The Course of Nonspecific Work-Related Upper Limb Disorders and the Influence of Demographic Factors, Psychologic Factors, and Physical Fitness on Clinical Status and Disability

van Eijsden-Besseling MD, van den Bergh KA, Staal JB, de Bie RA, van den Heuvel WJ. The course of nonspecific work-related upper limb disorders and the influence of demographic factors, psychologic factors, and physical fitness on clinical status and disability. Objective: To assess the course of nonspecific work-related upper limb disorders (WRULD) and the influence of sociodemographic factors, psychologic factors, and physical fitness on clinical status and functional disability. Design: Retrospective cohort study with cross-sectional analysis among computer workers with several stages of nonspecific WRULD; average follow-up 4 years. Sociodemographic and medical characteristics were assessed based on medical records at onset and diagnosis. After informed consent at follow-up, participants received a questionnaire assessing psychologic and physical fitness characteristics. Setting: Outpatient department of rehabilitation medicine, University Hospital Maastricht; tertiary referral center for nonspecific WRULD. Participants: Computer workers (N=182) with nonspecific WRULD, 18 to 50 years, first consultation 1998 to 2001; those with specific WRULD and incomplete medical records and treatment charts were excluded. Interventions: Not applicable. Main Outcome Measures: Stage of nonspecific WRULD (clinical status) and Disabilities of Arm, Shoulder and Hand questionnaire [DASH] (functional disability). Results: A total of 104 patients (57%) returned the completed questionnaire at follow-up (November 2003). Fourteen percent developed chronic benign pain syndrome, 9% recovered. The remaining (77%) worsened slightly. A higher DASH score was associated with being elderly (unstandardized regression coefficient [B=.64]), being a woman (B=10.42), having a lower educational achievement (B=9.72), and poorer self-reported physical fitness level (B=1.68); lower educational achievement and poorer self-reported physical fitness were associated with a more severe clinical status. Psychologic factors did not influence disability or clinical status. Conclusions: The prognosis of computer workers with nonspecific WRULD is not favorable. Those with a lower educational achievement and poorer self-reported physical fitness are at risk for a more severe clinical status and functional disability. Being elderly and a woman are also risk factors for further disability. A prospective cohort study is needed to unravel these relationships. Nevertheless, computer workers with nonspecific WRULD should be encouraged to enter fitness programs.

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