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      Risk factors for traumatic and non-traumatic lower limb pain among preadolescents: a population-based study of Finnish schoolchildren

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          Abstract

          Background

          The child's lower limb is the most commonly reported musculoskeletal location with pain and also the most commonly injured site in sports. Some potential risk factors have been studied, but the results are inconsistent. We hypothesized that distinction of traumatic from non-traumatic pain would provide a clearer picture of these factors. The aim of this study is to assess factors associated with lower extremity pain and its impact on preadolescents in a population-based cohort.

          Methods

          A structured pain questionnaire was completed by 1756 schoolchildren of third and fifth grades to assess musculoskeletal pain, psychosomatic symptoms, subjective disabilities, school absence and frequency of exercise. In addition, hypermobility and physical fitness were measured.

          Results

          The knee was the most common site of pain followed by the ankle-foot and thigh. Of the children who reported pain in their lower extremity, approximately 70% reported at least one disability and 19 % reported school absence attributed to their pain during the previous three-month period. Children with traumatic pain had a higher subjective disability index than those with non-traumatic pain (P = 0.02). Age less than 11 years, headache, abdominal pain, depressive feelings, day tiredness, and vigorous exercise were more common in children with lower limb pain than those free of it. In the stratified analysis, younger age was related to both traumatic and non-traumatic pain groups. Vigorous exercise was positively associated with traumatic pain, while subjects with non-traumatic pain had more frequent psychosomatic symptoms.

          Conclusion

          Risk factors and consequences of traumatic and non-traumatic lower limb pain are not similar. Traumatic lower limb pain is associated with practicing vigorous exercise and high level of physical fitness, while non-traumatic pain is more correlated with psychosomatic symptoms. These differences might be one of the reasons for the discrepancy of previous research conclusions. The two conditions need to be treated as different disorders in future studies.

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          Most cited references35

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          A maximal multistage 20-m shuttle run test to predict VO2 max.

          In order to validate a maximal multistage 20-m shuttle run test for the prediction of VO2 max, 91 adults (32 females and 59 males, aged 27.3 +/- 9.2 and 24.8 +/- 5.5 year respectively and with mean VO2 max (+/- SD) of 39.3 +/- 8.3 and 51.6 +/- 7.8 ml . kg-1 . min-1 respectively) performed the test and had VO2 max estimated by the retroextrapolation method (extrapolation to time zero of recovery of the exponential least squares regression of the first four 20-s recovery VO2 values). Starting at 8 km . h-1 and increasing by 0.5 km . h-1 every 2 min, the 20-m shuttle run test enabled prediction of the VO2 max (y, ml . kg-1 . min-1) from the maximal speed (x, km . h-1) by means of the following regression equation: y = 5.857x - 19.458; r = 0.84 and SEE = 5.4. Later, the multistage protocol was slightly modified to its final version, in which the test started at stage 7 Met and continued with a 1 Met (3.5 ml O2 . kg-1 . min-1) increment every 2 min. Twenty-five of the 91 subjects performed the 20-m shuttle test twice, once on a hard, low-friction surface (vinyl-asbestos tiles) and another time on a rubber floor, as well as a walking maximal multistage test on an inclined treadmill. There was no difference between the means of these tests or between the slopes of the VO2max - maximal speed regressions for the two types of surfaces. The 20-m shuttle run test and another maximal multistage field test involving continuous track running gave comparable results (r = 0.92, SEE = 2.6 ml O2 . kg-1 . min-1, n = 70). Finally, test and retest of the 20-m shuttle run test also yielded comparable results (r = 0.975, SEE = 2.0 ml O2 . kg-1 . min-1, n = 50). It is concluded that the 20-m shuttle run test is valid and reliable test for the prediction of the VO2 max of male and female adults, individually or in groups, on most gymnasium surfaces.
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            Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence.

            A 1-year follow-up study of 1756 third- and fifth-grade schoolchildren was conducted with a structured pain questionnaire to assess the prevalence and persistence of self-reported musculoskeletal pain symptoms and disability caused by pain. At follow-up, 1626 (92.7%) children participated in the study. Pain at least once a week persisted in 270 (52.4%) of the 564 children who reported musculoskeletal pain at least once a week in at least one part of the body at baseline. Of the regional pain symptoms, neck pain had highest persistence and, in girls, significantly more than in boys. Persistence of pain was not related to school grade. Widespread pain, determined as in the criteria for fibromyalgia, was found in 132 children (7.5%) and persisted in 35 children (29.7%, 95% CI 21.9-38.4) at follow-up. Disability was more severe in children with pain symptoms in more than one area. This study showed that about half of the preadolescents complaining of musculoskeletal pain at least once a week at baseline had persistent pain symptoms at follow-up. The prognosis of widespread pain in preadolescents was almost the same as the previous findings in adults.
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              The health and productivity cost burden of the "top 10" physical and mental health conditions affecting six large U.S. employers in 1999.

              A multi-employer database that links medical, prescription drug, absence, and short term disability data at the patient level was analyzed to uncover the most costly physical and mental health conditions affecting American businesses. A unique methodology was developed involving the creation of patient episodes of care that incorporated employee productivity measures of absence and disability. Data for 374,799 employees from six large employers were analyzed. Absence and disability losses constituted 29% of the total health and productivity related expenditures for physical health conditions, and 47% for all of the mental health conditions examined. The top-10 most costly physical health conditions were: angina pectoris; essential hypertension; diabetes mellitus; mechanical low back pain; acute myocardial infarction; chronic obstructive pulmonary disease; back disorders not specified as low back; trauma to spine and spinal cord; sinusitis; and diseases of the ear, nose and throat or mastoid process. The most costly mental health disorders were: bipolar disorder, chronic maintenance; depression; depressive episode in bipolar disease; neurotic, personality and non-psychotic disorders; alcoholism;, anxiety disorders; schizophrenia, acute phase; bipolar disorders, severe mania; nonspecific neurotic, personality and non-psychotic disorders; and psychoses. Implications for employers and health plans in examining the health and productivity consequences of common health conditions are discussed.
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                Author and article information

                Journal
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                2006
                18 January 2006
                : 7
                : 3
                Affiliations
                [1 ]Tampere School of Public Health, FIN-33014 University of Tampere, Tampere, Finland
                [2 ]Department of Physical and Rehabilitation Medicine, University Hospital of Turku, P.O box 52, 20520 Turku, Finland
                [3 ]Tampere School of Public Health, and The Pediatric Research Center, FIN-33014 University of Tampere, Tampere, Finland
                [4 ]The Rheumatism Foundation Hospital, Pikijärventie 1, 18120 Heinola, Finland
                [5 ]Department of Physical and Rehabilitation Medicine, The Rheumatism Foundation Hospital, Pikijärventie 1, 18120 Heinola, Finland
                Article
                1471-2474-7-3
                10.1186/1471-2474-7-3
                1382225
                16420704
                4023eca2-3bba-431a-8a8a-ee53bf4c6bf8
                Copyright © 2006 El-Metwally et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 June 2005
                : 18 January 2006
                Categories
                Research Article

                Orthopedics
                Orthopedics

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