UMR 1027, Toulouse, France CHU Toulouse, Service des Maladies Professionnelles et Environnementales, Toulouse, France Université Laval, Département de Médecine Sociale et Préventive, Cité Université, Québec, Canada INSERM U954, Vandœuvre-lès-Nancy, France CHU Nancy, Centre de Consultations de Pathologies Professionnelles, Vandœuvre-lès-Nancy, France.
Pain. 2012 Nov;153(11):2253-2259. doi: 10.1016/j.pain.2012.07.024. Epub 2012 Aug 31.
The role of psychosocial and physical factors in the development of shoulder pain has now been clearly demonstrated. However, only a few studies have analyzed these associations over time. The main goal of this study was to evaluate the predictive value of work-related psychological and mechanical factors on chronic shoulder pain. A total of 12,714 subjects (65% men) born in 1938, 1943, 1948, and 1953 participating in a French prospective longitudinal epidemiological investigation in 1990 to 1995 Enquête Santé Travail Et Vieillissement (ESTEV) were included. Clinical examination was performed by 400 trained occupational physicians. Personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between chronic shoulder pain and personal and occupational factors were analyzed using logistic regression modeling. A total of 1706 subjects experienced chronic shoulder pain in 1990, and 2089 experienced chronic shoulder pain in 1995. The incidence of chronic shoulder pain in 1995 was 11% (n=1355). Forceful effort (odds ratio [OR]=1.24 95% CI [1.05-1.44], awkward posture (OR=1.34 95% CI [1.19-1.52]), decision latitude (OR=1.19 [1.04 to 1.35]), and psychological demand (OR=1.19 95% CI [1.06-1.32]) in 1990 were significantly associated with chronic shoulder pain in 1995, even after adjustment for personal factors and previous shoulder pain status. Awkward posture (OR=1.43 [1.25 to 1.63]), psychological demand (OR=1.24 [1.09 to 1.40]), and decision latitude (OR=1.21 [1.04 to 1.41] work-related factors in 1990 were associated with the development of chronic shoulder pain between 1990 and 1995. These results suggest that awkward posture, forceful effort, job demand, and decision control are predictors of chronic shoulder pain at work. Interventions designed to reduce the incidence of chronic shoulder pain must include both mechanical and psychological factors.
心理社会和身体因素在肩痛发展中的作用现在已经得到明确证实。然而，只有少数研究分析了这些因素随时间的关联。本研究的主要目的是评估与工作相关的心理和机械因素对慢性肩痛的预测价值。共有 12714 名受试者（65%为男性），他们于 1938 年、1943 年、1948 年和 1953 年出生，参加了 1990 年至 1995 年期间进行的一项法国前瞻性纵向流行病学调查 Enquête Santé Travail Et Vieillissement（ESTEV）。临床检查由 400 名经过培训的职业医生进行。个人因素和工作暴露情况通过自我管理问卷进行评估。使用逻辑回归模型分析慢性肩痛与个人和职业因素之间的统计学关联。共有 1706 名受试者在 1990 年经历了慢性肩痛，2089 名受试者在 1995 年经历了慢性肩痛。1995 年慢性肩痛的发生率为 11%（n=1355）。1990 年，用力（比值比[OR]=1.24 95%置信区间[1.05-1.44]）、不自然姿势（OR=1.34 95%置信区间[1.19-1.52]）、决策自由度（OR=1.19 [1.04-1.35]）和心理需求（OR=1.19 95%置信区间[1.06-1.32]）与 1995 年的慢性肩痛显著相关，即使调整了个人因素和先前的肩痛状况。1990 年不自然姿势（OR=1.43 [1.25-1.63]）、心理需求（OR=1.24 [1.09-1.40]）和决策自由度（OR=1.21 [1.04-1.41]）与 1990 年至 1995 年期间慢性肩痛的发展相关。这些结果表明，不自然姿势、用力、工作需求和决策控制是工作中慢性肩痛的预测因素。旨在降低慢性肩痛发生率的干预措施必须同时包括机械和心理因素。
