WOMEN AT WORK DESPITE ILL HEALTH: DIAGNOSES AND PAIN BEFORE AND AFTER PERSONNEL SUPPORT A prospective study of hospital cleaners/home-help personnel with comparison groups B. J. Landstad, 1,2 K. Schu È ldt, 1,2 J. Ekholm, 1,2 L. Broman 1 and A. Bergroth 1,2,3 From the 1 Department of Public Health Sciences, Division of Rehabilitation Medicine, Karolinska Institute, Stockholm, 2 Centre for Studies on National Social Insurance, Mid Sweden University, O È stersund and 3 National Social Insurance Of®ce, Stockholm County, Sweden The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an indivi- dual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/ tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No bromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived “worst pain” was 70 mm on a visual analogue scale of 1–100 mm. Compar- isons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees. Key words: musculoskeletal diagnoses, referred pain, location of pain, intensity of pain, women, workplace intervention. J Rehab Med 2001; 33: 216–224 Correspondence address: B. J. Landstad, Department of Public Health Sciences, Division of Rehabilitation Medicine, Karolinska Institute/Hospital, Norrbacka Bldg. S1:01, S-171 76 Stockholm, Sweden. E-mail: Bodil.Landstad@ats.mil.se (Accepted February 2, 2001) INTRODUCTION Sweden has about 400,000 disability pensioners out of a total population of 8.8 million. The number of newly disability pensionersin 1999 was 38,000(NationalSocial InsuranceBoard database, Siluett). The total cost of disability pensions, sickness benets and disability allowances was about 9 billion Euro in 1998 (1). The most frequentdiagnosis resulting in the award of a disability pension is some form of musculoskeletal disease or disorder and this has been recognized as a major national problem. Theoretically the number of disability pensioners can be reduced either by increasing the number of long-term sick leavers reintroduced to the labour force or by decreasing the number of people who become long-term sick leavers. This paper deals with the latter alternative. It was felt important to study the effects of workplace actions aimed at preventing the transition from working despite ill health to long-term sick leave. This necessitated a study of what was causing the symptoms, i.e. of what diagnosis groups were involved. The incidence and prevalence of diseases/injuries have been reported for specic professional groups [see e.g. Hagberg & Wegman (2); for a review see Hagberg et al. (3)]. The prevalence of musculoskeletal diseases and disorders in a randomized Swedish population sample of working age was described in the Stockholm study (4–6). Disease/disorder prevalence is often described for either whole groups of employees or for long-term sick leavers only. There are no studies of the prevalence of disorders/diseases in subgroups of specic groups working despite ill health. Disease prevalence differs for different employment groups and circumstances; hence the need for specic studies. This lack of reports has led to a variety of guesses among people involved in rehabilitation about the reasons for this early sick-leave phase when people are able to work regularly, with the exception of short periods of sick leave. The occurrence of diseases/disorders in this very select group is particularly interesting as this phase may lead to long-term sick leave, with all its consequences. A frequent complaint among these employees was pain. Little is known about pain types and details in subgroupsof employees (3). In general, pain in lower or upper extremities (brachialgia) can occur in combination with more proximal focal pain in the Ó 2001 Taylor & Francis. ISSN 1650–1977 J Rehab Med 33 J Rehab Med 2001; 33: 216–224