To the best of our knowledge, no study has yet evaluated combined and 3-month pain prevalence for the neck, back and shoulder for Austrian helicopter pilots and crewmembers among several occupational groups. Therefore, the aim of this study was to estimate general musculoskeletal pain prevalences, particularly focusing on neck, shoulder and low back pain, and to evaluate potential neck pain risk factors among helicopter pilots and crewmembers within the Austrian armed forces, the Austrian airborne police and Austrian airborne rescue organizations.
This questionnaire-based cross sectional study was conducted within Austrian helicopter pilots and crewmembers from March to May Potential study participants were informed about the project and recruited at briefings, by emails and by telephone. In total, helicopter pilots and crewmembers from different professional sectors Austrian armed forces, Austrian airborne police and Austrian airborne rescue organizations agreed to participate in this study Inclusion criteria was a profession as a helicopter pilot or crewmember.
An online-based questionnaire was applied to all participants. The online questionnaire comprised two sections. In the second section, a modified version of the validated Nordic Musculoskeletal questionnaire [ 33 ] was used to assess prevalence and intensity of musculoskeletal symptoms pain in the following body regions: head, neck, shoulder, upper back, elbow, lower back, forearm, hip, knee and lower leg. In accordance to Murray et al.
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Participants who reported any pain frequency were further asked on pain occurrence in resting phase, during flying and on their possible inability to perform activities of daily living or working tasks interference with flying duty: yes or no; interference with leisure activity: yes or no. For the statistical analysis helicopter pilots and crewmembers were further divided into cases reporting any neck pain in the previous year and controls reporting no neck pain in the previous year. MP is a postdoc researcher in the field of injury prevention, epidemiology and exercise therapy.
BA is a biomechanics expert and registered physical therapist. WS is the head of the Austrian airborne police of the federal ministry of the interior and an experienced helicopter pilot. In order to quantify content validity for multi item scales of this questionnaire, the item content validity index I-CVI as well as the overall scale content validity index S-CVI were computed [ 35 , 36 ].
Pursuant to Polit et al. All items had an I-CVI of 0. Based on the expert ratings no items had to be discarded or improved and no further revisions were required. In total, seven flight-related risk variables and seven individual indicators were considered for the use in the risk factor analysis. Demographic data of study participants are presented as means and standard deviations as well as absolute and relative frequencies.
Factors with more than two categories helicopter type flown were binary coded for every single category to achieve univariate odds ratio OR. SPSS A total of helicopter pilots and crewmembers with a mean age of Most study participants worked in the air emergency sector The most frequent used type of helicopter was the EC The month prevalence of neck pain was Of these Furthermore, the majority of helicopter pilots had experienced 8—30 pain days among the shoulder As presented in Fig.
Of these crewmembers, Moreover, and 3-month pain prevalence of helicopter pilots and crewmembers among other anatomical locations are presented in Figs. For the total group, regardless if considering the month or 3-month prevalence, low back pain presents the second most frequent painful body region followed by the shoulder.
For helicopter pilots the 3-month prevalence of neck pain was Of these helicopter pilots, a minor part suffered from frequent pain few times per week in the previous three months among the neck Most crewmembers suffered from neck pain Similar to helicopter pilots, a small proportion of crewmembers reported frequent pain at the neck Self-reported interference with flying duty was not significantly different between crewmembers and pilots Although not significant, more crewmembers reported of an interference with leisure activity than helicopter pilots Both helicopter pilots and crewmembers reported pain occurrence most common during the resting phase compared to flying The risk of suffering a neck pain episode is 1.
Representing individual indicators, shoulder OR 4. Aim of the underlying study was to determine general musculoskeletal pain prevalence, particularly focusing on neck, shoulder and low back pain and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the Austrian armed forces, the Austrian airborne police and Austrian airborne rescue organizations.
The main finding of this study was that the month neck pain prevalence is considerably high among both, helicopter pilots and crewmember Furthermore, the 3-month prevalence of neck pain was Regardless if considering the or 3-month prevalence, low back pain presents the second most common painful body part followed by the shoulder.
NVG use OR 1. Being the first study evaluating the combined and 3-month pain prevalence for the whole body, our results reveal the highest musculoskeletal pain prevalence for neck pain. The results of the underlying study seem to be higher compared to results of other studies by Thomae et al. Murray et al. While Van den Oord et al.
Our evaluated 3-month prevalence of neck pain among helicopter pilots Furthermore, it is to mention that in our study only Therefore, one could speculate that the underlying neck prevalence among Austrian helicopter pilots and crewmembers should have been lower. Multivariate testing showed that the use of NVG resulted in a 1. No other flight related risk indicator profession, demographic data, NVG variables, flying hour data and helicopter type had an effect on risk. Many studies proofed, that NVG devices do not only allow pilots to enhance their visual capacity, but also come at the cost of increased mass leading to NVG-induced neck strain [ 21 , 22 ].
Interestingly, in our study, helmet weight alone may have had an impact on neck pain and we refer to results of a study by Sovelius et al. Higher weight of the helmet has a more significant effect on cervical muscle loading then the lighter NVG, which alters the center of gravity [ 39 ]. In our study neck pain cases reported of Therefore, our evaluated month neck pain prevalence must be considered as remarkably high with potential impact on interference with leisure activity and flying duty. Interference with leisure activity was reported by Undoubtedly, neck pain can influence operational safety [ 16 ] by limiting the level of concentration [ 6 ], motor control [ 26 , 27 ] and postural stability [ 28 ].
On the other hand, a study by Aherne et al. As a novelty, we evaluated pain prevalences for the whole body and found high prevalences in other close body regions too. For helicopter pilots as well as crewmembers, regardless if considering the month or 3-month prevalences, low back pain presents the second most frequent painful body region followed by the shoulder and upper back. It is noteworthy, that the month prevalence of low back A similar pattern was seen among crewmembers, again the 3-month prevalence of low back The questionnaire-based study was immediately conducted after the winter season March — May , which might not constitute the peak season of work for the majority of helicopter pilots and crewmembers.
This fact could have had influenced ratings of musculoskeletal disorders.
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Furthermore, our results proved that helicopter pilots and crewmember with low back pain had a 2. Many studies give evidence that previous pain and pain in other close body regions is associated with neck pain [ 41 ].
The underlying association between neck pain and pain in other close body regions gives somehow support to the argument that close body regions may share similar risk factors [ 41 ]. Obviously, flight-induced neck pain seems to be the major problem but literature on neck pain reported by helicopter pilots and crewmembers is still sparse [ 13 ]. Just recently, the issue of neck pain in helicopter aircrew has become an aeromedical concern by influencing the physical health [ 13 , 22 ]. Especially in Austria, due to its topographical position, thousands of HEMS missions approximate per year are flown by helicopter pilots and crewmembers per year [ 42 ].
All occupational groups might have different peak seasons of work due to different operations leading to various risks suffering from musculoskeletal disorders. Due to the increasing popularity of alpine outdoor activities in the winter as well as in the summer season, associated with a rising number of accidents [ 1 , 43 ], helicopter pilots and crewmembers are under high exposure to high forces. Thus, the occupational group of rescue organization is at particular risk to suffer from flight-related musculoskeletal disorders.
Our sample covered helicopter pilots and crewmembers of three different occupational areas representing a wide range of job related requirements. The three occupational groups might differ within work tasks and flight manoeuvres as other studies only used air force helicopter squadrons [ 12 , 13 , 38 , 44 ]. This could explain the higher neck pain prevalence in our study. Generally, the majority of helicopter pilots Similar results were found regarding shoulder and low back pain frequencies, as most of helicopter pilots In all neck pain cases, the mean pain intensity during episodes was 4.
Most of the study participants belonged to the air emergency Moreover, it is well known that military helicopter pilots and crewmembers will report a lower intensity of pain [ 45 ] compared to the general population and have been found reluctant to state pain due to fear of flying restrictions [ 20 ]. Again, these facts can influence the described prevalence and self-reported pain intensity.
The underlying results of this study highlight the need for longitudinal studies. Specific training strategies and further research is essential to reduce the pain prevalences among helicopter pilots and crewmembers. According to Sovelius et al. Generally, physical exercise training has been found effective against neck pain in a number of studies conducted within other working populations [ 46 , 47 ]. Only few exercise interventions, using randomized controlled study designs, have been conducted among aircrewmembers with successful outcome reducing neck pain [ 48 , 49 ].
Basically, exercise training may increase individual capacity and reduce the relative workload on the cervical musculature, by further reducing the risk of developing neck pain [ 50 ]. Sovelius et al. Trampoline training was shown to be effective in reducing muscle strain during in-flight, especially in the cervical muscles [ 51 ].
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Recapped, the hypothesis specific to helicopter pilots and crewmembers suggests training programs focus on muscular endurance and general fitness to limit the effects of cumulative exposure to multiple factors that contribute to neck pain [ 44 ]. However, there are no evidence-based guidelines and consensus regarding the prevention of flight-related neck pain among helicopter pilots and crewmembers of Austria. Thus, further randomized controlled studies are needed to clearly clarify the effectiveness of specifically tailored training interventions.
In the underlying questionnaire-based study, a response rate of Although study participants were informed about the project at briefings, emails, by telephone and reminders were sent fortnightly, we did not achieve a higher response rate. Unfortunately, only a small number of military pilots could be acquired, presenting a potential limitation.
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Pilots and crewmembers work on different air bases throughout Austria, thus to the best of our ability we tried to cover all branch establishments of the airborne police and air emergency of the whole nation. Therefore, this study can be assumed to be representative for helicopter pilots and crewmembers suffering from neck pain.
We defined pain as any pain within our study potentially leading to higher pain prevalences.
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