title: In rural Tibet, the prevalence of lower limb pain, especially knee pain, is high: an observational study.
abstract: OBJECTIVE
  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?
  
  
  METHODS
  Observational study using an investigator-administered questionnaire and observation walks through villages.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, QLD, Australia. d.hoy@uq.edu.au
authors.forename: Damian G
authors.initials: DG
authors.lastname: Hoy
authors.forename: Marlene
authors.initials: M
authors.lastname: Fransen
authors.forename: Lyn
authors.initials: L
authors.lastname: March
authors.forename: Peter
authors.initials: P
authors.lastname: Brooks
authors.forename: Joanne
authors.initials: J
authors.lastname: Durham
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Toole
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D007719:Knee Joint; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D019370:Observation; D010146:Pain / Q000453:epidemiology*; D010147:Pain Measurement; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D018609:Tibet / Q000453:epidemiology