In rural Tibet, the prevalence of lower limb pain, especially knee pain, is high: an observational study

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1 Hoy et al: Lower limb pain in Tibet In rural Tibet, the prevalence of lower limb pain, especially knee pain, is high: an observational study Damian G Hoy 1, Marlene Fransen 2, Lyn March 2, Peter Brooks 1, Joanne Durham 3 and Michael J Toole 4 1 The University of Queensland, 2 The University of Sydney, 3 Curtin University, 4 Macfarlane Burnet Institute for Medical Research and Public Health Australia Question: What is the point prevalence and 12-month prevalence of lower limb musculoskeletal pain in rural Tibet? Does this differ with gender or age? What factors that could contribute to lower limb musculoskeletal pain are commonly present? Design: Observational study using an investigator-administered questionnaire and observation walks through villages. Participants: 499 people aged 15 years and over living in 19 rural villages of Shigatse Municipality, Tibet. Results: The point prevalence of lower limb musculoskeletal pain was 40% (95% CI 34 to 46) while the 12-month prevalence was 48% (95% CI 42 to 54). In particular, the point prevalence of knee pain was 25% (95% CI 20 to 30) and the 12-month prevalence was 29% (95% CI 23 to 35), which was significantly higher than at any other site in the lower limb. On average, being female was not associated with lower limb musculoskeletal pain either currently (OR 1.3, 95% CI 0.9 to 1.9) or over the previous 12 months (OR 1.2, 95% CI 0.9 to 1.8), whereas being older than 50 years was, both for current pain (OR 4.1, 95% CI 2.8 to 6.1) and pain over the previous 12 months (OR 4.0, 95% CI 2.7 to 6.0). Observation walks through the villages revealed people squatting for sustained periods, carrying heavy loads for long distances, wearing poor quality footwear, and with severe bowing of the legs but no obesity. Conclusion: Lower limb musculoskeletal pain, particularly knee pain, is common in this rural Tibetan population. They live an extremely arduous life that appears to place considerable pressure on their knees. [Hoy DG, Fransen M, March L, Brooks Journal of Physiotherapy : Lower limb, Leg, Knee, Pain, Prevalence, Rural, Tibet Introduction Bone and Joint Decade Journal of Physiotherapy 2010 Vol. 56 Australian Physiotherapy Association

2 Research Method Design Participants Data analysis p Results. Characteristics of participants. Characteristic n = 499 Age (yr), n (%) (8) (16) (25) (19) (14) (13) (5) (~0) Gender, n female (%) 307 (62) 50 Journal of Physiotherapy 2010 Vol. 56 Australian Physiotherapy Association 2010

3 Hoy et al: Lower limb pain in Tibet. Number (%) of participants for each gender with current pain (point prevalence) and pain in last 12 months and odds ratios (95% CI) between the groups. Site of pain Groups Odds ratios between groups (n = 307) Current pain Pain in last 12 months Current pain Pain in last 12 months Male (n = 192) (n = 307) Male (n = 192) relative to male Lower limb 132 (43) 69 (36) 154 (50) 86 (45) 1.3 (0.9 to 1.9) Hip 25 (8) 9 (5) 27 (9) 11 (6) 1.8 (0.8 to 3.9) Knee 79 (26) 44 (23) 88 (29) 57 (30) 1.2 (0.8 to 1.8) Ankle 39 (13) 14 (7) 44 (14) 17 (9) 1.9 (1.0 to 3.5) Foot 31 (10) 9 (5) 34 (11) 11 (6) 2.3 (1.1 to 4.9) Anterior upper leg 16 (5) 7 (4) 20 (7) 9 (5) 1.5 (0.6 to 3.6) Anterior lower leg 31 (10) 14 (7) 40 (13) 15 (8) 1.4 (0.7 to 2.8) Posterior upper leg 28 (9) 7 (4) 32 (10) 10 (5) 2.7 (1.1 to 6.2) Posterior lower leg 28 (9) 10 (5) 31 (10) 12 (6) 1.8 (0.9 to 3.9) relative to male 1.2 (0.9 to 1.8) 1.6 (0.8 to 3.3) 1.0 (0.6 to 1.4) 1.7 (1.0 to 3.1) 2.0 (1.0 to 4.1) 1.4 (0.6 to 3.2) 1.8 (0.9 to 3.3) 2.1 (1.0 to 4.4) 1.6 (0.8 to 3.4) Journal of Physiotherapy 2010 Vol. 56 Australian Physiotherapy Association

4 Research Table 3. Number (%) of participants for each age group with current pain (point prevalence) and pain in last 12 months and odds ratios (95% CI) between the groups. Site of pain Groups Difference between groups 50 yr (n = 162) Current pain Pain in last 12 months Current pain Pain in last 12 months < 50 yr (n = 337) 50 yr (n = 162) < 50 yr (n = 337) Over 50 relative to under 50 Lower limb 102 (63) 99 (29) 114 (70) 126 (37) 4.1 (2.8 to 6.1) Hip 18 (11) 16 (5) 18 (11) 20 (6) 2.5 (1.2 to 5.1) Knee 66 (41) 57 (17) 73 (45) 72 (21) 3.4 (2.2 to 5.2) Ankle 27 (17) 26 (8) 28 (17) 33 (10) 2.4 (1.3 to 4.3) Foot 17 (11) 23 (7) 18 (11) 27 (8) 1.6 (0.8 to 3.1) Anterior upper leg 10 (6) 13 (4) 11 (7) 18 (5) 1.6 (0.7 to 3.8) Anterior lower leg 25 (15) 20 (6) 26 (16) 29 (9) 2.9 (1.6 to 5.4) Posterior upper leg 17 (11) 18 (5) 19 (12) 23 (7) 2.1 (1.0 to 4.1) Posterior lower leg 22 (14) 16 (5) 22 (14) 21 (6) 3.2 (1.6 to 6.2) Over 50 relative to under (2.7 to 6.0) 2.0 (1.0 to 3.9) 3.0 (2.0 to 4.5) 1.9 (1.1 to 3.3) 1.4 (0.8 to 2.7) 1.3 (0.6 to 2.8) 2.0 (1.2 to 3.6) 1.8 (1.0 to 3.4) 2.4 (1.3 to 4.4) Washing clothes by a stream in Shigatse, Tibet. Discussion p 52 Journal of Physiotherapy 2010 Vol. 56 Australian Physiotherapy Association 2010

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