A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders: A Randomized Controlled Trial Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. A workplace exercise versus health promotion intervention to prevent and reduce the economic and personal burden of non-specific neck pain in office personnel: protocol of a cluster-randomised controlled trial. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial Risk factors for neck pain in office workers: a prospective study Follow-up of neck and shoulder pain among sewing machine operators: The Los Angeles garment study. Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. Impact of functional restoration after anterior cervical fusion on chronic disability in work-related neck pain. Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders Effects on musculoskeletal pain from "Take a Stand!" - a cluster-randomized controlled trial reducing sitting time among office workers. Effectiveness of Workplace-Based Muscle Resistance Training Exercise Program in Preventing Musculoskeletal Dysfunction of the Upper Limbs in Manufacturing Workers Influence of Self-Efficacy on Compliance to Workplace Exercise Predicting Persistent Neck Pain: A 1-Year Follow-up of a Population Cohort Evaluation of ‘I-Preventive’: a digital preventive tool for musculoskeletal disorders in computer workers—a pilot cluster randomised trial Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial. Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Individual, physical and psychological risk factors for neck pain in Australian office workers: a 1-year longitudinal study Effect of workplace- versus home-based physical exercise on pain in healthcare workers: study protocol for a single blinded cluster randomized controlled trial Musculoskeletal symptoms and job satisfaction among office-workers: a cross-sectional study from Iran. Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Implementation of specific strength training among industrial laboratory technicians: long-term effects on back, neck and upper extremity pain Dose-response relationship of specific training to reduce chronic neck pain and disability. Group-based exercise at workplace: short-term effects of neck and shoulder resistance training in video display unit workers with work-related chronic neck pain—a pilot randomized trial Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers Effect of Training Supervision on Effectiveness of Strength Training for Reducing Neck/Shoulder Pain and Headache in Office Workers: Cluster Randomized Controlled Trial A Cross-Country Comparison of Short-and Long-Term Effects of an Ergonomic Intervention on Musculoskeletal Discomfort, Eyestrain and Psychosocial Stress in VDT Operators: Selected Aspects of the International Project Physical and psychosocial risk factors for musculoskeletal disorders in New Zealand nurses, postal workers and office workers Effect of workplace- versus home-based physical exercise on musculoskeletal pain among healthcare workers: a cluster randomized controlled trial. Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial Influence of Psychosocial Work Environment on Adherence to Workplace Exercise Effects of participatory ergonomic intervention on the development of upper extremity musculoskeletal disorders and disability in office employees using a computer Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. An occupational pain study Effects of physical activity programmes in the workplace (PAPW) on the perception and intensity of musculoskeletal pain experienced by garment workers. The Treatment of Neck and Low Back Pain: Who Seeks Care? Who Goes Where?
Objective : The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain . Methods : Sixty female subjects were r and omly assigned to an intervention group or a control group . The IG was administered of a 6-month , twice-a-week , tailored exercise program , whereas the CG received no intervention . Results : The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures . In addition , reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength . Conclusions : This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders , showing clinical ly meaningful reductions of pain symptoms and disability on upper limb and neck regions Aims : To quantify the relative contribution of work related physical factors , psychosocial workplace factors , and individual factors and aspects of somatisation to the onset of neck/shoulder pain .  Methods : Four year prospect i ve cohort study of workers from industrial and service companies in Denmark . Participants were 3123 workers , previously enrolled in a cross sectional study , where objective measurement of physical workplace factors was used . Eligible participants were followed on three subsequent occasions with approximately one year intervals . Outcomes of interest were : new onset of neck/shoulder pain ( symptom cases ) ; and neck/shoulder pain with pressure tenderness in the muscles of the neck/shoulder region ( clinical cases ) . Results : During follow up , 636 ( 14.1 % ) participants reported neck/shoulder pain of new onset ; among these , 82 ( 1.7 % ) also had clinical signs of substantial muscle tenderness . High shoulder repetition was related to being a future symptom case , and a future clinical case . Repetition was strongly intercorrelated with other physical measures . High job dem and s were associated with future status as a symptom case , and as a clinical case . A high level of distress predicted subsequent neck/shoulder pain , and neck/shoulder pain with pressure tenderness . Conclusions : High levels of distress , and physical and psychosocial workplace factors are predictors of onset of pain in the neck and /or shoulders , particularly pain with pressure tenderness in the muscles STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers INTRODUCTION Non-specific neck pain is a major burden to industry , yet the impact of introducing a workplace ergonomics and exercise intervention on work productivity and severity of neck pain  in a population of office personnel is unknown . RESEARCH QUESTION Does a combined workplace-based best practice ergonomic and neck exercise program reduce productivity losses and risk of developing neck pain in asymptomatic workers , or decrease severity of neck pain  in symptomatic workers , compared to a best practice ergonomic and general health promotion program ? DESIGN Prospect i ve cluster r and omised controlled trial . PARTICIPANTS AND SETTING Office personnel aged over 18 years , and who work>30 hours/week .  INTERVENTION Individualised best practice ergonomic intervention plus 3 × 20 minute weekly , progressive neck/shoulder girdle exercise group sessions for 12 weeks . CONTROL Individualised best practice ergonomic intervention plus 1-hour weekly health information sessions for 12 weeks . MEASUREMENTS Primary ( productivity loss ) and secondary ( neck pain and disability , muscle performance , and quality of life ) outcome measures will be collected using vali date d scales at baseline , immediate post-intervention and 12 months after commencement . PROCEDURE 640 volunteering office personnel will be r and omly allocated to either an intervention or control arm in work group clusters . ANALYSIS Analysis will be on an ' intent-to-treat ' basis and per protocol . Multilevel , generalised linear models will be used to examine the effect of the intervention on reducing the productivity loss in dollar units ( AUD ) , and severity of neck pain and disability . DISCUSSION The findings of this study will have a direct impact on policies that underpin the prevention and management of neck pain in office personnel Background Although leisure-time physical activity is important for health , adherence to regular exercise is challenging for many adults . The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise . This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers . Methods Cluster-r and omized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain ( industrial production units ) . Participants were r and omized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week ( n = 282 ) or a control group receiving advice to stay physically active ( n = 255 ) . The strength training program followed principles of progressive overload and periodization . The primary outcome was changes in self-reported neck and shoulder pain intensity ( scale 0 - 9 ) . Results 85 % of the participants followed the strength training program on a weekly basis . In the training group compared with the control group , neck pain intensity decreased significantly ( -0.6 , 95 % CI -1.0 to -0.1 ) and shoulder pain intensity tended to decrease ( -0.2 , 95 % CI -0.5 to 0.1 , P = 0.07 ) . For pain-cases at baseline ( pain intensity > = 3 ) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up ( pain intensity < 3 ) was 2.0 ( 95 % CI 1.0 to 4.2 ) for the neck and 3.9 ( 95 % CI 1.7 to 9.4 ) for the shoulders . Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces , and results in significant reductions of neck and shoulder pain . Trial registration NCT01071980 Background Persisting neck pain is common in society . It has been reported that the prevalence of neck pain in office workers is much higher than in the general population . The costs to the worker , employer and society associated with work-related neck pain are known to be considerable and are escalating . The factors that place office workers at greater risk of developing neck pain are not understood . The aim of this study is to investigate the incidence and risk factors of work-related neck pain in Australian office workers . Methods / design We will conduct a prospect i ve cohort study . A cohort of office workers without neck pain will be followed over a 12 month period , after baseline measurement of potential risk factors . The categories of risk factors being evaluated are physical ( cervical spine posture , range of movement , muscle endurance and exercise frequency ) , demographic ( age , sex ) , work environment ( sitting duration , frequency of breaks ) and psychosocial ( psychological distress and psychosocial work factors ) . Cox regression analysis will be used to identify risk factors associated with work-related neck pain , and will be expressed as hazard ratios with 95 % confidence intervals . The data will also enable the incidence of neck pain in this population to be estimated . Discussion In addition to clarifying the magnitude of this occupational health problem these data could inform policy in workplaces and provide the basis for primary prevention of neck pain in office workers , targeting the identified risk factors BACKGROUND The aim of the present study is to explore factors affecting or modifying self-reported neck/shoulder pain in sewing machine operators . METHODS We investigated self-report neck/shoulder pain in 247 workers who participated in a 4-month prospect i ve intervention study for musculoskeletal disorders . All participants were immigrants . We examine the influence of individual and work-related factors on changes in neck/shoulder pain during follow-up employing linear mixed models with time-spline functions . RESULTS We observed a dramatic decline ( 72 % ) in self-reported pain intensity in the first month of follow-up , followed by a small increase from the first to fourth month ( 4 % per month ) . Workers who perceived and reported their physical workload as high or worked overtime experienced less overall pain reduction . Higher baseline pain intensity , being of Hispanic ethnicity ( vs. Asian ) , and taking cumulative daily rest time during work of 35 min or more allowing for muscles to rest were associated with a larger pain reduction in the first month , but not thereafter . CONCLUSION Our findings indicate that some work-related factors may be of clinical relevance for reducing neck/shoulder pain . Having lower physical workloads and less overtime work should be considered when treating patients or planning workplace interventions for managing work-related musculoskeletal disorders in this underserved immigrant population OBJECTIVE All occupations expose workers to varied and unique conditions . The nature of work has been recognized as influencing the health of workers . Whether predictors for chronic neck and low back pain would be occupation-specific is unknown . This study aim ed to identify predictors for chronic neck and low back pain in a cohort of office workers . METHODS A prospect i ve study was carried out among 669 healthy office workers . At baseline , risk factors were assessed using a question naire and st and ardized physical examination . A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS , and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months . Two regression models were built to analyze the risk factors for developing chronic neck and low back pain . RESULTS Of the sample , 17 and 27 % of office workers who reported a new onset of neck or low back pain developed chronicity , respectively . Predictors for chronic neck pain were high body mass index , frequent neck extension during the work day , high initial pain intensity , and high psychological job dem and s. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity . CONCLUSIONS The findings suggest that predictors for chronic musculoskeletal pain in a sub population may be a subset of predictors identified in a general population or occupation specific . Successful management to prevent chronic musculoskeletal pain may also need to consider the patient 's occupation BACKGROUND CONTEXT Spinal surgery in the workers compensation population shows evidence of less favorable outcomes than in general health cases . Although spine surgery has been alleged to be a cause of poor outcomes , such outcomes may be improved by appropriate postsurgical rehabilitation . PURPOSE To compare objective demographic , physical and psychological measurements and socioeconomic outcomes of treatment in work-related disabling cervical pain for the combination of anterior cervical fusion ( ACF ) plus functional restoration , compared with rehabilitation alone . STUDY DESIGN / SETTING A prospect i ve study of patients undergoing ACF for degenerative disc disease before rehabilitation for work-related musculoskeletal disorders versus neck pain unoperated controls , with data collected in an outpatient tertiary interdisciplinary rehabilitation setting . PATIENT SAMPLE A group of 52 patients completed a functional restoration treatment program after undergoing ACF ( Group S ) at one or two levels for degenerative cervical disc disease . During the study period , 625 patients with work-related neck pain were identified from the same study population , from which a  rehabilitation ( Group R ) comparison group ( n=150 ) was identified who were stratified according to the number and location of other compensable body parts . OUTCOME MEASURES Socioeconomic outcomes relevant to chronic disabling work-related cervical spinal disorders are reported based on 1-year posttreatment interviews . Pre- to posttreatment assessment of pain intensity , disability , depression and cumulative physical capability were assessed prospect ively . METHODS All patients were totally or partially disabled before completing an  intensive , medically supervised , functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach . Preprogram preparation included drug detoxification , psychotropic medication management and preparatory aerobic and mobility training . The intensive treatment phase involved strength and endurance training , with counseling geared to goals of work return and fitness maintenance . The 1-year structured clinical interview had a contact rate of 93 % to 95 % , and partial information acquisition on all patients . RESULTS Although Group S had lower work return and work retention outcomes , the differences were not significant . Group S patients had significantly more health utilization from a new provider in the year after completion of functional restoration ( 46 % vs 24 % ; OR=2.7 [ 1.3 , 5.3 ] , p<.004 ) . Group S patients were also more likely to be depressed , both at pre- and postrehabilitation . There were no significant differences in recurrent injury , additional surgery , physical measures or pain/disability self-report between the groups . CONCLUSIONS Workers compensation patients with chronic disabling work-related cervical spinal disorders who undergo a cervical fusion , combined with functional restoration , have socioeconomic outcomes after their surgery statistically similar to those for unoperated controls . Surgery patients had a higher rate of additional health-care-seeking behaviors from new providers and a greater likelihood of being clinical ly depressed before and after rehabilitation . This study suggests that cervical fusion for degenerative disc disease in workers compensation patients is not contraindicated , as long as interdisciplinary rehabilitation is available for complex cases after the surgical procedure Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use . Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists . The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments . Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area . Our study investigates the effect of the latter approach . Methods / Design A r and omized controlled trial of 10 weeks duration is currently being conducted . Employed office workers with severe neck-shoulder pain are r and omized to  3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active . Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius . An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work . The first 100 positive replies entered the study . Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0 - 9 scale . Exclusion criteria were cardiovascular disease , trauma , hypertension , or serious chronic disease . Before and after the intervention period the participants replied to a question naire about musculoskeletal disorders and work disability , and underwent a st and ardized clinical examination of the neck and shoulder girdle . Further , on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week . The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination . Secondary outcomes are strength and work disability . Trial Registration Clinical Trials ( NCT ) : Context Nonoccupational musculoskeletal disorders account for a large proportion of work disability and represent a major financial burden on society . Contribution A voluntary , r and omized , controlled intervention study consisted of avoidance of bed rest , early mobilization , avoidance of splints , stretching exercises , ergonomic training , provision of educational booklets , and suggestions for optimal levels of physical activity . Although return to work was never forced , temporary work disability , long-term disability , and costs were significantly decreased in the intervention group . Implication s The personal and financial impact of work disability due to musculoskeletal disorders ( not related to work injury ) may be mitigated by a voluntary program of education and rehabilitation . The Editors Musculoskeletal disorders ( MSDs ) are prevalent and potentially disabling conditions ( 1 ) that consume a large proportion of health care re sources ( 2 - 4 ) and together are the leading cause of functional loss in adults ( 3 - 8 ) . The social costs of MSDs are enormous , often overshadowing those of other chronic conditions ( 9 , 10 ) . In industrialized societies , MSDs are one of the most common causes of temporary work disability and the chief cause of permanent work disability ( 11 ) , accounting for productivity losses equivalent to 1.3 % of the U.S. gross national product ( 12 ) . Work disability related to MSDs is a challenge to employability , business productivity , and the capacity of health and social security systems . Various strategies for addressing MSD-related work disability have been promoted in the field of occupational health , including strategies involving legislation , risk management , ergonomics , prevention , education , and social work ( 13 ) . However , the role of health systems remains ill-defined in this field . The purpose of this study was to evaluate whether an intervention program , integrated into the health system and offered to the working population , could reduce the impact of recent-onset MSD-related temporary work disability . Methods Setting Of the 5.5 million persons in Madrid , Spain , 98 % receive health coverage from the Instituto Madrileo de Salud . Care is organized into 11 health districts . Patients have direct access to primary care physicians , who refer patients to specialized care if needed . Disability compensation payments are made by the Instituto Nacional de la Seguridad Social ( INSS ) , a division of the Ministry of Work . Any worker who requires sick leave is given a temporary work disability initiation form that states the diagnosis made by the primary care physician and entitles the worker to receive INSS compensation payments . The form is renewed weekly by the primary care physician until the worker 1 ) recovers and receives an ending form , 2 ) reaches a maximum of 18 months of temporary work disability , or 3 ) receives a proposal for evaluation for permanent work disability . Proposals for permanent work disability are evaluated by the INSS , which determines the need for and type of long-term compensation . Inspection services in each health district oversee all administrative aspects of these processes . Design We did a r and omized , controlled study , unblinded for both patients and physicians , to test whether a clinical intervention could improve the outcome of patients with recent-onset MSD-related temporary work disability . The study began in March 1998 in health district 7 and in March 1999 in health districts 4 and 9 . Selection and r and omization of patients was done during the first year of the study in each district . Follow-up lasted for another year . Patients and Selection Criteria Health districts 4 , 7 , and 9 were chosen . Health district 4 had a total population of 508249 persons and an active working population of 192939 persons ; health district 7 had a total population of 522742 persons and an active working population of 179155 persons ; and health district 9 had a total population of 371294 persons and an active working population of 135475 persons ( 14 ) . The inclusion criterion was the issue of a common diseases temporary work disability initiation form , with an MSD-related cause reported by the primary care physician , within the inclusion period . The MSD-related causes included all arthropathies , connective tissue disorders , back disorders , soft-tissue rheumatisms , bone and cartilage disorders , musculoskeletal pain not caused by cancer , and nerve entrapment syndromes . Patients were excluded if they had a common diseases temporary work disability form with an MSD-related cause result ing from trauma or surgery . They were also excluded if they had work accidents or professional diseases noted on the temporary work disability initiation form . Work accidents are primarily sudden , external , violent causes of disease occurring at work or during travel to work , and they represent less than 27 % of cases of temporary work disability . Professional diseases include silicosis , asbestos-related mesothelioma , and noise-induced hearing loss , and they represent less than 1 % of cases of temporary work disability . R and omization All temporary work disability initiation forms meeting the selection criteria were collected daily by a study rheumatologist and coded . The patients associated with the forms were r and omly assigned to either the intervention group , which received a specific care program , or the  control group  , which received st and ard care ( Figure 1 ) . Computer-generated lists of pseudor and om numbers were produced for each district . Group assignments were r and omly done in blocks of 50 patients with intervention : control ratios of 1:1 in district 7 and 2:3 in districts 4 and 9 . This was done so that similar numbers of patients would be seen by the rheumatologists in all areas . The ratios were based on the number of episodes of MSD-related temporary work disability registered in previous years . Patients maintained their group assignments in successive episodes of MSD-related temporary work disability during follow-up . Figure 1 . Flow diagram of the study . Care in the Intervention Group A secretary contacted all patients assigned to the intervention group by telephone or mail as soon as possible after the initiation form was issued , offering them an appointment in the program . Patients who voluntarily decided to enter the program were attended by 2 rheumatologists in each district who worked full-time for the study . Patients were seen as often as necessary until the episode of temporary work disability was resolved or recovery was deemed unrealistic . Patients who were assigned to the intervention group but were unable or unwilling to participate , were already working , or could not be located were considered to be assigned to the intervention group throughout the study for statistical purpose s. Within the intervention program , care was delivered in regular visits and included education , clinical management , and administrative duties . Education At the first 45-minute visit , patients received a specific diagnosis , reassurance that no serious disease was present , instructions on self-management , instructions on taking medications on a fixed schedule , and information on indications for return to work before complete symptom remission . Return to work was negotiated with patients and was never forced on them . Instructions on self-management included instructions to avoid bed rest , instructions to promote early mobilization of the painful regions , restrictions on the use of splint and neck collars , training in stretching and strengthening exercises ( 15 - 18 ) , teaching of ergonomic care ( 19 ) , delivery of booklets in instances of back or neck pain ( 19 ) , and information on optimal levels of physical activity ( 20 ) . Patients with higher degrees of disability or abnormal pain behavior received immediate extra reassurance , information on pain-relieving positions , and a telephone call or second visit within 72 hours . Specific protocol s were created for low-back ( 21 ) , neck , shoulder , arm and h and , knee , and foot pain ( 19 , 22 - 25 ) and included the 3-level clinical -management system described later . Moving a patient from the lower to the upper levels of the system implied the need for further diagnostic or therapeutic procedures and was indicated 1 ) after a patient spent a predefined period at the lower level without return to work or substantial clinical improvement or 2 ) by the clinical judgment of the rheumatologist . At the first level of the system , patients received the clinical management started at the first visit , including a diagnosis based on clinical criteria , pharmacologic treatment of pain and inflammation , pharmacologic treatment of anxiety and depression , peripheral intra- and periarticular injections ( 26 ) , and education . Time spent at the first level averaged 2 to 6 weeks . At the second level , patients received maintenance of therapy plus referral for formal rehabilitation and laboratory tests , radiography , computerized tomography , magnetic resonance imaging , and electromyography . After 4 to 8 weeks with no improvement at the second level , patients were moved to the third level and received further diagnostic procedures or referral for surgical or other specialized care . Red flags were defined , including age older than 50 years for patients with axial pain , previous trauma , cancer , serious medical illness , inflammatory pain , night pain , drug abuse , corticosteroid use , fever , weight loss , progressively deteriorating function , and progressive neurologic deficit . The presence of a red flag precluded the use of the level system , and the patient in question was managed according to clinical criteria , with a focus on excluding serious illness . Treatment Failures Patients who did not respond to interventions at the second level of the system were examined for the presence of yellow flags , which included psychiatric illness , family problems , sociolabor conflicts , unemployment , and occupational causes of disability . The presence of a Objectives Prolonged sitting at work has been found to increase risk for musculoskeletal pain . The office-based intervention " Take a St and ! " was effective in reducing sitting time at work . We aim ed to study the effect of the intervention on a secondary outcome : musculoskeletal pain . Methods Take a St and ! included 19 offices ( 317 workers ) at four workplaces cluster r and omized to intervention or control . The multicomponent intervention lasted three months and included management support , environmental changes , and local adaptation . Control participants behaved as usual . Musculoskeletal pain was measured by self-report question naire assessing pain in neck-shoulders , back and extremities in three categories at baseline , and one and three months follow-up . Results At one month , there was no difference in odds ratio ( OR ) for pain in neck-shoulders between the two groups . However , after three months , the OR was 0.52 [ 95 % confidence interval ( 95 % CI ) 0.30 - 0.92 ] for pain in neck-shoulders in the intervention compared to the control group . No differences were found between the intervention and control group for pain in back and extremities over the three months . For total pain score a slight reduction was found in the intervention compared to the control group at one and three months [ -0.13 ( 95 % CI -0.23- -0.03 ) and -0.17 ( 95 % CI -0.32- -0.01 ) ] . Conclusions The secondary analyses showed that the office-based intervention Take a St and ! reduced neck-shoulder pain after three months and total pain score after one and three months among office workers , but not neck-shoulder pain after one month or pain in the back and extremities Aims Given the high levels of absenteeism due to musculoskeletal disorders of the upper limbs , there is a need for preventive strategies to protect workers exposed to high risk levels . The purpose of this study was to determine the effect of a workplace-based muscle resistance training exercise program in the presence of pain and musculoskeletal dysfunction of the upper extremities in manufacturing workers exposed to repetitive movements and excessive effort in the workplace . Method R and omized controlled trial in manufacturing workers . A sample of 120 healthy workers was allocated at r and om to an experimental group , which received a resistance-based exercise program , and a control group , which performed stretching exercises . Results The muscle resistance training exercise had a protective effect on the intensity of pain perceived by workers in their upper limbs ( RR : 0.62 95 % CI 0.44–0.87 ) compared with the group of workers who performed stretching exercises . Conclusion A workplace-based muscle resistance training exercise program is an effective preventive strategy in factory workers exposed to risk ; however , it is necessary for companies initially to adopt mechanisms to minimize exposure as a prevention strategy Background Continuous neck and shoulder pain is a common musculoskeletal complaint . Physical exercise can reduce pain symptoms , but compliance to exercise is a challenge . Exercise-specific self-efficacy has been found to be a predictor of participation in preplanned exercise . Little is known about the influence of exercise-specific self-efficacy on compliance to workplace physical exercise . Purpose To determine the influence of exercise-specific self-efficacy on compliance to specific strength exercises during working hours for laboratory technicians . Methods We performed a cluster-r and omized controlled trial , including laboratory technicians from two industrial production units in Copenhagen , Denmark . The participants were r and omized to supervised specific strength exercises for the neck and shoulder muscles  for 20 minutes three times a week ( n = 282 ) or to a reference group ( n = 255 ) . The participants answered baseline and follow-up questions regarding self-efficacy and registered all exercises in a diary . Results Overall compliance to exercises was 45 % . Compliance in company A ( private sector ) differed significantly between the three self-efficacy groups after 20 weeks . The odds ratio of compliance was 2.37 for moderate versus low self-efficacy , and 2.93 for high versus low self-efficacy . No significant difference was found in company B ( public sector ) or in the intervention group as a whole . Conclusion We did not find self-efficacy to be a general statistically significant predictor of compliance to exercises during 20 weeks , but found self-efficacy to be a predictor of compliance in a private sector setting . Workplace-specific differences might be present and should be taken into account Study Design . A population cohort study to determine the 1-year persistence of neck pain . Objectives . The aim of this study was to determine the persistence of  neck pain  over a 12-month period among the general adult population and to explore socio-demographic , health-related , occupational , physical , and lifestyle factors that might be linked to such persistence . Summary of Background Data . Musculoskeletal clinicians report that neck patients frequently return to consult for recurring episodes of pain . However , the persistent nature of neck pain has been less research ed than other common chronic pain syndromes . Methods . First , to identify a cohort of current neck pain sufferers , a baseline cross-sectional survey was conducted in a general population of 7,669 adults , 18 to 75 years of age , registered with two primary care practice s in South Manchester , UK . The second phase was a follow-up survey , 12 months later , to determine the 1-year persistence of neck pain among those who had reported neck pain at baseline . Persistence of neck pain was compared across groups of responders stratified by potential prognostic factors measured at baseline . “ Persistent ” neck pain was defined according to shading within the region of the neck on a blank body mannequin . The term “ persistent ” neck pain could therefore reflect chronic , recurrent , or continuous pain . Results . There were 1,359 neck pain responders in the baseline survey , and these subjects formed the study population for the prospect i ve study . At follow-up , 786 ( 58 % ) subjects responded , of whom 48 % reported having neck pain lasting for more than 1 day , during the previous month . Significant baseline characteristics , which independently predicted persistent neck pain , were age ( odds ratio [ OR ] = 3.4 ) , being off work at the time of the baseline survey ( OR = 1.6 ) , comorbid low back pain ( OR = 1.6 ) , and cycling as a regular activity ( OR = 2.4 ) . Conclusion . Among the general population , neck pain persists at 12 months in around half of those who report neck pain at the start of the period . An increased risk of persistent neck pain was associated with age 45 to 59 years and low back pain , and also with cycling . The linkwith psychological distress and the absence of a link with occupational factors compares with other previous findings for common musculoskeletal syndromes in the community Objectives I-Preventive is a digital preventive tool for musculoskeletal disorders ( MSDs ) in computer workers . We sought to determine its impact on pain in computer workers with upper limb MSDs and visual discomfort . Methods We conducted a pilot cluster r and omised trial in 2 different sites of a tyre factory in France . We r and omised 200 employees to either an  intervention group ( I-Preventive ) or control group  , each comprising symptomatic and asymptomatic employees . The workers were followed up for 5 months . The main outcome was overall recovery from symptoms following 1 month 's intervention based on Nordic-style and eyestrain question naires . Results We included 185/200 workers : 96 in the intervention group ( mean age 41.8±1.4 years ; 88.5 % males ) and 79 in the control group ( mean age 42.9±12.0 years ; 94.5 % males ) . The most painful areas ( numerical scale ≥2 ) were the neck ( 40.0 % ) , upper back ( 18.8 % ) and shoulders ( 15.7 % ) . For the most painful anatomical area , the Nordic score significantly decreased after 1 month in the intervention group ( p=0.038 ) ; no change was observed in the control group ( p=0.59 ) . After 1 month 's use , the intervention group reported less pain in the painful area and less visual discomfort symptoms ( p=0.02 ) . Adherence to the I-Preventive program was 60 % . Conclusions I-Preventive is effective in the short term on musculoskeletal symptoms and visual discomfort by promoting active breaks and eyestrain treatment . This easy-to-use digital tool allows each worker to focus on areas of their choice via personalised , easy exercises that can be performed in the workplace . Trial registration number NCT02350244 ; Pre- results OBJECTIVE Imbalance between work dem and s and individual re sources can lead to musculoskeletal disorders and reduced work ability . The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability . METHODS Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were r and omly allocated to 10 weeks of either strength training for the shoulder , arm , and h and muscles ( 3 times per week , 10 minutes per session ) or ergonomic training ( usual care control group ) from September to December 2012 . The outcome measure was the change from baseline to 10-week follow-up in the work ability index ( WAI ) . RESULTS A priori hypothesis testing showed a group × time interaction for WAI ( P<0.05 ) . Compared with the ergonomic training group , WAI increased 2.3 [ 95 % confidence interval ( 95 % CI ) 0.9 - 3.7 ] in the strength training group corresponding to a moderate effect size ( Cohen 's d 0.52 ) . Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group . Of the 7 items of WAI , item 2 ( work ability in relation to the dem and s of the job ) and item 7 ( mental re sources ) increased following strength training compared with ergonomic training ( P<0.05 ) . CONCLUSIONS Implementation of strength training at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks . Thus , strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se This study investigated effects of physical exercise on  musculoskeletal pain symptoms in all regions of the body , as well as on other musculoskeletal pain in association with neck pain . A single blind r and omized controlled trial testing a one-year exercise intervention was performed among 549 office workers ;  specific neck/shoulder resistance training , all-round physical exercise , or a reference intervention . Pain symptoms were determined by question naire screening of twelve selected body regions . Case individuals were identified for each body region as those reporting pain intensities at baseline of 3 or more ( scale of 0 - 9 ) during the last three months . For neck cases specifically , the additional number of pain regions was counted . Intensity of pain decreased significantly more in the neck , low back , right elbow and right h and in cases of the two exercise groups compared with the reference group ( P<0.0001 - 0.05 ) . The additional number of pain regions in neck cases decreased in the two exercise groups only ( P<0.01 - 0.05 ) . In individuals with no or minor pain at baseline , development of pain was minor in all three groups . In conclusion , both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Neck pain is more prevalent in office workers than in the general community . To date , findings from prospect i ve studies that investigated causal relationships between putative risk factors and the onset of neck pain in this population have been limited by high loss to follow-up . The aim of this research was to prospect ively evaluate a range of risk factors for neck pain in office workers , using vali date d and reliable objective measures as well as attain an estimate of 1-year incidence . We assembled a cohort of 53 office workers without neck pain and  measured individual , physical , workplace and psychological factors at  baseline . We followed participants for 1 year to measure the incidence of neck pain . We achieved 100 % participant follow-up . Cox regression analysis was applied to examine the relationship between the putative risk factors and the cumulative incidence of neck pain . The 1-year incidence proportion of  neck pain in Australian office workers was estimated in this study to be 0.49 ( 95 % CI 0.36–0.62 ) . Predictors of neck pain with moderate to large effect sizes were female gender ( HR : 3.07 ; 95 % CI : 1.18–7.99 ) and high psychological stress ( HR : 1.64 ; 95 % CI : 0.66–4.07 ) . Protective factors included increased mobility of the cervical spine ( HR : 0.44 ; 95 % CI : 0.19–1.05 ) and frequent exercise ( HR : 0.64 ; 95 % CI : 0.27–1.51 ) . These results reveal that neck pain is common in Australian office workers and that there are risk factors that are potentially modifiable Background The prevalence and consequences of musculoskeletal pain is considerable among healthcare workers , allegedly due to high physical work dem and s of healthcare work . Previous investigations have shown promising results of physical exercise for relieving pain among different occupational groups , but the question remains whether such physical exercise should be performed at the workplace or conducted as home-based exercise . Performing physical exercise at the workplace together with colleagues may be more motivating for some employees and thus increase adherence . On the other h and , physical exercise performed during working hours at the workplace may be costly for the employers in terms of time spend . Thus , it seems relevant to compare the efficacy of workplace- versus home-based training on musculoskeletal pain . This study is intended to investigate the effect of workplace-based versus home-based physical exercise on musculoskeletal pain among healthcare workers . Methods / Design This study was design ed as a cluster r and omized controlled trial performed at 3 hospitals in Copenhagen , Denmark . Clusters are hospital departments and hospital units . Cluster r and omization was chosen to increase adherence and avoid contamination between interventions . Two hundred healthcare workers from 18 departments located at three different hospitals is allocated to 10 weeks of 1 ) workplace based physical exercise performed during working hours ( using kettlebells , elastic b and s and exercise balls ) for 5 × 10 minutes per week and up to 5 group-based coaching sessions , or 2 ) home based physical exercise performed during leisure time ( using elastic b and s and body weight exercises ) for 5 × 10 minutes per week . Both intervention groups will also receive ergonomic instructions on patient h and ling and use of lifting aides etc . Inclusion criteria are female healthcare workers working at a hospital . Average pain intensity ( VAS scale 0 - 10 ) of the back , neck and shoulder ( primary outcome ) and physical exertion during work , social capital and work ability ( secondary outcomes ) is assessed at baseline and 10-week follow-up . Further , postural balance and mechanical muscle function is assessed during clinical examination at baseline and follow-up . Discussion This cluster r and omized trial will investigate the change in self-rated average pain intensity in the back , neck and shoulder after either 10 weeks of physical exercise at the workplace or at home . Trial registration Clinical Trials.gov ( NCT01921764 ) OBJECTIVE Office-work poses a high-risk for musculoskeletal disorders ( MSDs ) , with consequences for workers , employers and society . The aims of this study were to determine the prevalence of musculoskeletal symptoms in a sample of Iranian office workers , to investigate the association between pain severity and job satisfaction and to investigate the association between MSDs and job satisfaction . MATERIAL S AND METHODS Iranian office workers from a university setting ( n=91 ) were r and omly selected and included in this cross-sectional study . The  Nordic musculoskeletal question naire plus visual analogue scale of pain  , and the Brayfield-Rothe Job Satisfaction Index  were used to study the prevalence of MSDs , pain intensity and job satisfaction , respectively . Descriptive analysis , Pearson 's correlation , and multiple regression analysis were performed for statistical assessment . RESULTS Eighty-nine percent of participants reported musculoskeletal symptoms during the past 12 months , most commonly in the neck ( 69.2 % ) , low back ( 58.2 % ) , knees ( 41.8 % ) , shoulders ( 35.2 % ) , and upper back ( 34.1 % ) . There was a significant negative correlation between pain intensity and job satisfaction . Pain intensity , low-back pain in the last week , wrist pain in the past 12 months and shoulder pain were significantly associated with job satisfaction ( p<0.05 ) . CONCLUSION This study provides evidence that musculoskeletal symptoms are common in Iranian office workers , associated with low job satisfaction . These findings indicate the need for more attention to MSDs among office workers and design ing effective preventive interventions The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey . A question naire was mailed to 21,201 subjects aged 16 - 64 years , selected at r and om from the registers of 34 British general practice s. Information was collected on occupation and on regular use of keyboards ( for > 4 h in an average working day ) , pain in the upper limbs and neck , numbness or tingling in the upper limbs , headaches , and feelings of tiredness or stress . Associations were explored by logistic regression , with the result ant odds ratios converted into prevalence ratios ( PRs ) . Among 12,262 respondents , 4899 held non-manual occupations . These included 1871 regular users of keyboards ( e.g. computer operators , data processors , clerks , administrators , secretaries and typists ) .  Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall ( with 1 week period prevalences of 30 and 15 % , respectively ) , and were associated with older age , smoking , headaches and tiredness or stress . After adjustment for these factors , regular keyboard use was significantly associated with pain in the past week in the shoulders ( PRs 1.2 - 1.4 ) and the wrists or h and s ( PR 1.4 ) , but not with elbow pain or sensory symptoms over the same period , or with neck or upper limb pain that prevented normal activities in the past year . Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers . We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or h and , but risk estimates were lower than generally reported in workplace surveys . Previous estimates of risk in the occupational setting may have been biased by shared expectations , concerns , or other aspects of illness behaviour Background Previous studies have shown positive effects of physical exercise at the workplace on musculoskeletal disorders . However , long-term adherence remains a challenge . The present study evaluates long-term adherence and effects of a workplace strength training intervention on back , neck and upper extremity pain among laboratory technicians . Methods Cluster-r and omized controlled trial involving 537 industrial laboratory technicians . Subjects were r and omized at the cluster level to one of two groups : training group 1 ( TG1 , n = 282 ) performing supervised strength training from February to June 2009 ( round one ) or training group 2 ( TG2 , n = 255 ) performing supervised strength training from August to December 2009 ( round two ) . The outcome measures were changes in self-reported pain intensity ( 0–9 ) in the back , neck and upper extremity as well as Disability of the Arm , Shoulder and H and ( DASH , 0–100 ) . Results Regular adherence , defined as at least one training session per week , was achieved by around 85 % in both groups in the supervised training periods . In the intention-to-treat analyses there were significant group by time effects for pain in the neck , right shoulder , right h and and lower back and DASH - result ing in significant reductions in pain ( mean 0.3 to 0.5 ) and DASH ( mean 3.9 ) in the scheduled training group compared to the reference group . For TG1 there were no significant changes in pain in round two , i.e. they maintained the pain reduction achieved in round one . Subgroup analyses among those with severe pain ( > = 3 on a scale of 0–9 ) showed a significant group by time effect for pain in the neck , right shoulder , upper back and lower back . For these subgroups the pain reduction in response to training ranged from 1.1 to 1.8 . Conclusions Specific strength training at the workplace can lead to significant long-term reductions in spinal and upper extremity pain and DASH . The pain reductions achieved during the intensive training phase with supervision appears to be maintained a half year later PURPOSE To examine the dose-response relationship of specific strength- and endurance-training regimes for the cervical muscles , which have been shown to be effective among women with chronic neck pain and disability . METHODS A total of 180 female office workers , aged 25 to 53 yr , with chronic neck pain and disability were r and omized into a strength-training , an endurance-training , and a control group . The training groups participated in a 12-d rehabilitation period , in which instructions for the exercises were given by an experienced physical therapist . Both training groups continued with exercises at home for 12 months . Physical activity was measured with a training diary and a 1-month all-time recall question naire . All activities were registered and converted into metabolic equivalents ( METs ) . RESULTS Specific neck , shoulder , and upper-extremity training for more than 8.75 MET.h.wk was an effective training dose for decreasing neck pain . One MET-hour of training per week accounted for an 0.8-mm decrease of neck pain on a visual analog scale ( VAS ) and a 0.5-mm decrease on a disability index . Both strength and endurance training decreased perceived neck pain and disability . Declines in neck pain and disability correlated positively with the amount of specific training . CONCLUSION This study revealed that the described specific exercise protocol s were associated with decreases in chronic neck pain and disability . The effective dose of training was feasible and safe to perform among female office workers Effectiveness of exercise therapy in video display unit ( VDU ) workers with work-related chronic neck pain ( W-RCNP ) is unclear . The aim of the study was to assess the efficacy of group-based neck-shoulder resistance exercises on symptoms and muscular function in VDU workers with W-RCNP . Thirty-five employees with CNP were r and omly assigned to neck-shoulder resistance exercise ( NSRE ) group or to conventional stretching and postural exercise ( SPE ) group . Participants trained 45 min , twice a week for 7 weeks . Primary outcomes were pain intensity ( 0–10 numeric rating scale , NRS ) and pain-related disability ( Vernon Neck Disability Index , NDI ) . Secondary outcomes were cervical active range of motion ( AROM ) , endurance of neck flexors , strength of shoulder abductors , and health-related quality of life ( SF-36 ) . Post-treatment , pain and disability decreased 2.5 and 5 points in NSRE ( p = 0.001 ) and 5 and 8 points in SPE ( p = 0.002 ) , with no significant differences between groups . AROM improved significantly in both groups ; between-group differences were not significant . Neck flexors endurance and shoulder abductors strength improved by 59.6 and 34.2 % ( p = 0.001 ) in the NSRE group and by 27.6 % ( p = 0.009 ) and 2.3 % ( p = 0.002 ) in the SPE group ; between-group differences were significant ( p = 0.016 and p < 0.001 , respectively ) . SF-36 score remained unchanged . NSRE and SPE are feasible and equally effective in reducing pain and pain-related disability as group exercises in W-RCNP . NSRE may provide some advantage in improving strength and endurance in neck muscles . Further , larger studies should confirm these findings and assess whether a better muscle function confers long-term clinical advantages OBJECTIVE To establish basic epidemiological data on  chronic pain ( duration > 3 months ) in a defined population . Relationships between age , gender , and social class were tested . DESIGN A survey of pain symptoms , including location , intensity , duration , and functional capacity , was conducted by means of a mail question naire . SETTING General population s in two Swedish primary health care districts . Medical care was provided in a state health system . SUBJECTS A r and om sample ( from the population register ) of 15 % of the population aged 25 - 74 ( n = 1,806 ) . The response rate was 90 % . OUTCOME MEASURES Descriptive epidemiologic data in relation to objectives of the study . RESULTS Without sex differences , 55 % ( 95 % confidence interval , 53 - 58 % ) of the population had perceived persistent pain for 3 months and 49 % for 6 months . Among individuals with chronic pain , 90 % localized their pain to the musculoskeletal system to a variable extent . Women experienced more multiple localizations of pain and had pain in the neck , shoulder , arm , and thigh to a greater extent than men . Prevalence of pain increased by age up to 50 - 59 years for both genders and then slowly decreased . The neck-shoulder area was the most common site of pain ( 30.2 % ) , followed by the lower back ( 23.2 % ) . Even in the youngest age groups more than one of four reported chronic pain . Blue-collar workers and employers ( including farmers ) reported chronic pain to a greater extent than other groups . In 13 % of the population , manifest pain problems were associated with reduced functional capacity . CONCLUSION Chronic pain symptoms are common but unevenly distributed in a general population . The results may influence planning and consultation in primary health care as well as warranting selective prevention activities Background Neck and upper limb symptoms are frequently reported by computer workers .  Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms . A combined approach targeting work style and lifestyle physical activity seems promising , but little is known on the effectiveness of such combined interventions . Methods / design The RSI@Work study is a r and omised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers . Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and /or the last two weeks are r and omised into three groups : ( 1 ) work style group , ( 2 ) work style and physical activity group , or ( 3 ) control group . The work style intervention consists of six group meetings in a six month period that take place at the workplace , during work time , and under the supervision of a specially trained counsellor . The goal of this intervention is to stimulate workplace adjustment and to improve body posture , the number and quality of breaks and coping behaviour with regard to high work dem and s. In the combined ( work style and physical activity ) intervention the additional goal is to increase moderate to heavy physical activity . The control group receives usual care . Primary outcome measures are degree of recovery , pain intensity , disability , number of days with neck and upper limb symptoms , and number of months without neck and upper limb symptoms . Outcome measures will be assessed at baseline and six and 12 months after r and omisation . Cost-effectiveness of the group meetings will be assessed using an employer 's perspective . Discussion This study will be one of the first to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention in reducing neck and upper limb symptoms of computer workers . The results of the study are expected in 2007 Objective . To investigate the effect of workplace neck/shoulder strength training with and without regular supervision on  neck/shoulder pain and headache among office workers . Method . A 20-week cluster r and omized controlled trial among 351 office workers was r and omized into three groups : two training groups with the same total amount of planned exercises three times per week ( 1 ) with supervision ( 3WS ) throughout the intervention period , ( 2 ) with minimal supervision ( 3MS ) only initially , and ( 3 ) a reference group ( REF ) . Main outcome is self-reported pain intensity in neck and shoulder ( scale 0–9 ) and headache ( scale 0–10 ) . Results . Intention-to-treat analyses showed a significant decrease in neck pain intensity the last 7 days in 3MS compared with REF : −0.5 ± 0.2 ( P < 0.02 ) and a tendency for 3WS versus REF : −0.4 ± 0.2 ( P < 0.07 ) . Intensity of headache the last month decreased in both training groups : 3WS versus REF : −1.1 ± 0.2 ( P < 0.001 ) and 3MS versus REF : −1.1 ± 0.2 ( P < 0.001 ) . Additionally , days of headache decreased 1.0 ± 0.5 in 3WS and 1.3 ± 0.5 in 3MS versus REF . There were no differences between the two training groups for any of the variables . Conclusion . Neck/shoulder training at the workplace reduced neck pain and headache among office workers independently of the extent of supervision . This finding has important practical implication s for future workplace interventions Three groups of data entry female visual display terminal ( VDT ) workers from Norway ( n = 30 ) , Pol and ( n = 33 ) and the USA ( n = 29 ) were compared . Before intervention , the Norwegian group reported more neck pain compared with the Polish group . The Polish group reported less shoulder pain than both the U.S. and the Norwegian groups . The clinical examination documented fewer symptoms and signs of musculoskeletal illness among the Polish participants compared with the Norwegian and the U.S. groups . After intervention , the Norwegian group reported a reduction in neck pain while the U.S. group reported a reduction in shoulder pain . The Polish group reported an increase in neck , shoulder and forearm pain at follow-up compared to after intervention . The Polish group recorded higher flexion of the upper arm at follow-up parallel with an increase of pain in the upper part of the body . Visual discomfort showed variable results in the 3 countries Objective To investigate the association of physical and psychosocial risk factors with musculoskeletal disorders ( MSDs ) in New Zeal and nurses , postal workers and office workers . Design A cross-sectional postal survey asking about demographic , physical and psychosocial factors and MSDs . Participants A total of 911 participants was r and omly selected ; nurses from the Nursing Council of New Zeal and data base ( n=280 ) , postal workers from their employer 's data base ( n=280 ) and office workers from the 2005 electoral roll ( n=351 ) . Outcome Measures Self-reported pain in the low back , neck , shoulder , elbow , wrist/h and or knee lasting more than 1 day in the month before the survey . Results The response rate was 58 % , 443 from 770 potential participants . 70 % ( n=310 ) reported at least one MSDs . Physical work tasks were associated with low back ( odds ratio ( OR ) 1.35 , 95 % CI 1.14 to 1.6 ) , shoulder ( OR 1.41 , 95 % CI 1.17 to 1.69 ) , elbow ( OR 1.14 , 95 % CI 1.13 to 1.83 ) and wrist/h and pain ( OR 1.39 , 95 % CI 1.15 to 1.69 ) . Job strain had the strongest association with neck pain ( OR 3.46 , 95 % CI 1.30 to 9.21 ) and wrist/h and pain . Somatisation was weakly associated with MSDs at most sites . Better general and mental health status were weakly associated with lower odds of MSDs . Conclusions In injury prevention and rehabilitation the physical nature of the work needs to be addressed for most MSDs , with modest decreases in risk seemingly possible . Addressing job strain could provide significant benefit for those with neck and wrist/h and pain , while the effects of somatisation and the promotion of good mental health may provide smaller but global benefits OBJECTIVE Numerous studies has shown that regular physical exercise can reduce musculoskeletal pain , but the optimal setting to achieve high adherence and effectiveness remains unknown . This study investigated the effect of workplace versus home-based physical exercise on musculoskeletal pain among healthcare workers . METHODS The r and omized controlled trial ( RCT ) comprised 200 female healthcare workers from 18 departments at 3 hospitals . Participants were r and omly allocated at the cluster level to ten weeks of : ( i ) workplace physical exercise ( WORK ) performed during working hours for 5 × 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise , or ( ii ) home-based physical exercise ( HOME ) performed during leisure time for 5 × 10 minutes per week . Both groups received ergonomic counseling on patient h and ling and use of lifting aides . Average pain intensity ( 0 - 10 scale ) in the low back and neck/shoulder was the primary outcome . RESULTS Per week , 2.2 ( SD 1.1 ) and 1.0 ( SD 1.2 ) training sessions were performed in WORK and HOME groups , respectively . Pain intensity , back muscle strength and use of analgesics improved more following WORK than HOME ( P<0.05 ) . Between-group differences at follow-up ( WORK versus HOME ) was -0.7 points for pain intensity [ 95 % confidence interval ( 95 % CI ) -1.0- -0.3 ] , 5.5 Nm for back muscle strength ( 95 % CI 2.0 - 9.0 ) , and -0.4 days per week for use of analgesics ( 95 % CI -0.7- -0.2 ) . The effect size for between-group differences in pain intensity was small ( Cohen 's d=0.31 ) . CONCLUSIONS Workplace physical exercise is more effective than home-based exercise in reducing musculoskeletal pain , increasing muscle strength and reducing the use of analgesics among healthcare workers Background Specific strength training can reduce neck and shoulder pain in office workers , but the optimal combination of exercise frequency and duration remains unknown . This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed . Methods A total of 447 office workers with and without neck and /or shoulder pain were r and omly allocated at the cluster-level to one of four groups ; 1 × 60 ( 1WS ) , 3 × 20 ( 3WS ) or 9 × 7 ( 9WS ) min a week of supervised high-intensity strength training for 20 weeks , or to a reference group without training ( REF ) . Primary outcome was self-reported neck and shoulder pain ( scale 0–9 ) and secondary outcome work disability ( Disability in Arms , Shoulders and H and s ( DASH ) ) . Results The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF . Among those with pain ≥3 at baseline ( n=256 ) , all three training groups achieved significant reduction in neck pain compared with REF ( p<0.01 ) . From a baseline pain rating of 3.2 ( SD 2.3 ) in the neck among neck cases , 1WS experienced a reduction of 1.14 ( 95 % CI 0.17 to 2.10 ) , 3WS 1.88 ( 0.90 to 2.87 ) and 9WS 1.35 ( 0.24 to 2.46 ) which is considered clinical ly significant . DASH was reduced in 1WS and 3WS only . Conclusion One hour of specific strength training effectively reduced neck and shoulder pain in office workers . Although the three contrasting training groups showed no statistical differences in neck pain reduction , only 1WS and 3WS reduced DASH . This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace Objective : Physical exercise can reduce the prevalence of musculoskeletal disorders , but adherence to exercise is challenging for many employees . This study determines prognostic factors for adherence to workplace exercise . Methods : In Copenhagen , 132 office workers with neck/shoulder pain were r and omized to 2 or 12 minutes of exercise five days a week . Low , medium , and high adherence was defined as performing less than 10 , 10–30 , or more than 30 exercise sessions during the subsequent 10 weeks . Odds ratios ( OR ) for adherence were modeled by logistic regression . Results : Lower adherence to the 10-week exercise program was predicted by poorer psychosocial work environment and lower exercise self-efficacy . A longer exercise program was not associated with lower adherence . Conclusions : Concurrent strategies to improve psychosocial work environment and individual exercise beliefs should be considered when implementing exercise at the workplace Objective : To evaluate the participatory ergonomic method on the development of upper extremity musculoskeletal disorders and disability in office employees . Methods : This study is a r and omized controlled intervention study . It comprised 116 office workers using computers . Those in the intervention group were taught office ergonomics and the risk assessment method . Cox proportional hazards model and generalized estimating equations ( GEEs ) were used . Results : In the 10-month postintervention follow-up , the possibility of developing symptoms was 50.9 % . According to multivariate analysis results , the possibility of developing symptoms on the right side of the neck and in the right wrist and h and was significantly less in the intervention group than in the control group ( p<0.05 ) . Neck disability/symptom scores over time were significantly lower in the intervention group compared with the control group ( p<0.05 ) . Conclusion : The participatory ergonomic intervention decreases the possibility of musculoskeletal complaints and disability/symptom level in office workers Abstract Little is known about the mechanisms leading to chronic neck-shoulder musculoskeletal disorders  ( MSD ) . The aim of the present study was to investigate and compare motor function during controlled , low load , repetitive work together with chronic or acute experimental neck-shoulder pain . The clinical study was performed on workers with ( n = 12 ) and without ( n = 6 ) chronic neck-shoulder pain . In the experimental study , experimental muscle pain was induced in healthy subjects by intra-muscular injection of hypertonic saline into the trapezius muscle ( n = 10 ) . The assessed parameters related to motor performance were : work task event duration , cutting forces , surface electromyogram ( EMG ) activity in four shoulder muscles , displacement of the centre of pressure , and arm and trunk 3D movements . For controlled cutting force levels , chronic and acute experimental pain provoked a series of changes : a decreased working rhythm and a protective reorganisation of muscle synergy ( experimental study ) , higher EMG frequency contents which may indicate altered motor unit recruitment , and greater postural activity and a tendency towards increased arm and trunk movements . These pain-related changes can play a role in the development of MSD . The present clinical and experimental study demonstrated similar interactions between motor co-ordination and neck-shoulder pain in occupational setting s. We therefore suggest that this experimental model can be used to study mechanisms related to MSD . Information on such modulatory processes may help in the design of new strategies aim ed at reducing the development of MSD OBJECTIVE The physical activity programmes in the workplace ( PAPW ) are applied to minimize the prevalence , incidence and intensity of pain . This study evaluated the perception of pain and quantifies its intensity among garment workers before and after performing a PAPW . PARTICIPANTS We included 61 workers of a clothing company , who were classified r and omly into experimental group ( n = 44 ) 28.7 ± 8.8 years old and a control group ( n = 17 ) 27.8 ± 7.4 years ( 20 - 43 years ) . METHODS The Trigger Points test question naire was used to assess pain perception and quantify its intensity . The PAPW was conducted in 15-minute sessions per day , consisting of stretching exercises ( 40 % ) , muscular endurance ( 40 % ) , self-massage relaxation and massage techniques ( 10 % ) , and group dynamics ( 10 % ) . RESULTS The garment workers who participated in the PAPW showed a significant reduction of pain felt in the neck and wrists , and also a reduction in pain intensity in shoulders , arms , fingers and wrists that are most often strained during sewing . CONCLUSIONS Our findings suggest that PAPW that target muscle groups that are more tense in sewing tasks , may be considered by companies for supporting adaptation to the work environment and improving health by reducing muscle and joint pain Background .Neck and low back pain are leading causes of morbidity and health care utilization . However , little is known about the characteristics that differentiate those who seek from those who do not seek health care for their pain . Objectives .The objectives of this study were to : 1 ) describe health care utilization for neck and back pain ; 2 ) determine the characteristics of individuals seeking health care for neck and back pain ; and 3 ) identify the characteristics of patients who consult medical doctors , chiropractors , or both .  Design . Population -based cross-sectional mailed survey . Subjects . Subjects were r and omly selected adults from the Saskatchewan Health Insurance and Registration File . Measures .Demographic , socio-economic , general health , comorbidity , health-related- quality -of-life , pain severity and health care utilization data were collected . The main outcome was whether subjects with prevalent neck or low back pain visited a  health care provider in the previous month . Results .Twenty-five percent of individuals with neck or low back pain visited a health care provider . Seeking health care was associated with disabling neck or back pain , digestive disorders , worse bodily pain and worse physical-role-functioning . Compared with medical patients , fewer chiropractic patients lived in rural areas or reported arthritis , but they reported better social and physical functioning . More patients consulting both providers reported disabling neck or back pain . Conclusions .Individuals seeking care for neck or back pain have worse health status than those who do not seek care . Patients consulting chiropractors alone report fewer comorbidities and are less limited in their activities than those consulting medical doctors
Thus , WIs were seldom design ed to improve return-to-work .
Overall , there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity .
If present , significant results in favour of WIs were not sustained across follow-up times .
Overall , this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term , which was not sustained over time .
BACKGROUND Musculoskeletal disorders are the most common cause of disability in many industrial countries .
Recurrent and chronic pain accounts for a substantial portion of workers ' absenteeism .
Neck pain seems to be more prominent in the general population than previously known .
OBJECTIVES To determine the effectiveness of workplace interventions ( WIs ) in adult workers with neck pain .