No abstract

Disorders of the musculo-skeletal system are one of the main occupational diseases occurring in industrial countries and the number of reported cases is rapidly increasing, especially among the older age groups. Musculo-skeletal diseases can be influenced by a number of stress factors arising during physical work. The aim of this study is to identify the physical work stress factors, to which persons already suffering from musculo-skeletal diseases (patients at a rehabilitation center) have been exposed in their work, and, firstly, to examine whether these data can be used to predict the probability of future musculo-skeletal disorders in workers occupying this type of job, secondly, to determine how these factors interact with each other in the development of these disorders. Trained specialists in occupational medicine using a program called Medical Job-oriented Rehabilitation (MJOR), collected data on 6668 patients by means of a standardized checklist called Bavaria Rehabilitation Assessment Method (BRA). Analysis of the recursive binary partitioning trees revealed that 19 predictor variables corresponding to age and gender, plus repetitive operations, rotation in sedentary position, degree of hand force used and forced head/neck postures were good predictors for the disorders of the hand-/arm system, the cervico-brachial syndrome and the impingement syndrome of shoulder.

The current paper examines an assessment instrument used for combined medical and occupational rehabilitation (MOR) in a group of German hospitals. Patients with a history of musculo-skeletal disease make up a significant proportion of those undergoing rehabilitation. Scale and factor structures, discriminant factors and clustering procedures used in the Bavaria rehabilitation patient assessment method (BRPAM) are investigated in a cross-sectional study involving a sample of 800 patients. Although the results reveal good correlation between differences in the job demand/patient capability profiles and the typical stresses to which the relevant occupation is exposed, analyses also indicate that several factors and items are unstable. According to subjective assessment by the patients, the therapeutic objectives are fully attained in some 80% of cases. Discrepancies between job demands and patient capability revealed by the BRPAM yield pointers to choice of therapy and its chances of success, but these need to be examined in greater detail in long-term studies.