key: cord-0272247-mpv0oic2 authors: Bouziri, H.; Descatha, A.; Roquelaure, Y.; Dab, W.; Jean, K. title: Disentangling the roles of demographic and temporal changes in the incidence and prevalence of musculoskeletal disorders: a systematic review. date: 2021-09-23 journal: nan DOI: 10.1101/2021.09.20.21263840 sha: b92101c7aa6a6539468e54c7c1ad2510875b6af3 doc_id: 272247 cord_uid: mpv0oic2 Background: Musculoskeletal disorders (MSDs) accounted for nearly 1.71 billion people worldwide in 2019 with an estimate of over 126.6 million Americans (or one in two adults) affected and 40 million European workers in 2017. Since age constitutes an important risk factor for MSDs, the overall aging of the working population is expected to influence the burden of disease. However, factors other than aging may play a role in the global trends in MSDs We conducted a systematic review to summarize the evidence on the role of demographic and temporal changes in the occurrence of MSDs. Methods: The study protocol was registered in PROSPERO with the number CRD42020221499. Following the PRISMA guidelines, we searched PubMed, ScienceDirect and Web of Science over the 1990-2020 period for articles reporting temporal trends in MSDs incidence or prevalence in the general working-age population. We only included articles controlling for age in the analysis. To ensure the quality of the articles, the bias risk was assessed using the RoB-SPEO tool. The main indicators we extracted were age-controlled time trends in MSDs incidence or prevalence. Results: Among 966 articles, 16 fulfilled the inclusion criteria, representing 23 results according to the indicators extracted. No study was found with a high risk of bias. Nine used a definition of MSDs based on pain and 14 based on repercussions on work or social life. Twelve results presented time trends in prevalence and 11 in incidence. After controlling for age, temporal trends in MSDs presented some heterogeneity. Indeed, 10 results documented increases and 12 reported non-monotonic changes. Only 1 result reported a decreasing trend in the incidence of MSDs. Several factors other than aging were suggested to explain temporal trends in MSDs, mainly trends in obesity, changing occupational exposures, and cultural factors regarding pain tolerance. Conclusion: This review shows that factors in addition to aging of the working population may contribute to varying or increasing trends in MSDs. Results also highlight the scarcity of available evidence on time trends in the burden of MSDs and their underlying causes. In this systematic review, we collated and analyzed existing evidence on the respective roles 77 of demographic and temporal changes in the occurrence of MSDs. We searched four different electronic bibliographic databases for studies published between 87 1990 and 2020: Medline, ScienceDirect, Wiley, and Web of Science. The search terms 88 included: 1) "Musculoskeletal disease*" AND ("time trends" OR "time trends" OR "over time") 89 AND ("incidence" OR "prevalence"); 2) ("Musculoskeletal disease*" OR "Musculoskeletal 90 disorder*" OR "Absence of disease specific to professional diagnosis") AND ("time trends" 91 OR "time trends" OR "over time") AND ("incidence" OR "prevalence"); 3)"Musculoskeletal 92 disorder*" AND ("time trends" OR "time trends") AND ("incidence" OR "prevalence"). The Covidence Systematic Review software allowed the selection of studies, their download, and 94 the removal of duplicates [22] . Once the articles were selected by keywords, a first selective 95 screening was carried out based on titles and abstracts (step 1). Only original articles were 96 included; conference reports, literature reviews, and editorials were excluded. At this stage, 97 only articles that reported MSD or MSD proxies as primary or secondary outcomes while 98 mentioning the notion of temporal trend were included. The final inclusion of articles (step 2) was done based on a complete review of those 101 selected in the previous step. Articles defining MSD as a group or set of diseases localized 102 at or around the joints (wrists, elbows, shoulders, spine, or knees) were selected. The Both steps 1 and 2 were performed by two independent authors to assess the eligibility of 113 studies identified in the databases. Any conflict in article screening or full-text assessment 114 was resolved by a third senior researcher. All articles included were read for the 115 identification and extraction of the following characteristics: geographical localization, 116 population studied, study design and recruitment, start and end date of follow-up, MSD sites 117 (superior members, inferior members & back, or not specified), criteria used for MSD 118 definition (either based on pain or on disability), a diagnostic method for MSD. 119 120 2. Assessing risk of bias and quality of evidence To assess the risk of bias across included studies, we used the RoB-SPEO tool [23] . Most of 122 the bias judgmental criteria were adapted from the last systematic reviews of the Navigation 123 Guide. As this review focuses on temporal trends in a set of diseases and not on an 124 association with a specific exposure, we did not analyze bias related to exposure criteria. The biases we assessed were selection bias, potential biases linked to misclassification of 126 MSDs, biases due to incorrectly taking confounding factors into account, and bias due to 127 potential conflict of interest. Each article has been classified according to its level of bias 128 (low, probably low, probably high, high). We also assessed the quality of the statistical trend 129 tests by using this classification: satisfactory quality, probable satisfactory quality, probable All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2021. ; Among the articles included, 5 defined MSDs based on pain, and 11 defined them according 184 to a disabling disability. These 11 articles relying on a disabilities-related MSDs definition 185 were conducted in the Scandinavian countries, the United Kingdom, and Australia. Among 186 those, the site of MSDs was not specified for 8 articles, 2 articles considered MSD affecting 187 the inferior members and the back, and 1 considered MSD affecting the superior members. were considered likely to be at low risk of bias since here we are only looking at temporal 203 trends in MSDs. In the included studies, most of the study authors did not declare a conflict 204 of interest, nor did they receive any support from a company suggesting that there could be 205 a financial interest in the results. Therefore, we assessed these studies as having a low risk 206 of bias in this area. For the studies not clearly mentioning it in the paper, we checked that all 207 the authors were affiliated with public (research) agencies or scientific institutions and when justify an exclusion from the review ( Table 1) Table 2 ). Table 2) . The results show that the temporal evolution of the incidence of MSDs causing disability 240 tends to increase or vary according to their site. Among the 6 articles not specifying the All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2021. ; This literature review identified a limited number of articles reporting temporal trends in 279 MSDs by controlling for age. Study duration ranged from 10 to 55 years across studies, 280 which allowed for analyzing the occurrence of MSDs over a long term. Temporal trends in 281 MSDs varied according to the site of the MSDs, the criteria used to define MSDs (either 282 assimilated to pain and/or a disability), and the indicator used (prevalence or incidence). We 283 observed heterogeneity of the temporal trends of treated MSDs which mainly varied between 284 non-monotonic or increasing trends. Of note, based on studies reporting both crude and 285 age-controlled trends, we observed that accounting for or not accounting for age could lead 286 to diverging temporal trends, at least among the highest age categories. [7] 'Annual Activity Report 2020 -Safety and health at work -EU-OSHA'. All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2021. ; All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2021. ; Figure 2 : Temporal trends of the incidence and prevalence of MSDs according to their location and severity. A. Temporal trend of the prevalence of MSDs inducing repercussions on work or social life with age considerations. B. Temporal trend of the prevalence of pain with age considerations. C. Temporal trend of the incidence of MSDs inducing repercussions on work or social life with age considerations. All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Legend for the bias: low in green, probably low (PL) in light green, probably high (PH) in light orange, high in orange. Legend for the quality of the statistical tests: satisfactory quality (SQ) in green, probable satisfactory quality (PSQ) in light green, and probable unsatisfactory quality (PUS) in light orange. 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