Prevalence of Upper Extremity Musculoskeletal Disorders in Patients with Type 2 Diabetes in General Practice
Abstract
:1. Introduction
Objectives
2. Methods
2.1. Approach 1 (RNFM Database)
2.2. Approach 2 (Questionnaire in General Practice)
- -
- The Douleur Neuropathique 4 questionnaire (DN4) [20,21,22,23]: A commonly used questionnaire for screening and diagnosing neuropathic pain in patients with neurological complaints, valid for the Dutch population and validated to be used in patients with DM. For our study purpose, we left out the physical examination questions, and only used the two interview questions, which composed of 7 items (yes/no answers). The cut-off point for neuropathic pain is considered to be 4 out of 7 points.
- -
- Pain questionnaire [24]: A six-item questionnaire that classifies chronic MSK pain is adapted from the version used in epidemiological research by the Arthritis Research Campaign in the United Kingdom, translated in Dutch, and previously used in the Maastricht Study.
- -
- Epidemiology of diabetes intervention and complications association questionnaire for cheiroarthropathy [25]: This questionnaire was used to assess the medical history of upper extremity MSK disorders (yes/no answers). We incorporated eight questions concerning history of symptoms and previous diagnosis while the examination part was excluded. These questions were translated from English to the Dutch language.
- -
2.3. Sample Size Calculation
2.4. Data Analysis
2.4.1. Approach 1: RNFM Database
2.4.2. Approach 2: Questionnaire Study
3. Results
3.1. Approach 1: RNFM Database
3.1.1. Study Population Characteristics
3.1.2. MSK Disorders Overall
3.1.3. Shoulder Complaints and Syndromes
3.1.4. Hand Complaints or Syndromes
3.1.5. Regression Analyses and Associations
3.2. Approach 2: Questionnaire Study
3.2.1. Study Population Characteristics
3.2.2. Prevalence on Complaint Level
I—Life-Time Prevalence
II—Point Prevalence
3.2.3. Prevalence on Diagnosis Level
3.2.4. Regression Analyses and Associations
4. Discussion
4.1. Comparison with the Literature
4.2. Strengths and Limitations
4.3. Clininal Implications and Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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RNFM Study | Questionnaire Study | ||||
---|---|---|---|---|---|
Characteristics | Patients with Type 2 Diabetes | Patients without Diabetes | Total | Patients with Type 2 Diabetes with Pain Complaints When Filling the Questionnaire | Patients with Type 2 Diabetes without Pain Complaints When Filling the Questionnaire |
n = 2669 | n = 2669 | n = 200 | n = 100 | n = 100 | |
Age | |||||
mean ± SD | 60.3 ± 8.1 | 60.3 ± 8.1 | 61.7 ± 6.8 | 61.5 ± 6.6 | 61.9 ± 6.9 |
range (years) | 20–70 | 20–70 | 32–70 | 38–70 | 32–70 |
Females % | 40.10% | 40.10% | 39.2%* | 46.5% * | 32.00% |
Duration of diabetes | |||||
mean ± SD | 8.6 ± 6.2 | NA | 9.5 ± 6.3 | 10.1 ± 6.9 | 8.9 ± 5.5 |
range (years) | 0–47 | 0–39 | 0–39 | 0–26 | |
BMI (kg/m2) | |||||
mean ± SD | NA | NA | 29.9 ± 5.7 | 30.2 ± 6.5 | 29.7 ± 4.8 |
range | 16.0–58.8 | 16.0–58.8 | 19.4–44.9 | ||
HbA1C (mmol/mol) | |||||
mean ± SD | NA | NA | 55.3 ± 11.3 | 55.7 ± 12.3 | 54.9 ± 10.3 |
range | 39.0–131.0 | 39.0–131.0 | 40.0–93.0 | ||
Rheumatoid arthritis | |||||
n | 10/2669 | 8/2669 | 22/195 * | 19/97 * | 3/98 * |
(%) | (0.40) | (0.30) | (11.30) | (19.50) | (3.10) |
Osteoarthritis | |||||
n | 24/2669 | 59/2669 | 82/196 * | 56/98 * | 26/98 * |
(%) | (0.90) | (2.20) | (41.80) | (57.10) | (25.80) |
ICPC Code | Patients with Type 2 Diabetes | Patients without Diabetes | OR (95% CI); p-Value |
---|---|---|---|
n | n | ||
(%) | (%) | ||
95% CI | 95% CI | ||
MSK overall (any ICPC code of the chosen codes) | 434/2669 | 300/2669 | 1.55 (1.3, 1.8); <0.001 |
(16.30) | (11.20) | ||
14.8, 17.7 | 10.0, 12.5 | ||
Any shoulder disease (ICPC: L08 or L92) | 242/2639 | 175/2639 | 1.41 (1.1, 1.7); 0.001 |
(9.20) | (6.60) | ||
8.1, 10.3 | 5.7, 7.6 | ||
Shoulder complaints (ICPC: L08) | 154/2573 | 102/2573 | 1.53 (1.1, 1.9); 0.001 |
(6.00) | (4.00) | ||
5.1, 6.9 | 3.2, 4.8 | ||
Shoulder syndromes (ICPC: L92) | 115/2491 | 84/2491 | 1.38 (1.04, 1.8); 0.023 |
(4.60) | (3.40) | ||
3.8, 5.5 | 2.7, 4.1 | ||
Any hand disease (ICPC L11, L12, N93, L99.03 or L99.04) | 260/2669 | 160/2669 | 1.71 (1.3, 2.1); <0.001 |
(9.70) | (6.00) | ||
8.6, 10.9 | 5.1, 6.9 | ||
Wrist complaints (ICPC: L11) | 40/2639 | 21/2639 | 1.83 (1.08, 3.1); 0.023 |
(1.50) | (0.80) | ||
1.1, 2.0 | 0.5, 1.2 | ||
Hand/finger complaints (ICPC: L12) | 98/2620 | 71/2620 | 1.42 (1.0, 1.9); 0.024 |
(3.70) | (2.70) | ||
3.0, 4.5 | 2.1, 3.4 | ||
CTS (ICPC: N93) | 52/2525 | 27/2525 | 2.02 (1.2, 3.2); 0.003 |
(2.10) | (1.10) | ||
1.5, 2.7 | 0.7, 1.5 | ||
Dupuytren’s contracture (ICPC: L99.03) | 38/2654 | 22/2654 | 1.79 (1.1, 3.0); 0.030 |
(1.40) | (0.80) | ||
1.0, 1.9 | 0.5, 1.2 | ||
Trigger finger (ICPC: L99.04) | 85/2626 | 32/2626 | 2.81 (1.8, 4.2); <0.001 |
(3.20) | (1.20) | ||
2.6, 4.0 | 0.8, 1.7 |
Overall MSK Disorders | Any Shoulder Disorder | Shoulder Complaints | Shoulder Syndrome | Any Hand Disease | Wrist Complaints | Hand/Finger Complaints | Trigger Finger | Dupuytren’s Contractor | CTS | |
---|---|---|---|---|---|---|---|---|---|---|
(Any ICPC Code of the Chosen Codes) | (ICPC: L08 or L92) | (ICPC: L08) | (ICPC: L92) | (ICPC L11, L12, N93, L99.03 or L99.04) | (ICPC: L11) | (ICPC: L12) | (ICPC: L99.04) | (ICPC: L99.03) | (ICPC: N93) | |
OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | OR (95% CI); p-Value | |
Age in years | ||||||||||
≤50 | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
51–55 | 1.5 (0.9–2.5); 0.098 | 1.5 (0.8–2.8); 0.197 | 1.3 (0.6–2.8); 0.444 | 2.5 (1.1–6.2); 0.039 | 1.4 (0.7–2.8); 0.258 | 0.8 (0.2–3.5); 0.836 | 0.5 (0.1–2.3); 0.421 | 2.8 (0.7–10.7); 0.116 | 1.3 (0.2–8.3); 0.723 | 2.7 (0.8–8.7); 0.087 |
56–60 | 2.1 (1.3- 3.4); 0.001 | 1.8 (1.01–3.2); 0.033 | 1.9 (1.0–3.8); 0.048 | 1.6 (0.7–4.0); 0.246 | 2.1 (1.2–3.8); 0.008 | 1.9 (0.6–6.0); 0.242 | 0.6 (0.2–2.2); 0.507 | 3.3 (0.9–11.5); 0.057 | 1.3 (0.2–6.8); 0.740 | 4.3 (1.5–12.5); 0.007 |
61–65 | 2.1 (1.3–3.3); 0.001 | 1.7 (1.0–3.1); 0.039 | 1.6 (0.8–3.2); 0.128 | 1.7 (0.7–4.1); 0.179 | 2.2 (1.2–3.9); 0.005 | 1.2 (0.3–3.8); 0.748 | 1.1 (0.4–3.4); 0.738 | 5.0 (1.5–16.8); 0.008 | 2.3 (0.5–10.9); 0.259 | 3.1 (1.08–9.1); 0.035 |
66–71 | 1.7 (1.1–2.6); 0.015 | 1.3 (0.7–2.2); 0.322 | 1.0 (0.5–2.0); 0.908 | 1.7 (0.7–3.8); 0.200 | 1.8 (1.03–3.1); 0.037 | 1.4 (0.4–4.2); 0.524 | 0.8 (0.2–2.3); 0.680 | 2.4 (0.7–8.1); 0.153 | 2.5 (0.5–11.1); 0.213 | 2.4 (0.8–7.1); 0.093 |
Females | 1.3 (1.1–1.7); 0.002 | 1.2 (0.9–1.5); 0.164 | 1.1 (0.8–1.5); 0.523 | 1.2 (0.8–1.8); 0.187 | 1.6 (1.2–2.1); 0.000 | 3.4 (1.9–6.2); 0.000 | 2.3 (1.2–4.4); 0.009 | 1.7 (1.1–2.6); 0.016 | 0.8 (0.4–1.6); 0.596 | 1.7 (1.1–2.5); 0.008 |
Duration of diabetes in years | ||||||||||
0–2 | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference b | Reference |
3–5 | 3.02 (1.7–5.2); 0.000 | 2.9 (1.3–6.4); 0.006 | 4.5 (1.5–12.9); 0.005 | 1.8 (0.5–5.8); 0.290 | 3.5 (1.7–7.3); 0.001 | 4.1 (0.5–34.0); 0.184 | 1.4 (0.2–7.6); 0.640 | 2.9 (0.8–10.3); 0.088 | Reference b | 3.4 (1.1–10.1); 0.023 |
6–8 | 3.5 (2.08–6.1); 0.000 | 3.7 (1.7–8.0); 0.001 | 5.1 (1.8–14.8); 0.002 | 2.3 (0.7–7.1); 0.131 | 3.8 (1.8–7.9); 0.000 | 5.0 (0.6–40.4); 0.130 | 2.9 (0.6–13.7); 0.171 | 3.7 (1.08–12.7); 0.037 | 2.4 (0.8–6.9); 0.090 | 2.2 (0.7–6.7); 0.162 |
9–11 | 4.8 (2.8–8.3); 0.000 | 6.0 (2.8–12.9); 0.000 | 7.1 (2.5–20.3); 0.000 | 6.4 (2.2–18.4); 0.000 | 4.8 (2.3–9.9); 0.000 | 11.5 (1.5–88.0); 0.018 | 5.1 (1.1–23.2); 0.031 | 3.1 (0.9–11.1); 0.072 | 2.5 (0.8–7.2): 0.079 | 3.6 (1.2–10.8); 0.018 |
≥12 | 5.7 (3.3–9.6); 0.000 | 6.6 (3.1–13.8); 0.000 | 7.7 (2.7–21.5); 0.000 | 7.2 (2.5–20.2); 0.000 | 5.7 (2.8–11.6); 0.000 | 10.7 (1.4–80.9); 0.021 | 2.7 (0.5–12.6); 0.201 | 6.1 (1.8–20.1); 0.003 | 3.1 (1.2–8.1); 0.020 | 4.5 (1.6–13.0); 0.004 |
Pain Prevalence | (n) | % | 95% CI |
---|---|---|---|
Pain Life time prevalence per body site, n = 200 | |||
Any painful body site for at least 4 weeks (Shoulder, arm, elbow, hand or fingers) | 134 a | 67.3 | 61.0, 75.0 |
Any shoulder complaints | 89 b | 46.6 | 39.6, 54.0 |
Painful stiff Shoulder | 69 | 34.5 | 28.4, 42.1 |
Pain Point prevalence per body sites, n = 200 a | |||
Shoulder: any side * | 78 | 39.2 | 32.3, 46.0 |
unilateral | 44 | 22 | 16.2, 27.9 |
Elbow: any side * | 27 | 13.6 | 8.7, 18.3 |
unilateral | 21 | 10.6 | 6.2, 14.8 |
Wrist: any side * | 10 | 5 | 1.9, 8.0 |
unilateral | 6 | 3 | 0.6, 5.4 |
Upper arm: any side * | 14 | 7 | 3.4, 10.6 |
unilateral | 8 | 4 | 1.2, 6.7 |
Forearm: any side * | 8 | 4 | 1.2, 6.7 |
unilateral | 6 | 3 | 0.6, 5.4 |
Hand (including fingers): any side * | 61 | 30.7 | 24.1, 37.1 |
unilateral | 26 | 13 | 8.3, 17.7 |
Prevalence ofthe most painful affected body sites, n = 200 c | |||
Shoulder any side * | 43 | 22.8 | 16, 28 |
unilateral | 33 | 16.5 | 26, 46 |
Hand (including fingers) | 24 | 12.7 | 17, 35 |
Wrist | 3 | 1.6 | −0.02, 3.3 |
Prevalence of specific MSK disorders, n = 200 | |||
Frozen shoulder | 79 b | 41.4 | 33.5, 48.2 |
Carpal tunnel syndrome | 106 b | 55.5 | 48.8, 63.6 |
Trigger finger | 76 b | 39.8 | 30.8, 45.3 |
Dupuytren’s contracture | 79 d | 41.1 | 34.6, 49.4 |
Shoulder Pain Point Prevalence OR (95% CI); p-Value n = 78/200 | Frozen Shoulder OR (95% CI); p-Value n = 79/200 | Carpal Tunnel Syndrome OR (95% CI); p-Value n = 106/200 | Trigger Finger OR (95% CI); p-Value n = 76/200 | Dupuytren’s Contracture OR (95% CI); p-Value n = 79/200 | |
---|---|---|---|---|---|
p-Value | p-Value | p-Value | p-Value | p-Value | |
n = 78/200 | n = 79/200 | n = 106/200 | n = 76/200 | n = 79/200 | |
Age in years | 0.9 (0.9, 1.0); 0.144 | 0.9 (0.8, 0.9); 0.005 | 0.9 (0.9, 1.0); 0.441 | 1.03 (0.9, 1.1); 0.204 | 1.06 (1.006, 1.0); 0.031 |
Female | 1.5 (0.7, 3.0); 0.250 | 1.04 (0.5, 2.0); 0.902 | 2.2 (1.1, 4.6); 0.023 | 1.2 (0.6, 2.6); 0.468 | 1.09 (0.5, 2.2); 0.802 |
Duration of diabetes | 1.07 (1.0, 1.1); 0.015 | 1.03 (0.9, 1.1); 0.291 | 1.04 (0.9, 1.1); 0.216 | 1.03 (0.9, 1.1); 0.200 | 1.005 (0.9, 1.1); 0.848 |
BMI | 0.9 (0.9, 1.1); 0.943 | Cat 1: Ref * Cat 2: 0.3(0.1–0.9);0.036 Cat 3: 0.4(0.1–1.2);0.121 Cat 4: 0.2(0.4–1.3);0.099 | 0.9 (0.9, 1.1); 0.845 | 1.05 (0.9, 1.1); 0.104 | 1.04 (0.9, 1.1); 0.106 |
HbA1C | 0.9 (0.9, 1.0); 0.793 | 0.9 (0.9, 1.0); 0.293 | 1.01 (0.9, 1.0); 0.504 | 0.9 (0.9, 1.0); 0.588 | 1.02 (0.9, 1.1); 0.102 |
Rheumatoid arthritis | 4.5 (1.4, 14.6); 0.012 | 3.7 (1.2, 11.4); 0.022 | 0.5 (0.1, 2.0); 0.383 | 7.0 (1.8, 27.8); 0.005 | 1.5 (0.5, 4.5); 0.417 |
Other joint inflammation | 1.2 (0.5, 2.9); 0.625 | 1.07 (0.4, 2.5); 0.861 | 2.8 (1.1, 7.4); 0.033 | 1.7 (0.7, 4.3); 0.189 | 1.02 (0.4, 2.4); 0.961 |
Osteoarthritis | 3.1 (1.5, 6.2); 0.001 | 2.5 (1.2, 5.1); 0.011 | 4.2 (2.0, 8.8); <0.001 | 1.5 (0.7, 3.0); 0.236 | 3.1 (1.5, 6.2); 0.001 |
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Alabdali, L.A.S.; Jaeken, J.; Dinant, G.-J.; van den Akker, M.; Winkens, B.; Ottenheijm, R.P.G. Prevalence of Upper Extremity Musculoskeletal Disorders in Patients with Type 2 Diabetes in General Practice. Medicines 2021, 8, 8. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8020008
Alabdali LAS, Jaeken J, Dinant G-J, van den Akker M, Winkens B, Ottenheijm RPG. Prevalence of Upper Extremity Musculoskeletal Disorders in Patients with Type 2 Diabetes in General Practice. Medicines. 2021; 8(2):8. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8020008
Chicago/Turabian StyleAlabdali, Login Ahmed S., Jasmien Jaeken, Geert-Jan Dinant, Marjan van den Akker, Bjorn Winkens, and Ramon P. G. Ottenheijm. 2021. "Prevalence of Upper Extremity Musculoskeletal Disorders in Patients with Type 2 Diabetes in General Practice" Medicines 8, no. 2: 8. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8020008