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However, studies of health-related factors in manual therapists during the COVID-19 pandemic are scarce. Research in this field can provide valuable insights for future crises policy and guidelines, including in regions where the public health response to COVID-19 contrasts with that of most other international jurisdictions. The aim was to describe the prevalence of psychological distress and musculoskeletal pain, and to investigate factors potentially associated with high psychological distress and activity-limiting musculoskeletal pain in clinically active chiropractors and naprapaths during the second wave of the COVID-19 pandemic in Sweden.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A cross-sectional survey was distributed to a\u00a0representative sample of Swedish manual therapists, between November 2020 and January 2021.\u00a0High psychological distress and activity-limiting musculoskeletal pain were investigated regarding associations with residing in a municipality with a high spread of infection, a previous\/ongoing SARS-CoV-2 infection, clinical interferences and economic consequences associated with the pandemic. Generalized Linear Models with log link and binomial distribution were used, computing prevalence ratios (PR) with 95% confidence intervals (95% CI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 762 participants were included, representing 46% of the source population. The prevalence of depressive, anxiety, and stress symptoms was 17%, 7%, and 12%, respectively. Neck (50%), low back (46%), upper back (40%), and shoulders (39%) were the most prevalent musculoskeletal pain areas. Economic consequences due to the pandemic were associated with high psychological distress (PR\u2009=\u20092.30, 95% CI: 1.48\u20133.53).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>During the second wave of the COVID-19 pandemic in Sweden, manual therapists primarily suffered from musculoskeletal pain related to the back and shoulders, while depressive symptoms were the most common symptom of psychological distress. Owners of businesses that suffered economic consequences had a higher prevalence of high psychological distress, which may call for targeted support of this group in future similar contexts. Future longitudinal studies during the pandemic are warranted to assess these associations further.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12998-023-00511-2","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T13:02:42Z","timestamp":1694523762000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Psychological distress and musculoskeletal pain in manual therapists during the second wave of the COVID-19 pandemic in Sweden: a cross-sectional study"],"prefix":"10.1186","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1814-020X","authenticated-orcid":false,"given":"Nathan","family":"Weiss","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Skillgate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iben","family":"Ax\u00e9n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"511_CR1","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12943-020-01218-1","volume":"19","author":"W Feng","year":"2020","unstructured":"Feng W, Zong W, Wang F, Ju S. 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J Exp Psychopathol. 2011;2:197\u2013209. https:\/\/doi.org\/10.5127\/jep.008310.","journal-title":"J Exp Psychopathol"}],"container-title":["Chiropractic &amp; Manual Therapies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12998-023-00511-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12998-023-00511-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12998-023-00511-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T12:05:01Z","timestamp":1708085101000},"score":1,"resource":{"primary":{"URL":"https:\/\/chiromt.biomedcentral.com\/articles\/10.1186\/s12998-023-00511-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,12]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["511"],"URL":"https:\/\/doi.org\/10.1186\/s12998-023-00511-2","relation":{},"ISSN":["2045-709X"],"issn-type":[{"value":"2045-709X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,12]]},"assertion":[{"value":"9 May 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted according to the guidelines of the Declaration of Hensinki, and approved by the Swedish Ethical Review Authority Dnr: 2020-03836.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"I.A. is Co-Editor-in-Chief of Chiropractic & Manual Therapies. The editorial management system automatically blinded her from the submitted manuscript, and she had no part in this manuscript's editorial or peer-review process. The other authors declares that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}