Musculoskeletal disorders and occupational exposures: How should we judge the evidence concerning the causal association? Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. The implementation of occupational health guidelines principles for reducing sickness absence due to musculoskeletal disorders. Reducing musculoskeletal disorders among computer operators: comparison between ergonomics interventions at the workplace Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees. The Effectiveness of Standard Care, Early Intervention, and Occupational Management in Workers’ Compensation Claims: Part 2 Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: a randomised controlled trial. The Effectiveness of Standard Care, Early Intervention, and Occupational Management in Worker’s Compensation Claims The effect of workplace intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders. 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 Effectiveness of participatory training for prevention of musculoskeletal disorders: a randomized controlled trial Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial Workplace Prevention and Musculoskeletal Injuries in Nurses Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review. Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders Impact of Case Manager Training on Worksite Accommodations in Workers’ Compensation Claimants With Upper Extremity Disorders A randomised controlled trial evaluating an alternative mouse and forearm support on upper body discomfort and musculoskeletal disorders among engineers Effectiveness of a feedback signal in a computer mouse on upper extremity musculoskeletal symptoms: a randomised controlled trial with an 8-month follow-up Integrated Case Management for Work-Related Upper-Extremity Disorders: Impact of Patient Satisfaction on Health and Work Status A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators Effects of participatory ergonomic intervention on the development of upper extremity musculoskeletal disorders and disability in office employees using a computer Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China Musculoskeletal symptoms and job satisfaction among office-workers: a cross-sectional study from Iran. 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VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. An occupational pain study Multi dimensional system for evaluating preventive program for upper extremity disorders among computer operators. Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. Health-related effects of early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Early Workplace Intervention for Employees With Musculoskeletal-Related Absenteeism: A Prospective Controlled Intervention Study Evaluation of ‘I-Preventive’: a digital preventive tool for musculoskeletal disorders in computer workers—a pilot cluster randomised trial Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study Ergonomic Training Reduces Musculoskeletal Disorders among Office Workers: Results from the 6-Month Follow-Up. Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals Effectiveness of early part-time sick leave in musculoskeletal disorders University students' notebook computer use: lessons learned using e-diaries to report musculoskeletal discomfort Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries
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 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 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 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 OBJECTIVES A cross-sectional study was conducted to assess the association of upper extremity musculoskeletal disorders and work-related factors among employees using video display terminals at a large metropolitan newspaper . METHODS The study included 1050 r and omly selected workers from four departments . The workers were asked to complete question naires on symptoms , job tasks , and psychosocial and work organization conditions . Musculoskeletal disorders of the upper extremities were defined by frequency , duration , and intensity of symptoms not attributable to acute injury . Data were analyzed with the use of logistic regression . RESULTS A total of 973 workers completed the survey . The one-year period prevalence rate for any musculoskeletal disorder of the upper extremities was 41 % . Neck symptoms ( 26 % ) were the most frequently reported , followed by h and or wrist ( 22 % ) , shoulder ( 17 % ) , and elbow ( 10 % ) symptoms . Greater time working at the video display station was associated with increased h and or wrist symptoms in a dose-response relationship . In addition , variables corresponding to increased work-load dem and s ( eg , increased time working under deadline and increased job pressure ) were associated with increased neck , shoulder , and h and or wrist disorders . Women were more likely to report symptoms in several areas , but this finding may reflect the concentration of women in jobs involving more risk factors . CONCLUSIONS The results suggest a high prevalence of musculoskeletal disorders of the upper extremities among newspaper employees , and they provide additional evidence that increased work load , time pressure , and greater hours of computer use are related to the occurrence of work-related musculoskeletal disorders among these workers , particularly for disorders in the h and or wrist area Study Design . A prospect i ve cohort . Objectives . To compare the effectiveness of st and ard care , early intervention treatment , and occupational management in the management of Workers ’ Compensation injury cl aims . Summary of Background Data . The current management of occupational back pain and work-related upper extremity disorders with either st and ard care or early intervention treatment appears to be ineffective . Methods . A prospect i ve cohort looked at the effect of one company with access to st and ard care ( primary care ) changing to occupational management ( worksite encouragement to resume activity and work as soon as safely possible ) and then to early intervention treatment ( offsite work hardening ) . This information was then compared with the control company with access to early intervention treatment , which later changed to a combined occupational management/early intervention treatment approach .  Survival analysis was used to attempt to explain differences in time to injury cl aim closure . Results . Occupational management result ed in lower injury cl aim incidence , duration , and costs than early intervention treatment . Only the covariate of enhanced physical therapist ( work hardening ) involvement ( 2001 hazard rate ratio 17.41 , 95 % confidence interval 3.72–41.51 and 2002 hazard rate ratio 6.22 , 95 % confidence interval 2.51–15.40 ) was associated with delayed time to injury cl aim closure when the company had access to early intervention treatment . Only the covariate of serious injury was associated with delayed time to injury cl aim closure in the company when it had access to occupational management ( hazard rate ratio 1.67 , 95 % confidence interval 1.05–27.20 ) . Conclusions . It is recommended that an occupational management approach , in comparison to early intervention treatment and st and ard care , be considered for management of occupational injuries 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 Study Design . A retrospective and prospect i ve cohort . Objectives . To compare the effectiveness of occupational intervention , early intervention , and st and ard care in the management of Worker ’s Compensation injury cl aims . Summary of Background Data . The current management of occupational back pain and work-related upper extremity disorders with either st and ard care or early intervention appears to be ineffective . Methods . A retrospective cohort compared injury cl aim incidence , duration ,  and costs  between one company with access to st and ard care and another similar company with access to early intervention .  A prospect i ve cohort looked at the effect of one company changing from  st and ard care to occupational management  in comparison with the control group with early intervention .  Survival analysis was used to attempt to explain differences in injury cl aim duration . Results . St and ard care result ed in lower injury cl aim incidence , duration , and costs than early intervention , whereas occupational management result ed in lower injury cl aim incidence , duration , and costs than st and ard care . The covariates of physical therapist involvement , chiropractor involvement , injury severity , and relationship between Worker ’s Compensation and the employer were associated with delayed time to cl aim closure in the company with access to early intervention with the most important covariate being physical therapist involvement ( hazard rate ratio 19.88 , 95 % confidence interval 7.95–39.77 ) . Only the covariate of injury severity was associated with delayed time to cl aim closure in the company with access to occupational management ( hazard rate ratio 1.67 , 95 % confidence interval 1.05–27.20 ) . Conclusions . It is recommended that an occupational management approach , in comparison with st and ard care or early intervention , be considered for management of occupational injuries OBJECTIVES The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders . METHODS In this r and omized controlled study , subjects aged 18 - 60 years ( N=177 ) seeking medical advice due to upper-extremity symptoms were included if their symptoms , or the exacerbation of symptoms , had started < 30 days prior to the medical consultation and immediate sick leave was not required .  Workplace ergonomic improvements were made in the intervention group . Data on symptoms and sickness absences were gathered during one-year follow-up . RESULTS Pain intensity , pain interference with work , leisure time , or sleep did not differ between the intervention and control group during the one-year follow-up . During the first three months of follow-up , the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention ( N=89 ) and control ( N=84 ) group , but the total number of sickness absence days in the intervention group was about half of that in the control group ( mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined ) . During 4 - 12 months of follow-up , the percentage of employees with sickness absence due to upper-extremity disorder ( 10.1 % versus 16.7 % , P=0.20 ) or upper-extremity and other musculoskeletal disorders combined ( 20.2 % versus 32.1 % , P=0.07 ) was lower in the intervention than the control group . CONCLUSIONS Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders 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 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 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 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 determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints . Methods : A r and omized controlled trial with a 1-year follow-up was carried out . Thirty-eight subjects were allocated to multidisciplinary treatment ( intervention , n=23 ) , or to usual care provided by occupational health services ( n=15 ) . The intervention consisted of psychological and physical sessions provided by a medical specialist , a psychologist , a physiotherapist and an occupational therapist . It aims at reconditioning , “ de-medicalizing ” , unrestrained moving and return-to-work . The intervention process was evaluated on compliance to the protocol and the effectiveness of its components . The individual outcome variable was the severity of complaints . The societal outcomes included return-to-work and costs . Measurements were performed at baseline and after 2 , 6 and 12 months . Mixed model analyses were used for analysis . Results : The intervention achieves its aims : physical disabilities ( P=0.039 ) , kinesiophobia ( P<0.001 ) and physical functioning ( P=0.016 ) improved significantly as compared to usual care . In addition , the intervention was significantly more effective in reducing the severity of complaints than usual care . The intervention was equally effective compared to usual care in terms of return-to-work ( 86 % in the intervention group vs. 73 % in the usual care group ) . The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months . Conclusion : Multidisciplinary treatment affects individuals positively , but shows no significant difference in ( cost- ) effectiveness on the societal level as compared to usual care The Spinal Cord Injury Rehabilitation Evidence ( SCIRE ) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI . SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians ( SCI inpatient rehabilitation practice s , gait strategies , upper extremity reconstructive surgery , spasticity treatments , cardiovascular health and bone health ) . The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence . Each article was scored for its method ological quality using either the Physiotherapy Evidence Data base ( PEDro ) Score for r and omized controlled trials or the Downs and Black Tool for other types of studies . Following the individual study assessment , conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence , quality of studies and concurring evidence . The SCIRE project was design ed for health professionals to inform them of best practice Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making There is evidence that performing job tasks involving repetition , vibration , sustained posture or forceful movement may contribute to symptoms of work related upper extremity disorders . Typing is one such activity ; symptoms that develop as a result of this activity can affect performance of work , self-care and leisure occupations . Studies investigating the impact of ergonomic keyboards on symptom reduction are limited , and little research exists regarding the reduction of key activation force as an intervention . Methods : This r and omized , prospect i ve study used a sample of 68 symptomatic workers employed by a single company . One group received a commercially available ergonomic keyboard , a second group used a modified version of the same keyboard design ed to reduce activation force , vibration and key travel . We measured symptoms and clinical signs , functional status , and device satisfaction in both groups over a six-month study period . Results : Between-groups analyses indicated that the groups performed similarly on the outcomes of interest . Repeated-measure analysis identified a reduction of symptoms , an improvement in functional status , preference for and increased satisfaction with the intervention keyboards , and maintenance of typing speed and accuracy for both groups . Conclusions Management of the return-to-work process in cl aim ants with work-related upper extremity disorders often poses challenges to the health care provider , cl aim ant , and employer . Modifying workplace ergonomic risk factors as a component of the workplace accommodation process may improve return-to-work outcomes by reducing recurrent pain and discomfort . The present study is a case-control evaluation of the effects of a 2-day training program for nurse case managers  that was design ed to facilitate the implementation of workplace accommodations within a workers ’ compensation health care delivery system . After the training , 101 cl aim ants with compensable upper extremity disorders were r and omly assigned to case mangers with and without training . Overall , 208 accommodations were recommended and 155 of these were implemented ( 75 % ) . Cl aim ants of trained nurses received 1.5 times as many recommendations for accommodations  as cl aim ants managed by nurses not trained in the process , and 1.4 times as many accommodations were implemented , although no differences were found between the two groups in implementation rates . Trained nurses were more likely to recommend accommodations addressing workstation layout , computer-related improvements , furnishings , accessories , and lifting/carrying aids , whereas the untrained nurses were more likely to suggest light duty and lifting restrictions . This study indicates that the training was associated with a change in the practice behavior of case managers regarding the workplace accommodation process . More research is needed to identify barriers to implementation and develop more effective approaches to facilitate worksite accommodations in disabled workers with carpal tunnel syndrome and other persistent upper extremity disorders Objectives : The aim of this intervention study was to determine the effects of an alternative mouse and /or a forearm support board on the change in upper body discomfort scores and the development of incident musculoskeletal disorders . Methods : This r and omised controlled intervention trial followed 206 engineers for one year . Participants were r and omised to receive ( 1 ) a conventional mouse only , ( 2 ) an alternative mouse only , ( 3 ) a forearm support board , or ( 4 ) an alternative mouse plus forearm support board . Outcome measures included weekly upper body discomfort scores and incident musculoskeletal disorders . Results : During the study , 42 participants were diagnosed with an incident musculoskeletal disorder . The group that received the forearm support board experienced a reduction in their right upper extremity discomfort ( beta-coefficient −0.35 , 95 % CI −0.67 to −0.03 ) in comparison to those who did not receive a forearm board . The group that received the alternative mouse had a protective , but non-significant ( p = 0.20 ) , effect on incident cases of right upper extremity musculoskeletal disorders ( HR 0.57 , 95 % CI 0.24 to 1.34 ) and a non-significant reduction in neck/shoulder discomfort ( beta-coefficient −0.23 , 95 % CI −0.056 to 0.10 ) in comparison to those who received a conventional mouse . Conclusions : In engineers who use a computer for more than 20 h per week , a forearm support board may reduce right upper extremity discomfort attributed to computer use Objectives : To study the effectiveness of using a computer mouse with a feedback signal for upper extremity musculoskeletal symptoms in office workers . Methods : A r and omised controlled trial with 8 months of follow-up was carried out . The intervention consisted of a computer mouse with a feedback signal . In total , 354 subjects were allocated to the intervention group or the  control group . Measurements were performed with electronic question naires at baseline , after 4 months and after 8 months . Outcome variables were the prevalence and incidence of upper extremity musculoskeletal symptoms and disability in the upper extremities . The intervention process was evaluated by software registration . Results : The use of the mouse with a feedback signal result ed in a significant decrease in duration of mouse usage over time . No differences were found in the number of mouse usage rest breaks . No differences were found in the prevalence ( p = 0.29 ) or incidence ( p = 0.832 ) of upper extremity musculoskeletal symptoms between the groups 8 months after baseline . The prevalence decreased from 49 % at baseline to 44 % after 8 months in the control group , while it remained at 36 % in the intervention group . The incidence was 21 % in the control group and 22 % in the intervention group . Among the population with upper extremity musculoskeletal symptoms at baseline , the risk of experiencing symptoms after 8 months did not differ between the groups ( p = 0.49 ) . Minor disability was found in both groups . In the intervention group , a lower level of physical disability over time was reported than in the control group ( p = 0.02 ) . Conclusions : A feedback signal computer mouse does not affect the prevalence and incidence of upper extremity musculoskeletal symptoms , but it does lower disability scores . Given the high prevalence , study ing preventive interventions for upper extremity musculoskeletal symptoms is of high importance . Trial registration number : IS RCT N13222474 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 Background : Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders . Methods : This one year , r and omised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company . Participants were r and omised to receive ( 1  ) ergonomics training only , ( 2 ) training plus a trackball , ( 3 ) training plus a forearm support , or ( 4 ) training plus a trackball and forearm support . Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention . Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors , baseline pain levels , and psychosocial job factors . Results : Post-intervention , 63 participants were diagnosed with one or more incident musculoskeletal disorders  . Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders ( HR = 0.49 , 95 % CI 0.24 to 0.97 ) after adjusting for baseline pain levels and demographic and psychosocial factors . The armboard also significantly reduced neck/shoulder pain ( p = 0.01 ) and right upper extremity pain ( p = 0.002 ) in comparison to the control group . A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months . Conclusion : Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees 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 Objectives Studies from western countries show that dentists are vulnerable to work-related musculoskeletal disorders ( WMSDs ) of the neck and upper extremities , but little is known about their epidemiology among members of this rapidly growing profession in China . This study aims to investigate the prevalence of WMSDs and identify potential risk factors associated with their occurrence in the dental profession in China . Setting and participants A cross-sectional survey was carried out in 52 different hospitals in a large metropolitan city in China . A total of 304 question naires were distributed to respondents identified via stratified r and om sampling and 272 dentists ( 121 females and 151 males ) completed the survey . The response rate was 89.5 % . Outcomes Visual analogue score was used to record neck and upper limb musculoskeletal symptoms on a body chart . Work-related risk factors , including physical and psychosocial factors , were accounted for in the regression analysis . Results 88 % of the dentists reported at least one musculoskeletal disorder and 83.8 % suffered from neck pain . In the multivariate analyses , working hours per day were associated with neck pain ( OR=1.43 ; 95 % CI 1.03 to 1.98 ) . Inability to select the appropriate size of dental instrument was associated with shoulder ( OR=2.07 ; 95 % CI 1.00 to 4.32 ) and wrist/h and ( OR=2.47 ; 95 % CI 1.15 to 5.32 ) pain . As for psychosocial factors , high job dem and was associated with symptoms in the shoulder ( OR=1.09 ; 95 % CI 1.00 to 1.18 ) , elbow ( OR=1.11 ; 95 % CI 1.03 to 1.19 ) and wrist/h and ( OR=1.09 ; 95 % CI 1.02 to 1.17 ) . Regular physical exercise was associated with decreased neck pain ( OR=0.37 ; 95 % CI 0.14 to 1.00 ) . Conclusions The prevalence of WMSDs among Chinese dentists is high . Specifically , long working hours , inability to select the appropriate size of dental instrument and high job dem and are the most significant risk factors 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 OBJECTIVES There is considerable evidence documenting the association between psychosocial risk factors and  work disability due to musculoskeletal disorders , and this has prompted suggestions that psychosocial screening should be administered in the workplace in order to identify individuals at risk of prolonged absence . However , the predictive value of psychosocial risk factors on return-to-work is largely unknown . The present study aim ed to explore the predictive relationship between psychosocial risk factors and absence due to musculoskeletal disorders of the lower back and upper limbs . METHODS A prospect i ve study of 4637 workers from a large , multi-site company in the UK was conducted in which a wide range of established question naires were used to collect baseline psychosocial data . Respondents were then followed over the ensuing 15 months , and absence due to musculoskeletal disorders was recorded . RESULTS 219 workers took absence due to musculoskeletal disorders . Detrimental cut-off scores ( risks ) on the psychosocial instruments were established , and it was found that work-related psychosocial risk factors predicted the likelihood of a future spell of absence ( odds ratios ranging between 1.6 and 3.2 ) , but not the duration of that absence . CONCLUSIONS Although work-related psychosocial factors were associated with the occurrence of absence due to musculoskeletal disorders , these findings do not lend support to the use of routine occupational psychosocial screening in order to predict prolonged absence OBJECTIVE To prospect ively monitor occupational therapy activities and intervention techniques used during inpatient stroke rehabilitation in order to provide a description of current clinical practice . METHODS Data were collected prospect ively from 954 clients with stroke receiving occupational therapy from six U.S. rehabilitation hospitals . Descriptive statistics summarized frequency , intensity , and duration of occupational therapy sessions ; proportion of time spent in 16 therapeutic activities ; and proportion of those activities that included any of 31 interventions . RESULTS Clients received on average 11.8 days ( SD = 7.2 ) of occupational therapy , with each session lasting on average 39.4 min ( SD = 16.9 ) . Upper-extremity control ( 22.9 % of treatment time ) and dressing ( 14.2 % of treatment time ) were the most frequently provided activities . Interventions provided most frequently during upper-extremity control activities were strengthening , motor learning , and postural awareness . CONCLUSION Occupational therapy provided reflected an integration of treatment approaches . Upper-extremity control and basic activities of daily living were the most frequent activities . A small proportion of sessions addressed community integration Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden . The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service . Methods The trial design was a population -based , r and omised study . Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospect ively for one 6-month term to determine the baseline incidence of injury . After this period , two new successive cohorts in the same four companies were r and omised into two groups and followed prospect ively for 6 months . Military service is compulsory for about 90 % of 19-year-old Finnish men annually , who comprised the cohort in this study . This r and omised , controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group .  A neuromuscular training programme was used to enhance conscripts ' motor skills and body control , and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries . The main outcome measures were acute injuries of the lower and upper limbs . Results In the intervention groups , the risk for acute ankle injury decreased significantly compared to control groups ( adjusted hazards ratio ( HR ) = 0.34 , 95 % confidence interval ( 95 % CI ) = 0.15 to 0.78 , P = 0.011 ) . This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels . In the latter group of conscripts , the risk of upper-extremity injuries also decreased significantly ( adjusted HR = 0.37 , 95 % CI 0.14 to 0.99 , P = 0.047 ) . In addition , the intervention groups tended to have less time loss due to injuries ( adjusted HR = 0.55 , 95 % CI 0.29 to 1.04 ) . Conclusions A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts . A similar programme could be useful for all young individuals by initiating a regular exercise routine . Trial registration Clinical Trials.gov identifier number NCT00595816 BACKGROUND Lower extremity stiffness is thought to be an important factor in musculoskeletal performance . However , too little or too much stiffness is believed to increase the risk of musculoskeletal injury . PURPOSE To provide a current up date of the lower extremity stiffness literature as it pertains to both performance and injury . SUMMARY It appears that increased stiffness is beneficial to performance . As well it appears that there may be an optimal amount of stiffness that allows for injury-free performance . There is some evidence that increased stiffness may be related to bony injuries and decreased stiffness may be associated with soft tissue injuries . Further investigations should evaluate the relationship between stiffness and injury prospect ively . Initial reports suggest that stiffness can be modified in response to the external environment or verbal cues . RELEVANCE A greater underst and ing of the role of stiffness in both performance and injury will provide a stronger foundation for the development of optimal training intervention programs 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 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 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 ) : 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 Typing is associated with musculoskeletal complaints ( MSCs ) , caused by multiple risk factors . Although a wide variety of ergonomic intervention programs were conducted to reduce risk factors and MSC 's , only few of them were found evidence based . This study aim ed to test the efficacy of a workplace intervention in reducing MSC 's among computer workers . 66 computer workers were assigned r and omly to one of three intervention programs : ergonomic intervention including biofeedback , intervention without biofeedback and control group without intervention . The efficacy was tested by advanced assessment including ; pain location and severity , posture at work , upper extremity 3D kinematics , muscle activity and psychosocial status . Working hypothesis ; significant score differences will be found between the study groups which underwent ergonomic intervention and the control group on the following measures : pain complaints , upper extremity kinematics , muscle activity and psychosocial status . Significant differences were found between pre and post intervention and between research groups and the control group in pain , posture and motion . The ergonomic intervention with biofeedback had no unique contribution in comparison to other interventions . In conclusion ; the proposed intervention program was found efficient for reducing pain among computer workers PROBLEM STATEMENT Nurses have one of the highest rates of work-related musculoskeletal injury of any profession . Over the past 30 years , efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful . SPECIFIC AIMS The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care . Our first objective was to design and implement a multifaceted program that successfully integrated evidence -based practice , technology , and safety improvement . The second objective was to evaluate the impact of the program on injury rate , lost and modified work days , job satisfaction , self-reported unsafe patient h and ling acts , level of support for program , staff and patient acceptance , program effectiveness , costs , and return on investment . INTERVENTION The intervention included six program elements : ( 1 ) Ergonomic Assessment Protocol , ( 2 ) Patient H and ling Assessment Criteria and Decision Algorithms , ( 3 ) Peer Leader role , " Back Injury Re source Nurses " , ( 4 ) State-of-the-art Equipment , ( 5 ) After Action Review s , and ( 6 ) No Lift Policy . METHODS A pre-/post design without a control group was used to evaluate the effectiveness of a  patient care ergonomics program  on 23 high risk units ( 19 nursing home care units and 4 spinal cord injury units ) in 7 facilities .  Injury rates , lost work days , modified work days , job satisfaction , staff , and patient acceptance , program effectiveness , and program costs/savings were compared over two nine month periods : pre-intervention ( May 2001-January 2002 ) and post-intervention ( March 2002-November 2002 ) . Data were collected prospect ively through surveys , weekly process logs , injury logs , and cost logs . RESULTS The program elements result ed in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury . While the total number of lost workdays decreased by 18 % post-intervention , this difference was not statistically significant . There were statistically significant increases in two subscales of job satisfaction : professional status and tasks requirements . Self-reports by nursing staff revealed a statistically significant decrease in the number of ' unsafe ' patient h and ling practice s performed daily . Nurses ranked program elements they deemed to be " extremely effective " : equipment was rated as most effective ( 96 % ) , followed by No Lift Policy ( 68 % ) , peer leader education program ( 66 % ) , ergonomic assessment protocol ( 59 % ) , patient h and ling assessment criteria and decision algorithms ( 55 % ) , and lastly after action review s ( 41 % ) . Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation . Patient acceptance was moderate when the program started but increased to very high by the end of the program . Although the ease and success of program implementation initially varied between and within the facilities , after six months there was strong evidence of support at all levels . The initial capital investment for patient h and ling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $ 200,000/year in workers ' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation . CONCLUSIONS This multi-faceted program result ed in an overall lower injury rate , fewer modified duty days taken per injury , and significant cost savings . The program was well accepted by patients , nursing staff , and administrators . Given the significant increases in two job satisfaction subscales ( professional status and task requirements ) , it is possible that nurse recruitment and retention could be positively impacted OBJECTIVE Previously we reported that early part-time sick leave enhances return to work ( RTW ) among employees with musculoskeletal disorders ( MSD ) . This paper assesses the health-related effects of this intervention . METHODS Patients aged 18 - 60 years who were unable to perform their regular work due to MSD were r and omized to part- or full-time sick leave groups . In the former , workload was reduced by halving working time . Using vali date d question naires , we assessed pain intensity and interference with work and sleep , region-specific disability due to MSD , self-rated general health , health-related quality of life ( measured via EuroQol ) , productivity loss , depression , and sleep disturbance at baseline , 1 , 3 , 8 , 12 , and 52 weeks . We analyzed the repeated measures data ( 171 - 356 observations ) with the generalized estimating equation approach . RESULTS The intervention ( part-time sick leave ) and control ( full-time sick leave ) groups did not differ with regard to pain intensity , pain interference with work and sleep , region-specific disability , productivity loss , depression , or sleep disturbance . The intervention group reported better self-rated general health ( adjusted P=0.07 ) and health-related quality of life ( adjusted P=0.02 ) than the control group . In subgroup analyses , the intervention was more effective among the patients whose current problem began occurring < 6 weeks before baseline and those with ≤30 % productivity loss at baseline . CONCLUSIONS Our findings showed that part-time sick leave did not exacerbate pain-related symptoms and functional disability , but improved self-rated general health and health-related quality of life in the early stage of work disability due to MSD 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 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 To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health ( MH ) comorbidity , by synthesis ing evidence on effectiveness , cost-effectiveness and safety from systematic review s ( SRs ) . Design Scoping review of SRs . Methods We search ed literature data bases , registries and reference lists , and contacted key authors and professional organisations to identify SRs of r and omised controlled trials for complementary medicine for MSK or MH . Inclusion criteria were : published after 2004 , study ing adults , in English and scoring > 50 % on Assessing the Method ological Quality of Systematic Review s ( AMSTAR ) ; quality appraisal checklist ) . SRs were synthesis ed to identify research priorities , based on moderate/good quality evidence , sample size and indication of cost-effectiveness and safety . Results We included 84 MSK SRs and 27 MH SRs . Only one focused on MSK – MH comorbidity . Meditative approaches and yoga may improve MH outcomes in MSK population s. Yoga and tai chi had moderate/good evidence for MSK and MH conditions . SRs reported moderate/good quality evidence ( any comparator ) in a moderate/large population for :  low back pain ( LBP )  ( yoga , acupuncture , spinal manipulation/mobilisation , osteopathy ) , osteoarthritis ( OA ) ( acupuncture , tai chi ) , neck pain  ( acupuncture , manipulation/manual therapy ) , myofascial trigger point pain ( acupuncture ) , depression ( mindfulness-based stress reduction ( MBSR ) , meditation , tai chi , relaxation ) , anxiety ( meditation/MBSR , moving meditation , yoga ) , sleep disorders ( meditative/mind – body movement ) and stress/distress ( mindfulness ) . The majority of these complementary approaches had some evidence of safety — only three had evidence of harm . There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP , and manual therapy/manipulation for neck pain , but few SRs review ed cost-effectiveness and many found no data . Conclusions Only one SR studied MSK – MH comorbidity . Research priorities for complementary medicine for both MSK and MH ( LBP , OA , depression , anxiety and sleep problems ) are yoga , mindfulness and tai chi . Despite the large number of SRs and the prevalence of comorbidity , more high- quality , large r and omised controlled trials in comorbid population s are needed Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy . Underst and ing intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness . Findings from this population may also be useful as hypothesis-generating work for particular civilian setting s such as law enforcement officers ( SWAT teams ) , firefighters ( smoke jumpers ) , or others in physically dem and ing professions . Questions / purpose sThe purpose s of this study were ( 1 ) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk ; and ( 2 ) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers . Methods Our study was a planned secondary analysis from a prospect i ve cohort examining how baseline factors predict musculoskeletal injury . Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures . Survey data included demographic variables , injury history , and biopsychosocial questions . Physical performance measures included  ankle dorsiflexion , Functional Movement Screen , lower and upper quarter Y-balance test , hop testing , pain provocation , and the Army Physical Fitness Test ( consisting of a 2-mile run and 2 minutes of sit-ups and push-ups ) . A total of 320 Rangers were invited to enroll and 211 participated ( 66 % ) . Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys , medical record review s , and a query of the Department of Defense healthcare utilization data base . Injury surveillance data were available on 100 % of the subjects . Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest . A logistic regression equation was then calculated to find the most pertinent set of predictors . Of the 188 Rangers ( age , 23.3 ± 3.7 years ; body mass index , 26.0 ± 2.4 kg/m2 ) remaining in the cohort , 85 ( 45.2 % ) sustained a musculoskeletal injury of interest .  Results Smoking , prior surgery , recurrent prior musculoskeletal injury , limited-duty days in the prior year for musculoskeletal injury , asymmetrical ankle dorsiflexion , pain with Functional Movement Screen clearing tests , and decreased performance on the 2-mile run and 2-minute sit-up test were associated with increased injury risk . Presenting with one or fewer predictors result ed in a sensitivity of 0.90 ( 95 % confidence interval [ CI ] , 0.83–0.95 ) , and having three or more predictors result ed in a specificity of 0.98 ( 95 % CI , 0.93–0.99 ) . The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 ( 95 % CI , 2.0–9.2 ) , relative risk of 1.9 ( 95 % CI , 1.4–2.6 ) , and an area under the curve of 0.64 . Conclusions Multiple factors ( musculoskeletal injury history , smoking , pain provocation , movement tests , and lower scores on physical performance measures ) were associated with individuals at risk for musculoskeletal injury . The summation of the number of risk factors produced a highly sensitive ( one or less factor ) and specific ( three or more factors ) model that could potentially be used to effectively identify and intervene in those persons with elevated risk for musculoskeletal injury . Future research should establish if screening and intervening can improve musculoskeletal health and if our findings among US Army Rangers translate to other occupations or athletes . Level of Evidence Level II , prognostic study 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 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 Background The importance of staying active instead of bed rest has been acknowledged in the management of musculoskeletal disorders ( MSDs ) . This emphasizes the potential benefits of adjusting work to fit the employee 's remaining work ability . Despite part-time sick leave being an official option in many countries , its effectiveness has not been studied yet . We have design ed a r and omized controlled study to assess the health effects of early part-time sick leave compared to conventional full-day sick leave . Our hypothesis is that if work time is temporarily reduced and work load adjusted at the early stages of disability , employees with MSDs will have less disability days and faster return to regular work duties than employees on a conventional sick leave . Methods / Design The study population will consist of 600 employees , who seek medical advice from an occupational physician due to musculoskeletal pain . The inclusion requires that they have not been on a sick leave for longer than 14 days prior to the visit . Based on the physician 's judgement , the severity of the symptoms must indicate a need for conventional sick leave , but the employee is considered to be able to work part-time without any additional risk . Half of the employees are r and omly allocated to part-time sick leave group and their work time is reduced by 40–60 % , whereas in the control group work load is totally eliminated with conventional sick leave . The main outcomes are the number of days from the initial visit to return to regular work activities , and the total number of sick leave days during 12 and 24 months of follow-up . The costs and benefits as well as the feasibility of early part-time sick leave will also be evaluated . Conclusion This is the first r and omised trial to our knowledge on the effectiveness of early part-time sick leave compared to conventional full-time sick leave in the management of MSDs . The data collection continues until 2011 , but preliminary results on the feasibility of part-time sick leave will be available already in 2008 . The increased knowledge will assist in better decision making process regarding the management of disability related to MSDs . Trial Registration International St and ard R and omised Controlled Trial Number Register , register number IS RCT The objective of this pilot study was to identify if notebook accessories ( ergonomic chair , desktop monitor and notebook riser ) combined with a wireless keyboard , mouse and participatory ergonomics training would have the greatest impact on reducing  self-reported upper extremity musculoskeletal discomfort in university students . In addition to pre-post computing and health surveys , the Ecological Momentary Assessment was used to capture change in discomfort over time using a personal digital assistant ( PDA ) as the e-diary . The PDA was programmed with a survey containing 45 questions . Four groups of university students were r and omised to either intervention ( three external computer accessories ) or to control . Participants reported less discomfort with the ergonomic chair and notebook riser based on the pre-post survey data and the e-diary/PDA ANOVA analysis . However , the PDA data , adjusted for the effect of hours per day of computer use , showed no benefit of the chair and limited benefit from the riser . Statement of Relevance : University students ' use of notebook computers has increased . This study found evidence of a positive effect of an adjustable chair or notebook riser when combined with ergonomic training on reducing discomfort . Daily  notebook computer use of 4 h was confirmed as a risk factor . Without some form of ergonomic intervention , these students are likely to enter the workforce with poor computing habits , which places them on the road to future injuries as technology continues to play a dominant role in their lives People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness
Levels of evidence for interventions associated with positive effects were : Moderate evidence for arm supports ; and Limited evidence for ergonomics training plus workstation adjustments , new chair and rest breaks .
Levels of evidence for interventions associated with “ no effect ” were : Strong evidence for workstation adjustment alone ; Moderate evidence for biofeedback training and job stress management training ; and Limited evidence for cognitive behavioral training .
No interventions were associated with “ negative effects ” .
Conclusion It is difficult to make strong evidence d-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs .
There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace m and ated pre-placement screening exams .
Background Little is known about the most effective occupational health and safety ( OHS ) interventions to reduce  upper extremity musculoskeletal disorders ( MSDs ) and injuries .
Methods A systematic review used a best evidence synthesis approach to address the question : “ do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms , signs , disorders , injuries , cl aims and lost time ? ”