Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Musculoskeletal symptoms and job satisfaction among office-workers: a cross-sectional study from Iran. Reducing musculoskeletal disorders among computer operators: comparison between ergonomics interventions at the workplace Physical and psychosocial risk factors for musculoskeletal disorders in New Zealand nurses, postal workers and office workers Ergonomic Training Reduces Musculoskeletal Disorders among Office Workers: Results from the 6-Month Follow-Up. The implementation of occupational health guidelines principles for reducing sickness absence due to musculoskeletal disorders. Effectiveness of participatory training for prevention of musculoskeletal disorders: a randomized controlled trial 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 Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Musculoskeletal disorders and occupational exposures: How should we judge the evidence concerning the causal association? Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: a randomised controlled trial. Evaluation of ‘I-Preventive’: a digital preventive tool for musculoskeletal disorders in computer workers—a pilot cluster randomised trial 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 A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders. A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders: A Randomized Controlled Trial Workplace Prevention and Musculoskeletal Injuries in Nurses 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 The Effects of Office Ergonomic Training on Musculoskeletal Complaints, Sickness Absence, and Psychological Well-Being A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders. VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers 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. Incidence of musculoskeletal disorders among newly employed manufacturing workers. Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers. Coordinated and Tailored Work Rehabilitation: A Randomized Controlled Trial with Economic Evaluation Undertaken with Workers on Sick Leave Due to Musculoskeletal Disorders Integrated Case Management for Work-Related Upper-Extremity Disorders: Impact of Patient Satisfaction on Health and Work Status Effects of ergonomic intervention in work with video display units. Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial. The cost-effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on recovery from neck and upper limb symptoms and pain reduction in computer workers Effort-reward imbalance and one-year change in neck-shoulder and upper extremity pain among call center computer operators. Early Workplace Intervention for Employees With Musculoskeletal-Related Absenteeism: A Prospective Controlled Intervention Study Job stress management and ergonomic intervention for work-related upper extremity symptoms. Risk factors for neck pain in office workers: a prospective study A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders 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. No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial.
OBJECTIVE Since 2002 , an epidemiologic surveillance system of work-related , upper-limb musculoskeletal disorders ( MSDs ) has been implemented in France 's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population . METHODS The surveillance was based on a network of occupational physicians ( OPs ) and used the recommendations of a group of European experts ( criteria document consensus ) . In 2002 - 2003 , 80 of 400 OPs volunteered to participate . All underwent a training program to st and ardize the physical examination .  Health status was assessed by self-administered question naire and physical examination . Occupational risk factors were assessed by self-administered question naire .  Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document . RESULTS More than 50 % of the 2,685 men and women r and omly included in 2002 - 2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and approximately 30 % experienced them in the preceeding week . The prevalence of clinical ly diagnosed MSDs was high : approximately 13 % of workers experienced at least 1 of the MSDs . The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis . The prevalence of MSDs increased with age and varied widely across economic sectors and occupations . More than half of the workers were exposed to at least 2 risk factors of MSDs . Exposure varied according to industrial activity and occupation . According to the criteria document , a high percentage of MSD cases could be classified as probably work related ( 95 % in men and 89 % in women age < 50 , and 87 % in men and 69 % in women age > 50 ) . CONCLUSION Nonspecific upper-limb symptoms and specific upper-limb MSDs are common in the working population . These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs 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 Typing is associated with musculoskeletal disorders ( MSDs ) caused by multiple risk factors . This control study aim ed to evaluate the efficacy of a workplace intervention for reducing  MSDs among computer workers . Sixty-six subjects with and without MSD were assigned consecutively to one of three groups : ergonomics intervention ( work site and body posture adjustments , muscle activity training and exercises ) accompanied with biofeedback training , the same ergonomics intervention without biofeedback and a control group . Evaluation of MSDs , body posture , psychosocial status , upper extremity ( UE ) kinematics and muscle surface electromyography were carried out before and after the intervention in the workplace and the motion lab . Our main hypothesis that significant differences in the reduction of MSDs will exist between subjects in the study groups and controls was confirmed ( χ2 = 13.3 ; p = 0.001 ) . Significant changes were found in UE kinematics and posture as well . Both ergonomics interventions effectively reduced MSD and improved body posture . Practitioner Summary : This study aim ed to test the efficacy of an individual workplace intervention programme among computer workers by evaluating musculoskeletal disorders ( MSDs ) , body posture , upper extremity kinematics , muscle activity and psychosocial factors were tested . The proposed ergonomics interventions effectively reduced MSDs and improved body posture 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 BACKGROUND Musculoskeletal disorders are commonly reported among computer users . This study explored whether these disorders can be reduced by the provision of ergonomics education . METHODS A cluster r and omised controlled trial was conducted in which 3 units were r and omised for intervention and received training , and 3  units  were given a leaflet . The effect of intervention on workstation habits , musculoskeletal disorders , days and episodes of sick leave , and psychological well-being were assessed . RESULTS A significant improvement in workstation habits was found , and the differences remained significant at the follow-up time point for keyboard , mouse , chair , and desk use . The largest reduction in the percentage of musculoskeletal disorders was in the neck region ( -42.2 % , 95 % CI -60.0 to -24.4 ) . After adjusting for baseline values , significant differences were found at the follow-up time point in the neck , right shoulder , right and left upper limbs , lower back , and right and left lower limbs . No significant differences were found for the days and episodes of sick leave or the psychological well-being among workers after the intervention . CONCLUSION Consistent reductions were observed for all musculoskeletal disorders at the follow-up time point , although the difference was not statistically significant for the upper back . The improvements in the musculoskeletal disorders did not translate into fewer days lost from work or improved psychological well-being BACKGROUND Occupational health guidelines recommend a biopsychosocial approach to manage  sickness absence due to musculoskeletal disorders ( MSDs ) , with a primary focus on early intervention through provision of a supportive network . AIMS To investigate the implementation of a guidelines -based intervention ( early contact of absentees ; addressing psychosocial obstacles ; offering temporary modified work ; communicating among the players ) , and to determine whether this is effective for reducing return-to-work times and duration of future absence . METHODS A non-r and omized controlled trial was conducted within a UK company . Occupational health nurses at two experimental sites ( 1,435 workers ) were trained to deliver the intervention to workers taking absence due to MSDs ( low back and upper limb disorders ) , while usual care was delivered at three control sites ( 1,483 workers ) .  Company-recorded absence data were collected over a 12-month follow-up period . RESULTS The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site ( policies , procedures and individual approaches ) which had a detrimental effect on uptake and delivery . At the site where the intervention was delivered per protocol , absence was significantly less compared with controls ; 6.5 and 10.8 days , respectively . However , the duration of future absence was not significantly different ( 13.0 and 25.1 days , respectively ) . CONCLUSIONS An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs . Successful implementation , where the key players are onside and organizational obstacles are overcome , is difficult to achieve Purpose Health and safety training program has been applied to prevent work-related  musculoskeletal disorders ( MSDs ) in workplace . We evaluated the effectiveness of participatory training and didactic training programs on MSD prevention among frontline workers in Shenzhen , China . Methods The authors r and omly assigned 918 workers from intervention factories to receive participatory training ( intervention group ) , and 907 workers from intervention factories and 1,654 workers from control factories to receive didactic training ( control_1 group , control_2 group , respectively ) from June 1 , 2008 to November 30 , 2009 . Participants were asked to report experience of ache , pain or discomfort in 10 body parts at baseline and 1 year after training . Data were analyzed to compare the MSD prevalence 1 year before and 1 year after training in different groups from 2009 to 2010 . Results The follow-up rate was 61 % ( 2,120/3,479 ) at 1 year after training . In the year after training , there were no statistically significant changes in the proportion of workers who reported MSD in any body part . MSD prevalence rates in the intervention group reduced from 16.8 to 9.9 % for lower extremities ( χ2 = 13.102 , p < 0.001 ) and from 12.9 to 8.3 % ( χ2 = 9.433 , p = 0.002 ) for wrist and finger at 1 year after training . However , the rates did not change significantly for upper back , lower back , neck , shoulder and elbow in the intervention group and for all 10 body parts in two control groups . Conclusions Overall , the training programs did not seem to prevent the occurrence of MSD among frontline workers . However , participatory training might be effective to reduce MSD in the lower extremities and wrist and finger 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 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 Musculoskeletal disorders ( MSDs ) affecting the back , upper and lower extremities are widespread in the general population , implying a variety of causal factors . Multiple causes are not mutually exclusive , and a high background rate does not preclude associations with specific factors that are uncommon in the general population . MSDs have well-documented associations with occupational ergonomic stressors such as repetitive motion , heavy lifting , non-neutral postures , and vibration . Organizational features of the work environment , such as time pressure and low decision latitude , may also play a role , at least by potentiating the effects of physical loading . Numerous systematic review s have mostly concurred with these overall findings . Nevertheless , some continue to debate whether MSDs are sometimes work-related , even for those performing jobs with repetitive and routinized tasks , heavy lifting , and /or pronounced postural strain . This article discusses ( 1 ) some epidemiologic features of MSDs that underlie that debate ; and ( 2 ) the question of what should appropriately be considered a gold st and ard for scientific evidence on an etiological question such as the health effects of a non-voluntary exposure , such as an occupational or environmental agent . In particular , r and omized clinical trials have little relevance for determining the health effects of non-therapeutic risk factors Background Despite considerable knowledge about musculoskeletal disorders ( MSD ) and physical , psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD . In addition , studies of physical activity are often limited to either leisure activity or physical activity at work . Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking . This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD . Methods A question naire about musculoskeletal disorders , physical activity and background data ( employment status , age , gender , body mass index , smoking , education and physical stressors ) was completed by 2265 workers ( 58 % ) 18 to 70 years old in the Royal Norwegian Navy .  Multiple logistic regression with 95 % confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders . Results A total of 32 % of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year . The most common musculoskeletal disorders were in the lower back ( 15 % often or very often ) , shoulders ( 12 % often or very often ) and neck ( 11 % often or very often ) . After adjustment for confounders , physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows , knees and feet . Conclusion The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low . A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders  among personnel in the Royal Norwegian Navy . Prospect i ve studies are necessary to confirm the cause and effect in this association BACKGROUND AND OBJECTIVES Upper extremity musculoskeletal disorders ( MSD ) are very common in regular computer users and leading cause of work related illness . The objective of the present study is to evaluate effectiveness of yogic exercises in the improvement of symptoms of MSDs of upper limbs . MATERIAL S AND METHODS 60 study participants were r and omly divided into two groups that is yoga with counselling and only counselling group for 12 weeks . Symptom severity and functional status were assessed using the self administered Boston Carpal Tunnel Question naire and pre design ed symptom question naire before and after intervention . RESULTS There was significant reduction in symptom severity score ( P = 0.002 ) and improvement in functional status score in yoga with counselling group when compared to only counselling group . There is also a significant decrease in self reported symptoms like CT myalgia symptom ( P = 0.019 ) and improvement in weakness . CONCLUSION The present study showed a yoga based regimen is more effective than counselling alone in relieving symptoms of computer related musculoskeletal disorders 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 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 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 This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks 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 Objective The purpose of this study was to describe the availability of preventive devices and training in relation to neck , shoulder , and back musculoskeletal injuries/disorders ( MSD ) in registered nurses . Summary background data Nurses have one of the highest rates of MSD of any occupation . Studies have shown that mechanical lifting devices and lifting teams can reduce MSD rates and associated costs . Methods Data from 1163 r and omly selected currently working nurses ( 1 + years on the current job ) were collected in anonymous mailed surveys ( 74 % response rate ) . MSD cases had neck , shoulder , and /or back symptoms for at least 1 week , or at least monthly , and moderate or more pain , in the past year . Results Nurses with mechanical lifting devices available were significantly less likely to have neck or back MSDs . Back injury was less likely when lifting teams were available . However , adjustable beds and transfer sheets were associated with greater odds of back MSD . Training in workstation adjustment was associated with significantly lower MSD prevalence , though postural training was not . Conclusions Though use of mechanical devices and lifting teams was limited in nursing workplaces , these prevention strategies were related to reduced odds of MSD . Nursing administrators can use these findings to consider workplace changes 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 This study explored whether  musculoskeletal complaints can be reduced by the provision of ergonomics education . A cluster r and omized controlled trial study was conducted in which 3 units were r and omized to intervention and received training and 3 units were given a leaflet . The effect of intervention on knowledge , workstation practice s , musculoskeletal complaints , sickness absence , and psychological well-being were assessed at 6 and 12 months . Although there was no increment of knowledge among workers , significant improvements in workstation practice s in the use of monitor , keyboard , and chair were observed . There were significant reductions in neck and upper and lower back complaints among workers but these did not translate into fewer days lost from work . Workers ’ stress was found to be significantly reduced across the studies . In conclusion , office ergonomics training can be beneficial in reducing musculoskeletal risks and stress among workers BACKGROUND A prospect i ve study of computer users was performed to determine the occurrence of and evaluate risk factors for  neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms ( MSS ) and disorders ( MSD ) . METHODS Individuals ( n = 632 ) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years . At study entry , workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed . Daily diaries were used to document work practice s and incident MSS . Those reporting MSS were examined for specific MSD . Incidence rates of MSS and MSD were estimated with survival analysis . Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD . RESULTS The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years . The most common N/S MSD was somatic pain syndrome . The annual incidence of H/A MSS was 39 cases/100 person-years and of H/A MSD was 21 cases/100 person-years . The most common H/A disorder was deQuervain 's tendonitis . Forty-six percent of N/S and 32 % of H/A MSS occurred during the first month of follow-up . Gender , age , ethnicity , and prior history of N/S pain were associated with N/S MSS and MSD . Gender , prior history of H/A pain , prior computer use , and children at home were associated with either H/A MSS or MSD . CONCLUSIONS H/A and N/S MSS and MSD were common among computer users . More than 50 % of computer users reported MSS during the first year after starting a new job Background The prevalence of both overweight and musculoskeletal disorders ( MSD ) in the construction industry is high . Many interventions in the occupational setting aim at the prevention and reduction of these health problems , but it is still unclear how these programmes should be design ed . To determine the effectiveness of interventions on these health outcomes r and omised controlled trials ( RCTs ) are needed . The aim of this study is to systematic ally develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-)effectiveness . Methods / Design The Intervention Mapping ( IM ) protocol was applied to develop and implement a tailored programme aim ed at the prevention and reduction of overweight and MSD . The ( cost- ) effectiveness of the intervention programme will be evaluated using an RCT . Furthermore , a process evaluation will be conducted . The research population will consist of blue collar workers of a large construction company in the Netherl and s . InterventionThe intervention programme will be aim ed at improving ( vigorous ) physical activity levels and healthy dietary behaviour and will consist of tailored information , face-to-face and telephone counselling , training instruction ( a fitness " card " to be used for exercises ) , and material s design ed for the intervention ( overview of the company health promoting facilities , waist circumference measuring tape , pedometer , BMI card , calorie guide , recipes , and knowledge test).Main study parameters/endpointsThe intervention effect on body weight and waist circumference ( primary outcome measures ) , as well as on lifestyle behaviour , MSD , fitness , CVD risk indicators , and work-related outcomes ( i.e. productivity , sick leave ) ( secondary outcome measures ) will be assessed . Discussion The development of the VIP in construction intervention led to a health programme tailored to the needs of construction workers . This programme , if proven effective , can be directly implemented . Trial registration Netherl and s Trial Register ( NTR ) : Purpose The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders ( WUEMSDs )  among computer workers . Methods Four hundred computer workers answered a question naire on work-related upper extremity musculoskeletal symptoms ( WUEMSS ) . Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospect i ve , r and omized controlled 6-month intervention . Body posture and workstation layouts were assessed by the Ergonomic Question naire . We used the Visual Analogue Scale to assess the intensity of WUEMSS . The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities . Health-related quality of life was assessed with the Short Form-36 . After baseline assessment , those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions , an ergonomic training brochure , and workplace visits with workstation adjustments . Follow-up assessment was conducted after 6 months . Results In the intervention group , body posture ( p < 0.001 ) and workstation layout ( p = 0.002 ) improved over 6 months ; furthermore , intensity ( p < 0.001 ) , duration ( p < 0.001 ) , and frequency ( p = 0.009 ) of WUEMSS decreased significantly in the intervention group compared with the control group . Additionally , the functional status ( p = 0.001 ) , and physical ( p < 0.001 ) , and mental ( p = 0.035 ) health-related quality of life improved significantly compared with the controls . There was no improvement of work day loss due to WUEMSS ( p > 0.05 ) . Conclusions Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs Abstract This study assessed the effectiveness of a single intervention targeting work style and a combined intervention targeting work style and physical activity on the recovery from neck and upper limb symptoms . Computer workers with frequent or long‐term neck and upper limb symptoms were r and omised into the work style group ( WS , n = 152 ) , work style and physical activity group ( WSPA , n = 156 ) , or usual care group ( n = 158 ) . The WS and WSPA group attended six group meetings . All meetings focused on behavioural change with regard to body posture , workplace adjustment , breaks and coping with high work dem and s ( WS and WSPA group ) and physical activity ( WSPA group ) . Pain , disability at work , days with symptoms and months without symptoms were measured at baseline and after 6 ( T1 ) and 12 months ( T2 ) . Self‐reported recovery was assessed at T1/T2 . Both interventions were ineffective in improving recovery . The work style intervention but not the combined intervention was effective in reducing all pain measures . These effects were present in the neck/shoulder , not in the arm/wrist/h and . For the neck/shoulder , the work style intervention group also showed an increased recovery‐rate . Total physical activity increased in all study groups but no differences between groups were observed . To conclude , a group‐based work style intervention focused on behavioural change was effective in improving recovery from neck/shoulder symptoms and reducing pain on the long‐term . The combined intervention was ineffective in increasing total physical activity . Therefore we can not draw conclusions on the effect of increasing physical activity on the recovery from neck and upper limb symptoms 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 OBJECTIVES The incidence of upper-limb , neck-shoulder , and low-back disorders and their induction times were investigated among new workers in tasks with various physical workloads . METHODS New trailer assemblers ( N=364 ) were followed prospect ively for 45 months -- the workers ' health status via medical records and exposure to physical workload factors via job titles , walk-throughs , task descriptions , and some direct measurements . The incidence rate of first sick leave due to such disorders was calculated for different workload groups . The proportion of workers surviving without musculoskeletal disorders was estimated by the Kaplan-Maier product-limit estimator , and the effect of the exposure on the risk of incident disorders was estimated with the Cox proportional hazards model . RESULTS The highest annual incidences were observed for strenuous tasks , the incidence rate for men being 16.8 per 100 person-years [ 95 % confidence interval ( 95 % CI ) 8.0 - 30.9 ] for upper-limb disorders in strenuous tasks and 6.1 ( 95 % CI 2.0 - 14.1 ) in nonstrenuous tasks and that for women being 32.0 ( 95 % CI 11.7 - 69.7 ) and 9.9 ( 95 % CI 0.2 - 54.9 ) , respectively . The men 's risk of contracting an upper-limb or neck-shoulder disorder in strenuous tasks was about threefold [ hazard ratio ( HR ) 3.2 ( 95 % CI 1.1 - 9.4 ) for upper-limb disorders and 2.7 ( 95 % CI 0.9 - 8.1 ) for neck-shoulder disorders ] that of nonstrenuous tasks , whereas workload seemed not to affect low-back disorders . The workers first sought medical advice for their disorders typically some months after employment began . CONCLUSIONS Newly employed workers in h and -intensive tasks have a high risk of upper-limb and neck-shoulder disorders . An etiologic role for activities involving high force dem and s in upper-limb and neck-shoulder disorders is possible Background and Purpose The purpose of this study was to evaluate the efficacy of a preventive ergonomic intervention , which was provided by physical therapists , on spinal and upper-extremity work-related posture and symptom complaints of workers who use video display terminals ( VDT ) . Subjects Two hundred employees who spent at least 20 hours per week at a VDT were r and omly divided into 2 groups . Group E received the ergonomic intervention and an informative brochure , and group I received only the brochure . Methods Both groups were evaluated at the beginning of the study and at a follow-up 5 months later . The following tools were used : a pain drawing and the Rapid Entire Body Assessment ( REBA ) method to assess spinal and upper-extremity work-related posture . Results Group E had a lower REBA score and reduced lower back , neck , and shoulder symptoms compared with group I. Discussion and Conclusion The results suggest that a personalized preventive ergonomic intervention can improve spinal and upper-extremity work-related posture and musculoskeletal symptoms for workers who use VDTs An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers . Sixty workers were r and omly assigned to either : 1 ) a control group ; 2 ) an office training group that received personal , ergonomic training and workstation adjustments or 3 ) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the worker 's current sitting posture together with the correct posture photo taken earlier during office training . Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment ( RULA ) method before , during and after the six weeks intervention . Both training methods provided effective short-term posture improvement ; however , sustained improvement was only attained with the photo-training method . Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain . The photo-training method had a greater positive effect on women than on men Introduction In Denmark , the magnitude and impact of work disability on the individual worker and society has prompted the development of a new “ coordinated and tailored work rehabilitation ” ( CTWR ) approach . The aim of this study was to compare the effects of CTWR with conventional case management ( CCM ) on return-to-work of workers on sick leave due to musculoskeletal disorders ( MSDs ) . Methods The study was a r and omized controlled trial with economic evaluation undertaken with workers on sick leave for 4–12 weeks due to MSDs . CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan . The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up . Secondary outcomes were work status as well as pain intensity and functional disability , measured at baseline , 3 and 12 months follow-up . The economic evaluation ( intervention costs , productivity loss , and health care utilization costs ) was based on administrative data derived from national registries . Results For the time intervals 0–6 months , 6–12 months , and the entire follow-up period , the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group . The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up . Conclusions Workers on sick leave for 4–12 weeks due to MSD who underwent “ CTWR ” by an interdisciplinary team had fewer sickness absence hours than controls . The economic evaluation showed that — in terms of productivity loss — CTWR seems to be cost saving for the society Compare the effects of integrated case management and usual care on patient satisfaction in employees with work-related upper extremity disorder ( WRUED ) , and consider the implication s of higher levels of satisfaction . Describe those patient-related and work-related factors that predict the severity of upper limb symptoms and the degree of functional limitation 6 and 12 months after intervention . Enumerate the factors influencing the interval before return to work in employees with WRUED who are managed by traditional or integrated case management . An integrated case management ( ICM ) approach ( ergonomic and problem-solving intervention ) to work-related upper-extremity disorders was examined in relation to patient satisfaction , future symptom severity , function , and return to work ( RTW ) .  Federal workers with work-related upper-extremity disorder workers ’ compensation cl aims ( n = 205 ) were r and omly assigned to usual care or ICM intervention .  Patient satisfaction was assessed after the 4-month intervention period . Question naires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention . Time from intervention to RTW was obtained from an administrative data base . ICM group assignment was significantly associated with greater patient satisfaction . Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW . At 12 months , predictors of positive outcomes included male gender , lower distress , lower levels of reported ergonomic exposure , and receipt of ICM . Findings highlight the utility of targeting workplace ergonomic and problem solving skills OBJECTIVES This study evaluated the effect of an intensive ergonomic approach and education on workstation changes and  musculoskeletal disorders among workers who used a video display unit ( VDU ) . METHODS A r and omized controlled design was used . The subjects ( N=124 ) were allocated into three groups ( intensive ergonomics , ergonomic education , reference ) using stratified r and om sampling . The evaluation involved question naires , a diary of discomfort , measurements of workload , and an ergonomic rating of the workstations . The assessment s were made 2 weeks before the intervention and after 2 and 10 months of follow-up . RESULTS The intensive and training groups showed less musculoskeletal discomfort than the reference group after 2 months of follow-up . Positive effects on discomfort were seen primarily for the shoulder , neck , and upper back areas . No significant differences were found for the strain levels or prevalence of pain . After the intervention the ergonomic level was distinctly higher in the intensive ergonomic group than in the education or reference group . CONCLUSIONS Both the intensive ergonomics approach and education in ergonomics help reduce discomfort in VDU work . In attempts to improve the physical ergonomics of VDU workstations , the best result will be achieved with cooperative planning in which both workers and practitioners are actively involved 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 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 Objectives To evaluate the cost-effectiveness of a work style ( WS ) intervention and a work style plus physical activity ( WSPA ) intervention in computer workers with neck and upper limb symptoms compared with usual care . Methods An economic evaluation was conducted from an employer 's perspective and alongside a r and omised controlled trial in which 466 computer workers with neck and upper limb symptoms were r and omised to a WS group ( N=152 ) , a WSPA group ( N=156 ) or a usual care group ( N=158 )  . Total costs were compared to the effects on recovery and pain intensity . In the primary analyses , missing effect data were imputed using multiple imputation techniques . Results Total costs during the 12-month intervention and follow-up period were € 1907 ( WS ) , € 2811 ( WSPA ) and € 2310 ( usual care ) . Differences between groups were not statistically significant . Neither intervention was more effective than usual care in improving overall recovery .  The WS intervention was more effective than usual care in reducing current pain , average pain and worst pain in the past 4 weeks , but the WSPA intervention was not . The acceptability curve showed that when a company is willing to pay approximately € 900 for a 1-point reduction in average pain ( scale from 0 to 10 ) , the probability of cost-effectiveness compared to usual care is 95 % . Similar results were observed for current and worst pain . Conclusions This study shows that the WS intervention was not cost-effective for improving recovery but was cost-effective for reducing pain intensity , although this reduction was not clinical ly significant . The WSPA intervention was not cost-effective compared with usual care . Trial registration number IS RCT N87019406 OBJECTIVE The literature on psychosocial job factors and musculoskeletal pain is inconclusive in part due to insufficient control for confounding by biomechanical factors . The aim of this study was to investigate prospect ively the independent effects of effort-reward imbalance ( ERI ) at work on regional musculoskeletal pain of the neck and upper extremities of call center operators after controlling for ( i ) duration of computer use both at work and at home , ( ii ) ergonomic workstation design , ( iii ) physical activities during leisure time , and ( iv ) other individual worker characteristics . METHODS This was a one-year prospect i ve study among 165 call center operators who participated in a r and omized ergonomic intervention trial that has been described previously . Over an approximate four-week period , we measured ERI and 28 potential confounders via a question naire at baseline . Regional upper-body pain and computer use was measured by weekly surveys for up to 12 months following the implementation of ergonomic interventions .  Regional pain change scores were calculated as the difference between average weekly pain scores pre- and post intervention . RESULTS A significant relationship was found between high average ERI ratios and one-year increases in right upper-extremity pain after adjustment for pre-intervention regional mean pain score , current and past physical workload , ergonomic workstation design , and anthropometric , sociodemographic , and behavioral risk factors . No significant associations were found with change in neck-shoulder or left upper-extremity pain . CONCLUSIONS This study suggests that ERI predicts regional upper-extremity pain in -computer operators working > or=20 hours per week . Control for physical workload and ergonomic workstation design was essential for identifying ERI as a risk factor Sickness absenteeism caused by musculoskeletal disorders ( MSDs ) is a persistent and costly occupational health challenge . In a prospect i ve controlled trial , we compared the effects on sickness absenteeism of a more proactive role for insurance case managers as well as workplace ergonomic interventions with that of traditional case management .  Patients with physician-diagnosed MSDs were r and omized either to the  intervention group or  the reference group offered the traditional case management routines . Participants filled out a comprehensive question naire at the initiation of the study and after 6 months . In addition , administrative data were collected at 0 , 6 , and 12 months after the initiation of the project . For the entire 12-month period , the total mean number of sick days for the intervention group was 144.9 ( SEM 11.8 ) days/person as compared to 197.9 ( 14.0 ) days in the reference group ( P < 0.01 ) . Compared with the reference group , employees in the intervention group significantly more often received a complete rehabilitation investigation ( 84 % versus 27 % ) . The time for doing this was reduced by half ( 59.4 ( 5.2 ) days versus 126.8 ( 19.2 ) , P < .01 ) . The odds ratio for returning to work in the intervention group was 2.5 ( 95 % confidence interval 1.2–5.1 ) as compared with the reference group . The direct cost savings were USD 1195 per case , yielding a direct benefit-to-cost ratio of 6.8 . It is suggested that the management of MSDs should to a greater degree focus on early return to work and building on functional capacity and employee ability . Allowing the case managers a more active role as well as involving an ergonomist in workplace adaptation meetings might also be beneficial In practice the secondary prevention of work-related upper extremity ( WRUE ) symptoms generally targets biomechanical risk factors . Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability . The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone . Seventy office workers with WRUE symptoms were r and omly assigned to an ergonomics intervention group ( assessment and modification of work station and stretching exercises ) or a combined ergonomic and job stress intervention group ( ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress ) . Baseline , 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks , job stress , pain , symptoms , functional limitation , and general physical and mental health were obtained from all participants . While both groups experienced significant decreases in pain , symptoms , and functional limitation from baseline to three months with improvements continuing to 12 months post baseline , no significant differences between groups were observed for any outcome measures . Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone 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 Objectives : To examine the efficacy of a participatory ergonomics intervention in preventing musculoskeletal disorders among kitchen workers .  Participatory ergonomics is commonly recommended to reduce musculoskeletal disorders , but evidence for its effectiveness is sparse . Methods : A cluster r and omised controlled trial among the 504 workers of 119 kitchens in Finl and was conducted during 2002–2005 . Kitchens were r and omised to an intervention ( n = 59 ) and control ( n = 60 ) group . The duration of the intervention that guided the workers to identify strenuous work tasks and to seek solutions for decreasing physical and mental workload , was 11 to 14 months . In total , 402 ergonomic changes were implemented . The main outcome measures were the occurrence of and trouble caused by musculoskeletal pain in seven anatomical sites , local fatigue after work , and sick leave due to musculoskeletal disorders . Individual level data were collected by a question naire at baseline and every 3 months during the intervention and 1-year follow-up period . All response rates exceeded 92 % . Results : No systematic differences in any outcome variable were found between the intervention and control groups during the intervention or during the 1-year follow-up . Conclusions : The intervention did not reduce perceived physical work load and no evidence was found for the efficacy of the intervention in preventing musculoskeletal disorders among kitchen workers . It may be that a more comprehensive re design of work organisation and processes is needed , taking more account of workers ’ physical and mental re sources 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 QUESTION Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain , reducing disability and improving health-related quality of life in visual display unit workers with early non-specific work-related upper limb disorders than strength and fitness exercises delivered by physiotherapists ? DESIGN R and omised trial with concealed allocation and intention-to-treat analysis . PARTICIPANTS Eighty-eight ( 6 drop-outs ) visual display unit workers with early non-specific work-related upper limb disorders . INTERVENTION One group received 10 weeks of postural exercises while the other group received 10 weeks of strength and fitness exercises . OUTCOME MEASURES Pain was measured with a 10-cm visual analogue scale , disability was measured with the Disabilities of Arm , Shoulder and H and question naire , and health-related quality of life was measured with the Short Form-36 . Number of participants experiencing upper limb complaints was also collected . Outcome measures were collected at baseline and again at 3 , 6 , and 12 months . RESULTS There was no significant difference in decrease in pain between the groups at 3 months ( 0.6 cm , 95 % CI 0.0 to 1.2 ) , 6 months ( 0.2 , 95 % CI -0.3 to 0.7 ) , or at 12 months ( 0.1 , 95 % CI -0.6 to 0.8 ) . Differences between the groups in upper limb complaints , disability , and health related quality of life were also small and not significant at any measurement occasion . CONCLUSION Postural exercises did not result in a better outcome than strength and fitness exercises . However , 55 % of visual display unit workers with early non-specific work-related upper limb disorders reported being free of complaints one year after both interventions were commenced . TRIAL REGISTRATION IS RCT N15872455
We found inconsistent evidence that the use of an arm support or an alternative mouse may or may not reduce the incidence of neck or shoulder MSDs .
For other physical ergonomic interventions there is no evidence of an effect .
For organisational interventions , in the form of supplementary breaks , there is very low- quality evidence of an effect on upper limb discomfort .
For training and multifaceted interventions there is no evidence of an effect on upper limb pain or discomfort .
BACKGROUND Work-related upper limb and neck musculoskeletal disorders ( MSDs ) are one of the most common occupational disorders worldwide .
Studies have shown that the percentage of office workers that suffer from MSDs ranges from 20 to 60 per cent .
The direct and indirect costs of work-related upper limb MSDs have been reported to be high in Europe , Australia , and the United States .
Although ergonomic interventions are likely to reduce the risk of office workers developing work-related upper limb and neck MSDs , the evidence is unclear .
This is an up date of a Cochrane Review which was last published in 2012 .
OBJECTIVES To assess the effects of physical , cognitive and organisational ergonomic interventions , or combinations of those interventions for the prevention of work-related upper limb and neck MSDs among office workers .