| Background and PurposeMusculoskeletal disorders and complaints comprise an important public health problem due to high impact on disability, sickness absence and work disability, and health care costs. Pain also common in older women as well but many women experience an increase of symptoms during the climacteric transition, and often attribute their problems to menopause. The age of 40 is usually considered to be the point when climacteric period starts, but many researchers claim this phase could begin from the age of 35 years too. To date, the population-based data on musculoskeletal symptoms in different anatomical sites are scarce, especially in community-based sample of the climacteric women. Treatment of osteoarthritis aims to reduce pain. Recent guidelines for the management of knee osteoarthritis emphasise the central role of exercise. Most studies focus on the conditions of osteoarthfitis, but relatively few studies examine the relationships between the rehabilitation exercise and musculoskeletal pain in climacteric women, especially in the prospective, randomized, double-blind multinational clinical trial. In this study, we proposed to recruit a cohort of pre-, peri-, and postmenopausal women, and characterize the chronology and physiological concomitants of the pre- and postmenopausal transition. This paper aims to report the methodology of the study of this cohort, related factors and prevalence of musculoskeletal symptoms, and to study the effect of the rehabilitation exercise on musculoskeletal pain. It could supply more evidence for the rehabilitation exercise on the prevention and control of musculoskeletal pain in climacteric women as a assistant way.Objective:1. To investigate the related factors and prevalence of musculoskeletal symptom in women aged 35-64.2. To explore whether rehabilitation exercise mode in menopausal women with musculoskeletal pain would affect skeletal pain, body mass, body mass index, knee extensors muscle strength.Materials and methods:1. 743 women aged 35-64 years who lived Beijing community attended our survey by the stratum clustering sample method. We conducted the survey by face-to-face interview with the questionnaire. The items of the questionnaire are detailed as following: the basic conditions (such as age, career, education, income, etc), the current and previous heath condition, menses and parity, musculoskeletal symptom in recent 2 weeks, height and weight, etc.2. The fifty menopausal women with musculoskeletal pain were randomized to join the intervention or control group: 25 participated in the intervention group and 25 in the control group. Participants of the intervention group were given 12-week exercise-based rehabilitation program. The content of the program is to advise subjects in the intervention group to perform all walking bouts on treadmills, 40 minutes one time, 3 times a week. The exercise intensity is equivalent to 65-70% of the maximum heart rate. Participants of the control group were requested to continue their life style and to record the duration, speed and RPE in a training diary, the researcher give them some advices such as avoiding climbing and so on. Pain intensity was measured by visual analogue scale (VAS).3. Definitions and criterions: The musculoskeletal symptom includes hand-joint swelling, stiffness, neck pain, low back pain, knee pain and pain in other sites. To examine the degree of musculoskeletal pain, the subjects were asked about the frequency of pain. One answer was selected from these three selections: 'rarely', 'occasionally' and 'frequently', and scored as 0, 1 and 2, respectively. To examine stiffness or hand-joint swelling, the subjects were asked 'no', 'yes', and scored as 0 and 1, respectively. Menopausal status is subdivided into three groups according to PENN-5 definition of The Journal of The North American Menopause Society: Premenopause, menopausal transition, Postmenopause. Premenopause Regular is defined as cycles, with no change in cycle length (21-35days). menopausal transition is defined as≥2 cycle length changes, (≥7 days) or 3-11 months of amenorrhea. Postmenopause is defined as≥12 months of amenorrhea. The subjects were divided into two groups based on 'STRAW' staging system: early menopause, late menopause. Early menopause is defined as first 5 years of menopause. Late menopause is defined as more than 5 years of menopause.StatisticsAll data were entered into database Epidata3.02 and were analyzed by SPSS11.5 (statistics software package for social science). Qualitative data were analyzed by frequency, proportion; quantitative data were analyzed by mean and standard deviation; measurement data were compared by T test or ANOVA for normally distributed continuous variables and the non-parameter test for skewed continuous variables. The prevalence of symptoms was compared between the categories of each background factor by using Chi-square test. Logistic regression was used to choose the significant factors relating to musculoskeletal symptoms. P＜0.05 was considered significant.Results1. 743 women aged 35-64 years (96.1% of the total participants) participated in the present study and were accepted for it.2.The musculoskeletal symptoms were commonly reported by women, including low back pain (72.8%), neck pain (61.1%), knee pain (56.8%), the other sites pain (61.4%), stiffness(23.6%), hand joint swelling(21.1%).3. The difference in prevalence of musculoskeletal symptoms among three menstrual status groups was statistically significant (P＜0.01). Postmenopausal women experienced a significantly higher prevalence of musculoskeletal symptoms compared with pre and postmenopausal women. Early Postmenopausal women reported a significantly higher prevalence of stiffness than the three other groups of women.4. By using multiple logistic regression model, a high risk for neck pain was independently associated with menopausal transition, early postmenopause, late postmenopause, higher educational level (OR=1.665,OR= 1.879, OR=1.733,OR=1.497); knee pain were independently associated menopausal transition, early postmenopause, late postmenopause, weight gain, aging, higher educational level (OR=2.131 ,OR=2.506, OR=2.257, OR=1.085,OR= 1.050, OR=1.240); stiffness were independently associated early postmenopause, obesity, aging(OR=2.272,OR=1.865,OR=1.061); low back pain were independently associated menopausal transition, early postmenopause, (OR=2.194,OR=1.698); hand joint swelling were independently associated aging, obesity (OR=1.044,OR=1.955); the other sites pain were independently associated menopausal transition ,early postmenopause, weight gain, marital status, Employment.5. Significant statistical differences in low back pain and in knee pain were found between the intervention and the control group groups after 12-week intervention (P＜0.05, P＜0.01 ) ;6. Significant decrease in body mass index and reduction in percentage of body fat were found within the intervention group between baseline and 12-week measurements. Significant increase in body mass index and reduction in percentage of body fat were found within the control group. Comparison of the extent of change between groups showed no statistical significant differences (P＞0.05) ;7. No significant statistical changes were found in Lumbar spine BMD, Total body BMD, BMD femoral neck and knee extensors muscle strength in either group (P＞0.05).8. No participants reported the activity-related injuries, their adherence to the protocol was 96.0%, the drop-out rate in the study was 8.0%.Conclusion1. The musculoskeletal symptoms were commonly reported by women aged 35-64. Low back pain was the most prevalent symptom.2. The most important determinants that impaired the whole profile of low back pain were menopause, high level of education. 3. Neck pain was negatively affected by the variables of menopausal transition, menopause, high level of education.4. Several variables were independently affecting the risk of knee pain such as aging, weight gain, menopausal transition status, postmenopausal status, high level of education.5. Perimenopausal status, early menopausal status, marital status, Employment, higher body mass index were risk factors, which contributed to any musculoskeletal site pain.6. The risk of stiffness in the total cohort worsened in line with aging, obesity, early menopausal status.7. Aging and obesity were also independently associated with hand joint swelling reporting.8. The rehabilitation exercise for 12 weeks was effective in attenuating low back pain, knee pain among climacteric women.9. The rehabilitation exercise for 12 weeks fails to alter body mass index, percentage of body fat, bone mineral density and extensors muscle strength in the overweight women.10. The rehabilitation exercise to be recommend to the climacteric women with musculoskeletal pain is safe and and the adherence is high. |
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