A randomised controlled trial of postural interventions for prevention of musculoskeletal symptoms among computer users Office ergonomics training and a sit-stand workstation: effects on musculoskeletal and visual symptoms and performance of office workers. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department The effect of forearm support on musculoskeletal discomfort during call centre work. Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial Ergonomic Training Reduces Musculoskeletal Disorders among Office Workers: Results from the 6-Month Follow-Up. Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Computer users' risk factors for developing shoulder, elbow and back symptoms. A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders. Effort-reward imbalance and one-year change in neck-shoulder and upper extremity pain among call center computer operators. Users identified challenges in applying GRADE to complex interventions and suggested an extension to GRADE. The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers. The Effect of an Ergonomic Intervention on Musculoskeletal, Psychosocial and Visual Strain of VDT Data Entry Work: The United States Part of the International Study Key Steps in Conducting Systematic Reviews for Underpinning Clinical Practice Guidelines: Methodology of the European Association of Urology. Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: a randomised controlled trial. Comparisons of Musculoskeletal Complaints and Data Entry Between a Sitting and a Sit-Stand Workstation Paradigm Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders. Productivity associated with visual status of computer users. A global representation of vitamin D status in healthy populations Office ergonomics education: a comparison of traditional and participatory methods. Assessing the performance of methodological search filters to improve the efficiency of evidence information retrieval: five literature reviews and a qualitative study. Evaluation of sit-stand workstations in an office setting: a randomised controlled trial Effects of participatory ergonomic intervention on the development of upper extremity musculoskeletal disorders and disability in office employees using a computer
Aims : To examine the effect of two workstation and postural interventions on the incidence of  musculoskeletal symptoms among computer users . Methods : R and omised controlled trial of two distinct workstation and postural interventions ( an alternate intervention and a conventional intervention ) among 376 persons using computer keyboards for more than 15 hours per week . The incidence of neck/shoulder symptoms and h and /arm symptoms during six months of follow up among individuals in the intervention groups was compared to the incidence in computer users who did not receive an intervention ( comparison group ) . For individuals in the intervention groups , study staff adjusted workstations , where possible , and trained individuals to assume the intervention postures . Individuals reported musculoskeletal symptoms in a weekly diary . Participants who reported discomfort intensity of 6 or greater on a 0–10 visual analogue scale or who reported musculoskeletal symptoms requiring use of analgesic medication were considered symptomatic . Results : There were no significant differences in the incidence of musculoskeletal symptoms among the three intervention groups . Twenty two ( 18.5 % ) participants in the alternate intervention group , 25 ( 20.2 % ) in the conventional intervention group , and 25 ( 21.7 % ) in the comparison group developed incident arm or h and symptoms . Thirty eight ( 33.3 % ) participants in the alternate intervention group , 36 ( 31.0 % ) in the conventional intervention group , and 33 ( 30.3 % ) in the comparison group developed incident neck or shoulder symptoms . Compliance with all components of the intervention was attained for only 25–38 % of individuals , due mainly to the inflexibility of workstation configurations . Conclusions : This study provides evidence that two specific workplace postural interventions are unlikely to reduce the risk of upper extremity musculoskeletal symptoms among computer users Work Related Musculoskeletal Disorders ( WMSDs ) among office workers with intensive computer use is widespread and the prevalence of symptoms is growing . This r and omized controlled trial investigated the effects of an office ergonomics training combined with a sit-st and workstation on musculoskeletal and visual discomfort , behaviors and performance .  Participants performed a lab-based customer service job for 8 h per day , over 15 days and were assigned to :  Ergonomics Trained ( n = 11 ) or Minimally Trained ( n = 11 ) . The training consisted of : a 1.5-h interactive instruction , a sit/st and practice period , and ergonomic reminders . Ergonomics Trained participants experienced minimal musculoskeletal and visual discomfort across the 15 days , varied their postures , with significantly higher performance compared to the Minimally Trained group who had a significantly higher number of symptoms , suggesting that training plays a critical role . The ability to mitigate symptoms , change behaviors and enhance performance through training combined with a sit-st and workstation has implication s for preventing discomforts in office workers 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 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 Using a computer keyboard with the forearms unsupported has been proposed as a causal factor for  neck/shoulder and arm/h and diagnoses . Recent laboratory and field studies have demonstrated that forearm support might be preferable to working in the traditional " floating " posture . The aim of this study was to determine whether providing forearm support when using a normal computer workstation would decrease musculoskeletal discomfort in intensive computer users in a call centre . A r and omised controlled study ( n = 59 ) , of 6 weeks duration was conducted . Thirty participants ( Group 1 ) were allocated to forearm support using the desk surface with the remainder ( Group 2 ) acting as a control group . At 6 weeks , the control group was also set up with forearm support . Both groups were then monitored for another 6 weeks . Question naires were used at 1 , 6 and 12 weeks to obtain information about discomfort , workstation setup , working posture and comfort .  Nine participants ( Group 1 n = 6 , Group 2 n = 3 ) withdrew within a week of commencing forearm support either due to discomfort or difficulty in maintaining the posture . At 6 weeks , the group using forearm support generated significantly fewer reports of discomfort in the neck and back , although the difference between the groups was not statistically significant . At 12 weeks , there were fewer reports of neck , back and wrist discomfort when preintervention discomfort was compared with post intervention discomfort . These findings indicate that for the majority of users , forearm support may be preferable to the " floating " posture implicit in current guidelines for computer workstation setup 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 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 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 OBJECTIVES This prospect i ve study concentrated on determining factors of computer work that predict  musculoskeletal symptoms in the shoulder , elbow , and low-back regions . METHODS A question naire on ergonomics , work pauses , work techniques , and psychosocial and work factors was delivered to 5033 office workers at baseline in early 1999 ( response rate 69 % ) and to 3361 respondents at the time of the follow-up in late 2000 ( response rate 77 % ) . An increased frequency or intensity of symptoms was the outcome variable , including only nonsymptomatic respondents from the baseline question naire ( symptom frequency below 8 days within the last 12 months or intensity score below 4 within the last 3 months ) . RESULTS In the follow-up , 10 % , 18 % , and 23 % had symptoms more often in the elbow , shoulder , and low back , respectively , and 14 % , 20 % , and 22 % had more intense symptoms .  Women were more likely to be afflicted than men in all regions . In the full-fit multivariate logistic regression analysis , little influence on the timing of a rest pause and being disturbed by glare or reflection were significant predictors of shoulder symptoms , screen below eye height was a significant predictor for elbow symptoms , and previous symptoms was a significant predictor for symptoms in all regions . Computer worktime and psychosocial dimensions were not significant predictors . CONCLUSIONS Influence on work pauses , reduction of glare or reflection , and screen height are important factors in the design of future computer workstations . Since previous symptoms was a significant predictor of recurrent symptoms in all three regions under study , it can be concluded that musculoskeletal symptoms are persistent BACKGROUND A prospect i ve study of computer users was performed to determine the occurrence of and evaluate risk factors for  neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms ( MSS ) and disorders ( MSD ) . METHODS Individuals ( n = 632 ) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years . At study entry , workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed . Daily diaries were used to document work practice s and incident MSS . Those reporting MSS were examined for specific MSD . Incidence rates of MSS and MSD were estimated with survival analysis . Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD . RESULTS The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years . The most common N/S MSD was somatic pain syndrome . The annual incidence of H/A MSS was 39 cases/100 person-years and of H/A MSD was 21 cases/100 person-years . The most common H/A disorder was deQuervain 's tendonitis . Forty-six percent of N/S and 32 % of H/A MSS occurred during the first month of follow-up . Gender , age , ethnicity , and prior history of N/S pain were associated with N/S MSS and MSD . Gender , prior history of H/A pain , prior computer use , and children at home were associated with either H/A MSS or MSD . CONCLUSIONS H/A and N/S MSS and MSD were common among computer users . More than 50 % of computer users reported MSS during the first year after starting a new job OBJECTIVE The literature on psychosocial job factors and musculoskeletal pain is inconclusive in part due to insufficient control for confounding by biomechanical factors . The aim of this study was to investigate prospect ively the independent effects of effort-reward imbalance ( ERI ) at work on regional musculoskeletal pain of the neck and upper extremities of call center operators after controlling for ( i ) duration of computer use both at work and at home , ( ii ) ergonomic workstation design , ( iii ) physical activities during leisure time , and ( iv ) other individual worker characteristics . METHODS This was a one-year prospect i ve study among 165 call center operators who participated in a r and omized ergonomic intervention trial that has been described previously . Over an approximate four-week period , we measured ERI and 28 potential confounders via a question naire at baseline . Regional upper-body pain and computer use was measured by weekly surveys for up to 12 months following the implementation of ergonomic interventions .  Regional pain change scores were calculated as the difference between average weekly pain scores pre- and post intervention . RESULTS A significant relationship was found between high average ERI ratios and one-year increases in right upper-extremity pain after adjustment for pre-intervention regional mean pain score , current and past physical workload , ergonomic workstation design , and anthropometric , sociodemographic , and behavioral risk factors . No significant associations were found with change in neck-shoulder or left upper-extremity pain . CONCLUSIONS This study suggests that ERI predicts regional upper-extremity pain in -computer operators working > or=20 hours per week . Control for physical workload and ergonomic workstation design was essential for identifying ERI as a risk factor OBJECTIVES To explore user perspectives on applying the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) to systematic review s of complex interventions . STUDY DESIGN AND SETTING Thirty-three authors of recent ( 2013 onward ) systematic review s were contacted regarding their perspectives on using  GRADE from three Cochrane review groups : Cochrane Developmental , Psychosocial , and Learning Problems Group ; Cochrane Public Health Group ; and Cochrane Depression , Anxiety , and Neurosis Group . Framework Analysis was applied to the data to identify the challenges in applying GRADE and suggestions for its extension , that is , adaptation . These two themes were cross-compared between the groups of answers from " simple " vs. " complex " intervention review authors to identify the specific perspectives on using GRADE in review s of complex interventions . RESULTS Specific challenges were identified in applying GRADE to review s of complex interventions . These were related to the assessment of nonr and omized studies and performance bias in GRADE . Authors perceived these challenges to contribute to frequent downgrading of the " best evidence possible " for complex interventions . Meanwhile , GRADE was found to lack an analytic approach to enable adequate evidence synthesis and assessment of intervention implementation elements . CONCLUSION Users suggest that the GRADE guidance be extended to address-specific considerations for complex interventions An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers . Sixty workers were r and omly assigned to either : 1 ) a control group ; 2 ) an office training group that received personal , ergonomic training and workstation adjustments or 3 ) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the worker 's current sitting posture together with the correct posture photo taken earlier during office training . Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment ( RULA ) method before , during and after the six weeks intervention . Both training methods provided effective short-term posture improvement ; however , sustained improvement was only attained with the photo-training method . Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain . The photo-training method had a greater positive effect on women than on men The United States MEPS ( musculoskeletal — eyestrain — psychosocial — stress ) study consisted of 1 group of 28 female data entry operators . The intervention was in 3 parts : workstation re design ( including advanced ergonomic chairs , motorized adjustable workstations , advanced adjustable keyboards , adjustable copyholders , adjustable footrests , monitor support surfaces ) and ergonomic training/coaching and corrective lenses . After the intervention , statistically significant reductions in physical signs ( trigger points , neck and shoulder mobility ) , subjective reports of intensity and frequency of musculoskeletal pain , and subjective reports of visual problems were observed . Static load during the work sample , as assessed by experts , improved after the intervention as did measured postural angles of head and trunk and subjective assessment of users of ergonomic characteristics of the workplaces . For all of these measures , improvements observed 1 month after intervention were also observed in the 1-year follow-up . Trapezius load , as assessed by electromyography ( EMG ) , decreased after intervention , but then increased in the follow-up . The increase was interpreted as a calibration problem CONTEXT The findings of systematic review s ( SRs ) and meta-analyses ( MAs ) are used for clinical decision making . The European Association of Urology has committed increasing re sources into the development of high quality clinical guidelines based on such SRs and MAs . OBJECTIVE In this paper , we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office . EVIDENCE ACQUISITION The process involves explicit methods and the findings should be reproducible . When conducting a SR , the essential first step is to formulate a clear and answerable research question . An extensive literature search lays the foundation for evidence synthesis . Data are extracted independently by two review ers and any disagreements are resolved by discussion or arbitration by a third review er . EVIDENCE SYNTHESIS In SRs , data for particular outcomes in individual r and omised controlled trials may be combined statistically in a meta- analysis to increase power when the studies are similar enough . Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size , result ing in heterogeneity in outcome between studies . A number of different tools are available such as Cochrane Risk of Bias assessment tool for r and omised controlled trials . In circumstances where there is too much heterogeneity , or when a review has included nonr and omised comparative studies , it is more appropriate to conduct a narrative synthesis . The GRADE tool for assessing quality of evidence strives to be a structured and transparent system , which can be applied to all evidence , regardless of quality . A SR not only identifies , evaluates , and summarises the best available evidence , but also the gaps to be targeted by future studies . CONCLUSIONS SRs and MAs are integral in developing sound clinical practice guidelines and recommendations . PATIENT SUMMARY Clinical practice guidelines should be evidence based , and systematic review s and meta-analyses are essential in their production . We have discussed the key steps of conducting systematic review s and meta-analyses in this paper 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 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 Background : Seated working positions are often regarded as a cause for discomfort in the musculoskeletal system . Performing work in different working positions — that is , alternating between sitting and st and ing ( sit-st and workstation paradigm)—could help reduce physical complaints . Objective : The questions were whether performing office work partly in a st and ing position leads to reduced complaints and whether st and ing would change the efficiency of data entry office work . Method : We investigated the effect of a sit-st and workstation paradigmd during experimental data entry office work on physical and psychological complaints and data entry efficiency by conducting a r and omized controlled trial with 60 male participants ages 18 to 35 years . Results : In this experiment , musculoskeletal complaints were reduced by a sit-st and workstation paradigm . A trend could be identified indicating a small but nonsignificant loss of efficiency in data entry while st and ing . Conclusion : A sit-st and workstation paradigm reduces musculoskeletal complaints without considerably affecting data entry efficiency under the presented study conditions ( young male participants , short duration , fixed and controlled sit-st and workstation paradigm , simulated experimental working condition ) . Application : According to the present data , implementing a sit-st and workstation paradigm can be an effective workplace health intervention to reduce musculoskeletal complaints . This experiment encourages further studies on the effectiveness of a sit-st and workstation paradigm . Experimental research and field studies that prove the reduction of complaints when introducing a sit-st and workstation paradigm in the workplace could be the basis for evidence -based recommendations regarding such interventions Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted BACKGROUND Despite widespread recommendations regarding posture during computer use , associations between specific postures and musculoskeletal health are not well characterized . METHODS Six hundred and thirty-two newly hired computer users were followed prospect ively to evaluate associations between posture and neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms and musculoskeletal disorders . Participants ' postures were measured at entry and they reported symptoms on weekly diaries . Participants reporting symptoms were examined for specific disorders . Multivariate Cox regression models were used to estimate associations between postural variables and risk of symptoms and disorders , controlling for confounding variables . RESULTS Keying with an inner elbow angle > 121 degrees , greater downward head tilt , and presence of armrests on the participants chair were associated with lower risk of N/S symptoms or N/S disorders .  Keying with elbow height below the height of the " J " key and the presence of a telephone shoulder rest were associated with a greater risk of N/S symptoms or N/S disorders . Horizontal location of the " J " key > 12 cm from the edge of the desk was associated with a lower risk of H/A symptoms and H/A disorders . Use of a keyboard with the " J " key > 3.5 cm above the table surface , key activation force > 48 g , and radial wrist deviation of > 5 degrees while using a mouse was associated with a greater risk of H/A symptoms or H/A disorders . The number of hours keying/week was associated with H/A symptoms and disorders . CONCLUSIONS The results suggest that the risk of musculoskeletal symptoms and musculoskeletal disorders may be reduced by encouraging specific seated postures BACKGROUND The aim of this project is to examine the potential connection between the astigmatic refractive corrections of subjects using computers  and their productivity and comfort . We hypothesize that improving the visual status of subjects using  computers  results in greater productivity , as well as improved visual comfort . METHODS Inclusion criteria required subjects 19 to 30 years of age with complete vision examinations before being enrolled . Using a double-masked , placebo-controlled , r and omized design , subjects completed three experimental tasks calculated to assess the effects of refractive error on productivity ( time to completion and the number of errors ) at a computer . The tasks resembled those commonly undertaken by computer users and involved visual search tasks of : ( 1 ) counties and population s ; ( 2 ) nonsense word search ; and ( 3 ) a modified text-editing task . RESULTS Estimates of productivity for time to completion varied from a minimum of 2.5 % upwards to 28.7 % with 2 D cylinder miscorrection . Assuming a conservative estimate of an overall 2.5 % increase in productivity with appropriate astigmatic refractive correction , our data suggest a favorable cost-benefit ratio of at least 2.3 for the visual correction of an employee ( total cost 268 dollars ) with a salary of 25,000 dollars per year . CONCLUSIONS We conclude that astigmatic refractive error affected both productivity and visual comfort under the conditions of this experiment . These data also suggest a favorable cost-benefit ratio for employers who provide computer-specific eyewear to their employees Purpose This paper visualizes the available data on vitamin D status on a global map , examines the existing heterogeneities in vitamin D status and identifies research gaps . Methods A graphical illustration of global vitamin D status was developed based on a systematic review of the worldwide literature published between 1990 and 2011 . Studies were eligible if they included sample s of r and omly selected males and females from the general population and assessed  circulating 25-hydroxyvitamin D [ 25(OH)D ] levels .  Two different age categories were selected : children and adolescents ( 1–18 years ) and adults ( > 18 years ) . Studies were chosen to represent a country based on a hierarchical set of criteria . Results In total , 200 studies from 46 countries met the inclusion criteria , most coming from Europe . Forty-two of these studies ( 21 % ) were classified as representative . In children , gaps in data were identified in large parts of Africa , Central and South America , Europe , and most of the Asia/Pacific region . In adults , there was lack of information in Central America , much of South America and Africa . Large regions were identified for which the mean 25(OH)D levels were below 50 nmol/L. Conclusions This study provides an overview of 25(OH)D levels around the globe . It reveals large gaps in information in children and adolescents and smaller but important gaps in adults . In view of the importance of vitamin D to musculoskeletal growth , development , and preservation , and of its potential importance in other tissues , we strongly encourage new research to clearly define 25(OH)D status around the world Health and safety literature stresses the value of programs aim ed at preventing musculoskeletal injuries . The concepts of empowerment learning are often recommended as guidelines for worker education yet these approaches are largely untested . The present study compares the traditional approach involving lecture and discussion with a participatory method .  A sample of 102 participants employed at a central ized reservation facility was used . Participants were r and omly assigned to either the  traditional education group or  the participatory education group . Data collection utilized surveys completed by study participants and observational checklists completed by a trained observer . Data were collected prior to intervention and at approximately 3 , 6 , and 12 months post intervention . Results of data analysis provide no evidence that participatory methods are more effective than traditional methods in encouraging workers to position their work equipment correctly or to maintain good working postures to prevent musculoskeletal injuries BACKGROUND Effective study identification is essential for conducting health research , developing clinical guidance and health policy and supporting health-care decision-making . Method ological search filters ( combinations of search terms to capture a specific study design ) can assist in search ing to achieve this . OBJECTIVES This project investigated the methods used to assess the performance of method ological search filters , the information that search ers require when choosing search filters and how that information could be better provided . METHODS Five literature review s were undertaken in 2010/11 : search filter development and testing ; comparison of search filters ; decision-making in choosing search filters ; diagnostic test accuracy ( DTA ) study methods ; and decision-making in choosing diagnostic tests . We conducted interviews and a question naire with experienced search ers to learn what information assists in the choice of search filters and how filters are used . These investigations informed the development of various approaches to gathering and reporting search filter performance data . We acknowledge that there has been a regrettable delay between carrying out the project , including the search es , and the publication of this report , because of serious illness of the principal investigator . RESULTS The development of filters most frequently involved using a reference st and ard derived from h and - search ing journals . Most filters were vali date d internally only . Reporting of methods was generally poor . Sensitivity , precision and specificity were the most commonly reported performance measures and were presented in tables . Aspects of DTA study methods are applicable to search filters , particularly in the development of the reference st and ard . There is limited evidence on how clinicians choose between diagnostic tests . No published literature was found on how search ers select filters . Interviewing and question ing search ers via a question naire found that filters were not appropriate for all tasks but were predominantly used to reduce large numbers of retrieved records and to introduce focus . The Inter Technology Appraisal Support Collaboration ( InterTASC ) Information Specialists ' Sub-Group ( ISSG ) Search Filters Re source was most frequently mentioned by both groups as the re source consulted to select a filter . R and omised controlled trial ( RCT ) and systematic review filters , in particular the Cochrane RCT and the McMaster Hedges filters , were most frequently mentioned . The majority indicated that they used different filters depending on the requirement for sensitivity or precision . Over half of the respondents used the filters available in data bases . Interviewees used various approaches when using and adapting search filters . Respondents suggested that the main factors that would make choosing a filter easier were the availability of critical appraisal s and more detailed performance information . Provenance and having the filter available in a central storage location were also important . LIMITATIONS The question naire could have been shorter and could have included more multiple choice questions , and the review s of filter performance focused on only four study design s. CONCLUSIONS Search filter studies should use a representative reference st and ard and explicitly report methods and results . Performance measures should be presented systematic ally and clearly . Search ers find filters useful in certain circumstances but expressed a need for more user-friendly performance information to aid filter choice . We suggest approaches to use , adapt and report search filter performance . Future work could include research around search filters and performance measures for study design s not addressed here , exploration of alternative methods of displaying performance results and numerical synthesis of performance comparison results . FUNDING The National Institute for Health Research ( NIHR ) Health Technology Assessment programme and Medical Research Council-NIHR Methodology Research Programme ( grant number G0901496 ) Background Excessive sitting time is a risk factor for cardiovascular disease mortality and morbidity independent of physical activity . This aim of this study was to evaluate the impact of a sit-st and workstation on sitting time , and vascular , metabolic and musculoskeletal outcomes in office workers , and to investigate workstation acceptability and feasibility . Methods A two-arm , parallel-group , individually r and omised controlled trial was conducted in one organisation . Participants were asymptomatic full-time office workers aged ≥18 years . Each participant in the intervention arm had a sit-st and workstation installed on their workplace desk for 8 weeks . Participants in the control arm received no intervention . The primary outcome was workplace sitting time , assessed at 0 , 4 and 8 weeks by an ecological momentary assessment diary . Secondary behavioural , cardiometabolic and musculoskeletal outcomes were assessed . Acceptability and feasibility were assessed via question naire and interview . ANCOVA and magnitude-based inferences examined intervention effects relative to controls at 4 and 8 weeks . Participants and research ers were not blind to group allocation . Results Forty-seven participants were r and omised ( intervention n = 26 ; control n = 21 ) . Relative to the control group at 8 weeks , the intervention group had a beneficial decrease in sitting time ( −80.2 min/8-h workday ( 95 % CI = −129.0 , −31.4 ) ; p = 0.002 ) , increase in st and ing time ( 72.9 min/8-h workday ( 21.2 , 124.6 ) ; p = 0.007 ) and decrease in total cholesterol ( −0.40 mmol/L ( −0.79 , −0.003 ) ; p = 0.049 ) . No harmful changes in musculoskeletal discomfort/pain were observed relative to controls , and beneficial changes in flow-mediated dilation and diastolic blood pressure were observed . Most participants self-reported that the workstation was easy to use and their work-related productivity did not decrease when using the device . Factors that negatively influenced workstation use were workstation design , the social environment , work tasks and habits . ConclusionS hort-term use of a feasible sit-st and workstation reduced daily sitting time and led to beneficial improvements in cardiometabolic risk parameters in asymptomatic office workers . These findings imply that if the observed use of the sit-st and workstations continued over a longer duration , sit-st and workstations may have important ramifications for the prevention and reduction of cardiometabolic risk in a large proportion of the working population .Trial registration Clinical Trials.gov NCT02496507 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
Moderate evidence was observed for : ( 1 ) no effect of workstation adjustment , ( 2 ) no effect of rest breaks and exercise and ( 3 ) positive effect of alternative pointing devices .
For all other interventions mixed or insufficient evidence of effect was observed .
Conclusion : Few high quality studies were found that examined the effects of interventions in the office on musculoskeletal or visual health
Background : The literature examining the effects of workstation , eyewear and behavioral interventions on  musculoskeletal and visual symptoms among computer users is large and heterogeneous .
Methods : A systematic review of the literature used a best evidence synthesis approach to address the general question “ Do office interventions among computer users have an effect on musculoskeletal or visual health ? ”