Cold exposure and musculoskeletal conditions; A scoping review

Abstract

Background: Musculoskeletal conditions are major contributors to years lived with disability. Cold exposure can be a risk factor, but any conclusion is obscure.Aim: The aim of the present scoping review was to identify the existing evidence of an association between cold exposure and musculoskeletal conditions. The aim also included to consider pain in different regions and their assessment, as well as different measures of cold exposure, effect sizes, and to assess the feasibility of future systematic reviews and meta-analyses.Eligibility criteria: The studies must have: an epidemiological design, defined cold exposure to come prior to the health outcome, defined exposure and outcome(s), existence of effect estimate(s) or data that made it possible to calculate such an estimate. Further, studies were required to be in English language and published in peer-reviewed journals. Studies that had a specific goal of studying cold exposure as an aggravator of already existing health problems were excluded.Sources: We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions(R), and Embase Classic + Embase for original studies.Charting method: The included studies were reviewed for study population, measurement of exposure and outcome, and effect size. Each publication was assessed for risk of bias.Results: The included studies were heterogeneous in populations, measures of cold exposure and musculoskeletal conditions. Most studies used self-reported data. They were mostly cross-sectional studies, only two were prospective and one was a case-control study. Associations were found for different cold exposures and regional musculoskeletal conditions, but the heterogeneity and lack of studies impeded valid synthesis of risk magnitude, or meta-analyses.Conclusion: The studies identified in this review indicate that cold exposure increases the risk of musculoskeletal conditions. However, there is a need for studies that better assess temporality between exposure and outcome. Future studies should also include better exposure assessment, including both objective measurements and measures of subjective experience of cold exposure. The heterogeneity in measurement of exposure and outcome impeded any meta-analysis.

Occupational cold exposure is associated with upper extremity pain

“…To conclude, the occurrence of upper extremity pain in our study was roughly in line with other recent investigations, although temporal data and more specific definitions of pain outcomes would have made comparisons easier. Our findings of statistical associations between contact and ambient cooling in relation to reporting upper extremity pain are also in line with the general trend of previous research ( 5 ).…”

“…In our study, any occurrence of upper extremity pain (regardless of location) was reported by 15%, which can be compared to official Swedish statistics, where roughly 19% reported work-related issues in the neck, shoulder and arm ( 19 ). In a recent scoping review, it was concluded that studies on the association between cold exposure and MSDs are heterogenous with regards to study samples, measures of exposure and outcome, as well as methodological approaches ( 5 ). However, the included studies generally indicated that cold exposure increases the risk of MSDs, and this was demonstrated separately for the hands and wrists ( 10 , 11 , 20 , 21 ), lower arms and elbows ( 11 , 20 , 21 ) as well as upper arms and shoulders ( 10 , 20 , 22 , 23 ).…”

“…However, the included studies generally indicated that cold exposure increases the risk of MSDs, and this was demonstrated separately for the hands and wrists ( 10 , 11 , 20 , 21 ), lower arms and elbows ( 11 , 20 , 21 ) as well as upper arms and shoulders ( 10 , 20 , 22 , 23 ). The effect sizes in the included studies varied widely, with point estimates (OR) ranging from 1.1 to 20.1, reflecting the heterogenous nature of the previous literature ( 5 ). In the study by Farbu et al, which was conducted in a quite similar setting as our study (as a population-based cohort in northern Norway), chronic pain in the hands was reported by 6%, in the arms 8%, and in the shoulders 13% among those who worked in a cold environment less than one quarter of the time ( 6 ).…”

“…There are also several literature reviews that have documented the impacts of hand-arm vibration exposure on the occurrence of MSDs ( 3 , 4 ). However, there is yet insufficient evidence to confidently determine the effects of contact and ambient cooling of the upper extremity in relation to development of pain and disability as consequence of MSDs ( 5 ). Previous population-based studies in a Scandinavian setting have documented associations between feeling cold at work and reporting long-standing pain in the hand, arm and shoulder, both in cross-sectional ( 6 ) and longitudinal analyses ( 7 ).…”

The association between cold exposure and musculoskeletal disorders: a prospective population-based study

“…There is a large body of occupational epidemiologic findings showing associations between NSP and LBP and several occupational ergonomic exposures, such as manual material handling, awkward body postures, repetitive movements, vibration, and high job demands (Ariens et al 2000;Marras 2000;Mayer et al 2012;Farioli et al 2014;Iqbal and Alghadir 2017;Kuijer et al 2018; Swedish agency for health technology assessment and assessment of social services 2022). However, it has been suggested that occupational cold exposure could be an additional risk factor for developing NSP and LBP (Pienimäki 2002;Mäkinen and Hassi 2009;Farbu et al 2021b, a).…”