ABSTRACT
An investigation into the work-related pain (WRP) experienced by Massage Therapists (MTs) in Ontario, Canada was undertaken using voluntary completion of an online questionnaire following broad distribution of requests to take part in this study. Data from respondents were included for analysis if they provided informed consent and were a currently or previously registered MT in the region. With voluntary participation, self-selection respondent bias must be considered in evaluating reported results. Valid questionnaires (n=1103) were analyzed both quantitatively and qualitatively. Massage therapists ranged in age from 20 to 73 years, and 85% of respondents were female. The overwhelming majority (85%) of MTs had experienced, or were experiencing, WRP at one or more of five pre-identified, primary locations with the hand/wrist, the most common site (65.5%); followed by the fingers/thumb (60.3%), shoulder (55.0%), lower back (50.1%), and neck (49.2%). Females were significantly more likely to report neck and shoulder pain than males, and were significantly more likely to report WRP at a higher number of body locations, with approximately one in five female MTs reporting WRP at all (5) primary sites. On a 10-point pain-severity scale, females reported significantly higher perceived pain than males. Work-related pain was attributed to the gradual onset of musculoskeletal conditions by 60.3% of respondents, with no other choice of cause being reported by more than 11.1%. There was clear indication of WRP impacting the lives of MTs, with 48% reporting an impact on activities of daily living, 31% reporting a loss of income, 54.6% working in pain, and 30.5% considering changing (or having changed) their profession. Various work adjustments to WRP were reported, including altered biomechanics and greater rest between patient treatments. The reported data suggested that WRP was a limiting factor for MTs' work capacity.
ABSTRACT
Electrocardiogram (ECG)-based detection of left ventricular systolic dysfunction (LVSD) has poor specificity and positive predictive value, even when including major ECG abnormalities, such as left bundle branch block (LBBB) within the criteria for diagnosis. Although machine-read ECG algorithms do not provide information on LVSD, advanced ECG (A-ECG), using multiparameter scores, has superior diagnostic utility to strictly conventional ECG for identifying various cardiac pathologies, including LVSD. METHODS: We evaluated the diagnostic utility of A-ECG in a case-control study of 40 patients with LVSD (LV ejection fraction < 50% by echocardiography), due to non-ischemic cardiomyopathy (NICM), and 39 other patients without LVSD. Diagnostic sensitivity and specificity for LVSD were determined after applying a previously validated probabilistic A-ECG score for LVSD to stored standard (10 s) clinical 12L ECGs. In 25 of the NICM patients who had serial ECGs and echocardiograms, changes in the A-ECG score versus in echocardiographic LV ejection fraction were also studied to determine the level of agreement between the two tests. RESULTS: Analyses by A-ECG had a sensitivity of 95% for LVSD (93% if excluding N = 11 patients with LBBB) and specificity of 95%. In the 29 NICM patients without LBBB who had serial ECGs, sensitivity improved to 97% when all ECGs were considered. By comparison, human readers in a busy clinical environment had a sensitivity of 90% and specificity of 63%. A-ECG score trajectories demonstrated improvement, deterioration or no change in LVSD, which agreed with echocardiography, in 76% of cases (n = 25). CONCLUSION: A-ECG scoring detects LVSD due to NICM with high sensitivity and specificity. Serial A-ECG score trajectories also represent a method for inexpensively demonstrating changes in LVSD. A-ECG scoring may be of particular value in areas where echocardiography is unavailable, or as a gatekeeper for echocardiography.
