连续参与者计算了2周后的重测稳定性。基于机械理论，形成了4个暴露指标。通过因子分析获得了另外5个结构。
所有指标均显示出良好的重测稳定性，其中5个具有非常好的内部一致性。由于指标之间存在重叠，有2个指标具有独特的性质。其中一个主要涉及姿势，另一个主要涉及测量的提举。然而，在调整姿势指标后，后者与肩颈疼痛结果无关。姿势指标与结果呈现暴露-效应关系。职业头衔存在很大程度的暴露错误分类。
建议将姿势指标作为机械暴露指标，用于分析与肩颈疼痛其他可能决定因素（即心理社会因素）的相互作用。在大型人群研究中使用这样的指标而非职业头衔将降低错误分类的风险。
