The Cultural and Psychosocial Influences on Disability (CUPID) Study

Lead Investigator: David Coggon
Co-investigators: Dr Cathy Linaker, Dr Clare Harris, Ms Georgia Ntani, Profesor Keith Palmer, Professor Cyrus Cooper, Dr Karen Walker-Bone, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Serra C, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B; Sim MR, Harcombe H, Cox K, Marziale MH, Sarquis LM, Harari F, Feire R, Harari N,; Monroy MV, Quintana LA, Rojas M, Salazar Vega EJ, Harris EC, Vargas-Prada S, Martinez JM, Declos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Sirk T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW; Urquhart DM, Derrett S, McBride D, Herbison P, Gray A.
Study funders: Colt Foundation (CF/03/05); United States National Institutes of Health (NIH) (www.grants.nih.gov) Grant 5D43 TW00 0644-13, sub-award 0005919H; NIH Grant 5D43 TW00 0644-15, sub-award 0005919J; Spanish Health Research Fund (www.imia.medinfo.org) (FIS 070422); Epidemiology and Public Health CIBER, Carlos III Institute of Health, Ministry of Science and Innovation, Spain; Department of Experimental Medicine, University of Insubria (www.unisubria.eu), Varese, Italy; Deputy for Training and Research, Shahroud University of Medical Sciences, Iran (www.shmu.ac.ir); International Training and Research in Environmental and Occupational Health (ITREOH) Program of the University of Alabama at Birmingham (Grant number 5 D43 TWO5750 from the National Institutes of Health and the Fogarty International Center (NIH-FIC)) (www.fic.nih.gov/Programs/Pages/environmental-occupational-health.aspx); University of Tokyo (www.u-tokyo.ac.up/en/; Monash University Strategic Grant Scheme and Monash University Near Miss Grant for NHMRC projects in 2008 (www.monash.edu.au); NHMRC, Australia; Ministry of Higher Education, Malaysia; Health Research Council of New Zealand (International Investment Opportunity Fund Grant) (www.hrc.govt.nz)

Background:
Non-specific pain, especially in the back and arm, is the main musculoskeletal cause of incapacity for work in the UK and many other countries.  Established risk factors include occupational physical activities such as heavy lifting and repetitive forceful movements, and psychological characteristics such as low mood and tendency to somatise.  However, these do not explain major changes in the prevalence of disabling musculoskeletal pain that have been observed in the uK and elsewhwere.  We hypothesised that while some cases of musculoskeletal pain may be attributable to mechanical injury of tissues, the large majority, although possibly triggered by transient musculoskeletal strains, are perpetuated through psychologically mediated nocebo responses, conditioned not only by mood and tendency to somatise, but also by culturally determined health beliefs and expectations.

Main study questions:
(1) How much does the occurrence of musculoskeletal symptoms and associated disability vary between workers who are carrying out jobs with similar physical demands, but in different cultural environments?
(2) To what extent is the variation explained by known and suspected risk factors, and is it influenced by health beliefs?

Study design:
Data on musculoskeletal symptoms, disability and potential risk factors have been collected by a standardised questionnaire from 12,426 workers in 47 occupational groups in 18 countries. The occupational groups comprised nurses, office workers using computer keyboards and “other workers” (most of whom carried out repetitive manual tasks with their hands or arms).  Further information on symptoms, disability and any changes to work has been collected through a follow-up questionnaire after an interval of 12 months.

Outputs:
Bonzini M, Bertu L, Veronesi G, Conti M, Coggon D, Ferrario MM.  Is musculoskeletal pain a consequence or a cause of occupational stress?  A longitudinal study.  Int Arch Occup Environ Health 2015;88(5):607-12.  DOI 10.1007/soo420-0140982-1.  PMID: 25261316 PMCID: PMC

Campos-Fumero A, Delclos G, Douphrate DI, Felknor S, Vargas-Prada S, Serra C, Coggon DN, Gimeno D.  Upper extremity musculoskeletal pain among office workers in three Spanish speaking-countries: findings from the CUPID study.  Occup Environ Med 2016;73:394-400.

Carugno M, Pesatori AC, Ferrario MM, Ferrari AL, da Silva FJ, Martins AC, Felli VEA, Coggon D, Bonzini M.  Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses.  Cadernos de Saúde Pública.  2012;28:1632-42.

Coggon D, Ntani G, Palmer KT, Felli VE, Harari R et al.  The CUPID (Cultural and Psychosocial Influences on Disability) Study: methods of data collection and characteristics of study sample.  PLoS ONE 2012;7(7): e39820. doi:10.1371/journal.pone.0039820.

Coggon D, Ntani G, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Serra C, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B; Sim MR, Harcombe H, Cox K, Marziale MH, Sarquis LM, Harari F, Feire R, Harari N,; Monroy MV, Quintana LA, Rojas M, Salazar Vega EJ, Harris EC, Vargas-Prada S, Martinez JM, Declos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Sirk T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW; Urquhart DM, Derrett S, McBride D, Herbison P, Gray A.  Disabling musculoskeletal pain in working populations: Is it the job, the person or the culture?  Pain 2013;154:856-63.

Coggon D, Ntani G, Vargas-Prada S, Martinez JM, Serra C, Benavides FG, Palmer KT and other members of the CUPID Collaboration.  International variation in musculoskeletal sickness absence: Findings from the CUPID study.  Occup Environ Med. 2013;70:575-84.

Coggon D, Ntani G, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Serra C, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B; Sim MR, Harcombe H, Cox K, Marziale MH, Sarquis LM, Harari F, Feire R, Harari N,; Monroy MV, Quintana LA, Rojas M, Salazar Vega EJ, Harris EC, Vargas-Prada S, Martinez JM, Declos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Sirk T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW; Urquhart DM, Derrett S, McBride D, Herbison P, Gray A.  Patterns of multi-site pain and associations with risk factors.  Pain 2013;154:1769-77.

Coggon D, Ntani G, Walker-Bone K, et al. Epidemiological differences between localised and non-localised low back pain. Spine 2017;42:740-747

Coggon D, Ntani G. Trajectories of multisite musculoskeletal pain and implications for prevention. Occupational and Environmental Medicine 2017;74:465–466

Coggon D, Ntani G, Palmer KT, Felli V, Harari F, Quintana LA, Felknor SA et al. Drivers of international variation in prevalence of disabling low back pain: Findings from the CUPID study. European Journal of Pain 2019;23(1):35-45. doi: 10.1002/ejp.1255. Epub 2018 Jun 27.

Coggon D, Ntani G, Walker-Bone K, Felli VE, Harari F, Barrero LH, Felknor SA, et al Determinants of international variation in the prevalence of disabling wrist and hand pain. BMC Musculoskeletal Disorders 2019;20:436

Coggon D, Ntani G, Walker-Bone K et al. Associations of sickness absence for pain in the low back, neck and shoulders with wider propensity to pain. Occup Environ Med

Ferrari AL, Baptista PCP, Felli VEA, Coggon D.  Translation, adaptation and validation of the “Cultural and Psychosocial Influences on Disability (CUPID) Questionnaire” for use in Brazil.  Rev Latino-Am Enfermagem  2010;18:1092-8.

Freimann T, Coggon D, Merisalu E, Animägi L, Pääsuke M.  Risk factors for musculoskeletal pain amongst nurses in Estonia: a cross-sectional study.  BMC Musculoskeletal Disorders. 2013;14:334 doi:10.1186/1471-2474-14-334.  PMID: 24289649

Gillibrand S, Ntani G, Coggon D.  Do exposure limits for hand-transmitted vibration prevent carpal tunnel syndrome?  Occupational Medicine 2016;66:399-402.

Harcombe H, McBride D, Derrett S, Gray A.  Prevalence and impact of musculoskeletal disorders in New Zealand nurses, postal workers and office workers.  Aust N Z J Public Health 2009;33:437-41.

Harcombe H, McBride D, Derrett S, Gray A.  Physical and psychosocial risk factors for musculoskeletal disorders in New Zealand nurses, postal workers and office workers.  Injury Prevention 2010;16:96-100.

Hoe VCW, Kelsall HL, Urquhart DM, Sim MR.  Risk factors for musculoskeletal symptoms of the neck or shoulder alone or neck and shoulder among hospital nurses.  Occup Environ Med 2011;69:198-204.

Matsudaira K, Palmer KT, Reading I, Hirai M, Yoshimura N, Coggon D.  Prevalence and correlates of regional pain and associated disability in Japanese workers.  Occup Environ Med 2011;68:191-196.

Oha K, Animägi L, Pääsuke M, Coggon D, Merisalu E.  Individual and work-related risk factors for musculoskeletal pain: a cross sectional study among Estonian computer users.  BMC Musculoskeletal Disorders 2014;15:181.  http://www.biomedcentral. com/1471-2474/15/181.  PMID: 24884911 PMCID: PMC

Sadeghian F, Raei M, Ntani G, Coggon D.  Predictors of incident and persistent neck/shoulder pain in Iranian workers: A cohort study.  PLoS One 2013;8(2):e57544.

Sadeghian F, Coggon D, Ntani G, Hosseinzadeh S.  Predictors of low back pain in a longitudinal study of Iranian nurses and office workers.  WORK 2015;51(2):239-44 doi: 10.3233/WOR-141850.  PMID: 24763343

Sarquis LMM, Coggon D, Ntani G, Walker-Bone K, Palmer KT, Felli VE, Harari R et al. Classification of neck/shoulder pain in epidemiological research: a comparison of risk factors, disability and prognosis among 12,195 workers from 18 countries. Pain 2016; 157:1028-1036

Shiri R, Viikari-Juntura E, Coggon D.  Leisure-time physical activity and sciatica: A systematic review and meta-analysis. European Journal of Pain 2016;20:1563-1572 doi: 10.1002/ejp.885

Solidaki E, Chatzi L, Bitsios P, Markatzi I, Plana E, Castro F,  Palmer K, Coggon D, Kogevinas M. Work related and psychological determinants of multi-site musculoskeletal pain.    Scand J Work Environ Health 2010;36:54-61.

Solidaki E, Chatzi L, Bitsios P, Coggon D, Palmer KT, Kogivenas M.  Risk factors for new onset and persistence of multi-site musculoskeletal pain in a longitudinal study of workers in Crete.  Occup Environ Med.  2013;70:29-34.

Surawera IK, Hoe VCW, Kelsall HL, Urquhart DM, Sim MR.  Physical and psychosocial factors associated with wrist or hand pain among Australian hospital-based nurses. Injury Prevention 2013;19:13-8.

Urquhart DM, Kelsall HL, Hoe VCW, Cicuttini FM, Forbes AB, Sim MR.  Are psychosocial factors associated with low back pain and work absence for low back pain in an occupational cohort? The Clinical Journal of Pain 2013;29(12):1015-20

Vargas-Prada S, Serra C, Martinez J, Ntani G, Delclos G, Palmer K, Coggon D, Benavides F.  Psychological and culturally-influenced risk factors for the incidence and persistence of low back pain and associated disability in Spanish workers: findings from the CUPID study.  Occup Environ Med.  2013;70:57-62.

Vargas-Prada S, Martinez JM, Coggon D, Declos G, Benavides FG, Serra C.  Health beliefs, low mood and somatising tendency: their contribution to the incidence and persistence of musculoskeletal pain with and without reported disability.  Scand J Work Environ Health.  2013;39:589-98. doi:10.5271/sjweh.3377. PMID: 23955508. PMCID: PMC3819230

Vargas-Prada S, Serra C, Coggon D, Martinez JM, Ntani G, Delclos G, Palmer KT, Benavides FG.  Are determinants for new and persistent upper limb pain different?  An analysis based on anatomical sites.  WORK 2015; 53(2):313-23.

Vargas-Prada S, Coggon D, Ntani G, Walker-Bone K, et al. Descriptive epidemiology of somatising tendency: findings from the CUPID study. PLoS One. 2016 Apr 29;11(4):e0153748.

Warnakulusariya S, Peiris-John R, Ntani G, Coggon D, Sathiakumar N, Wickremasinghe AR.  Musculoskeletal pain in four occupational populations in Sri Lanka.  Occupational Medicine 2012;62:269-72.