The effects of neck–shoulder pain development on sensory–motor interactions among female workers in the poultry and fish industries. A prospective study Predictive risk factors for chronic regional and multisite musculoskeletal pain: A 5-year prospective study in a working population Differential effects of mental load on proximal and distal arm muscle activity Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. An occupational pain study 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 The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers Test-retest reliability of a WRULD functional capacity evaluation in healthy adults. Sickness absence in patients with arm, neck and shoulder complaints presenting in physical therapy practice: 6 months follow-up. The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals Cost-effectiveness of postural exercise therapy versus physiotherapy in computer screen-workers with early non-specific work-related upper limb disorders (WRULD); a randomized controlled trial No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial. Effect of two contrasting interventions on upper limb chronic pain and disability: a randomized controlled trial. 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The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees. Workplace Prevention and Musculoskeletal Injuries in Nurses The Risk Assessment Score in Acute Whiplash Injury Predicts Outcome and Reflects Biopsychosocial Factors Physical exposure assessment in monotonous repetitive work--the PRIM study. Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Computer mouse position as a determinant of posture, muscular load and perceived exertion. Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders. 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Effects of Ergorest® Arm Supports on Muscle Strain and Wrist Positions During the Use of the Mouse and Keyboard in Work With Visual Display Units: A Work Site Intervention A Randomized Controlled Trial Evaluating the Effects of New Task Chairs on Shoulder and Neck Pain Among Sewing Machine Operators: The Los Angeles Garment Study Effect of an intervention addressing working technique on the biomechanical load of the neck and shoulders among hairdressers. The Integration of Electromyography (SEMG) at the Workstation: Assessment, Treatment, and Prevention of Repetitive Strain Injury (RSI) Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders The Ipswich Microbreak Technique to alleviate neck and shoulder discomfort during microscopic procedures. Lateral epicondylitis in general practice: course and prognostic indicators of outcome. 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Shoulder disorders in general practice: prognostic indicators of outcome. Risk factors for neck pain in office workers: a prospective study
Abstract Objectives . The purpose of this prospect i ve laboratory study was to follow newly employed workers in the fish or poultry industry for 6 months and investigate possible changes in sensory manifestations and motor performance during low load , repetitive work simulation . It was investigated whether the changes were an effect of employment duration and of development of neck – shoulder complaints . Methods . Twelve newly employed female filleting employees without any sign of neck – shoulder tenderness/pain at the time of employment of 0 months took part in two laboratory recording sessions planned within 1 month of employment and after 6 months of employment at the plant . After 6 months , six workers out of 12 had developed pain and /or tenderness in the neck – shoulder region . The recording sessions evaluated sensory-motor aspects by measuring pressure pain threshold , work-task timing , cutting forces , surface electromyographic activity of four shoulder muscles , displacement of the centre of pressure , and 3D movements of the arm and trunk during simulation of low load , repetitive filleting . Results . Effects due to the duration of employment were observed in both groups , i.e. decreased sensibility to pressure , decrease in the duration of the work cycle , increased arm starting position with respect to the upright position , and decreased range of motion of the arm and trunk ( P<0.05 ) after 6 months . Among the workers with neck – shoulder complaints , increased sensibility to pressure , lower force level , higher electromyographic activity , decreased amplitude of arm movement , and increased trunk posture and movement amplitude ( P<0.05 ) were observed , compared with workers without complaints . Conclusions . Differences in terms of sensory manifestations and motor control strategy were seen after 6 months of employment with or without neck – shoulder complaints . In general , changes in sensory manifestations and motor control strategy after 6 months work were most likely of importance , as they underlined a learning process as employment duration increased . Moreover , the present sensory – motor changes observed among workers with neck – shoulder complaints highlighted the potential physical risk factors associated with low load , repetitive work Summary Physical and psychological work‐related factors pertaining to the 5‐year incidence of multiple body sites musculoskeletal pain ( MSP ) may be gender specific . In particular , psychological factors seem to be predictive of onset of MSP , but only in women . Only the physical work factor ( ie , forceful effort constraints ) was an important robust predictor of multisite MSP , but only in men . ABSTRACT The role of psychosocial and physical factors in the development of musculoskeletal pain ( MSP ) has now been clearly demonstrated . However , it is unclear whether these factors contribute to specific regional MSP or to multisite pain . The main goal of this study was to assess the impact of work‐related factors  according to gender on the development of regional and multisite MSP . A total of 12,591 subjects ( 65 % men and 35 % women ) who were born in 1938 , 1943 , 1948 , and 1953 and were participating in a French longitudinal prospect i ve epidemiological survey ( ESTEV ) in 1990 to 1995 were eligible . Personal factors and work exposure were assessed by self‐administered question naires . Statistical associations between chronic MSP ( regional body site or multisite ) , personal factors , and occupational factors were analyzed using logistic regression modeling . The incidence of regional MSP and multisite pain in 1995 were , respectively , 17 % and 25.6 % . For women , highly repetitive movements predicted neck/shoulder pain ; posture and vibrations predicted arm and low back pain ; and effort with tools predicted arm pain . For men , forceful effort and vibrations predicted neck/shoulder pain ; posture and forceful effort predicted lower limb and low back pain ; and forceful effort and effort with tools predicted arm pain . Physical constraints ( ie , forceful effort or vibrations ) were associated with multisite pain in both genders . Only for women , psychological factors were risk factors predictive of upper limb pain and in 3 or 4 painful anatomical sites . These results support the hypothesis that some physical and psychological work‐related factors are predictive of regional or multisite MSP but differ according to gender . Gender differences and risk factors for work‐related musculoskeletal pain should be also taken into account to more effectively target preventive measures Work-related upper extremity disorders ( WRUEDs ) that result from keyboarding  tasks are prevalent and costly . Although the precise mechanisms causing the disorder are not yet fully understood , several risk factors have been proposed . These include the repetitive nature of the motor task and the associated sustained static working postures , but also more psychological factors such as mental load . Epidemiological surveys have shown that WRUEDs are more prone to develop in the postural muscles of the neck/shoulder area than in the executive muscles controlling the h and . The present study investigated whether the activation patterns of these two muscle types are differentially affected by an additional mental load during the performance of a repetitive tapping task .  Participants tapped various keying patterns with their dominant index finger at two prescribed tempi . Mental load was manipulated by means of an auditory short-term memory task . We recorded the  EMG activity of two neck/shoulder muscles ( trapezius and deltoid ) , two upper arm muscles ( biceps and triceps ) , and four forearm muscles ( flexor digitorum superficialis , extensor digitorum , extensor carpi radialis longus and extensor carpi ulnaris ) and analyzed the kinematics and impact forces of the index finger . The results confirmed that the upper limb has two functions . Specifically , activity of the executive distal musculature was increased during tapping at the higher pace , while the activity of the postural upper limb musculature was elevated due to the memory task . We argue that continuously increased muscular activity can lead to fatigue and thus eventually cause musculoskeletal complaints . The results are discussed with respect to biomechanical adaptation strategies that deal with the consequences of increased noise in the neuromotor system due to enhanced mental processing 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 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 Abstract This study assessed the effectiveness of a single intervention targeting work style and a combined intervention targeting work style and physical activity on the recovery from neck and upper limb symptoms . Computer workers with frequent or long‐term neck and upper limb symptoms were r and omised into the work style group ( WS , n = 152 ) , work style and physical activity group ( WSPA , n = 156 ) , or usual care group ( n = 158 ) . The WS and WSPA group attended six group meetings . All meetings focused on behavioural change with regard to body posture , workplace adjustment , breaks and coping with high work dem and s ( WS and WSPA group ) and physical activity ( WSPA group ) . Pain , disability at work , days with symptoms and months without symptoms were measured at baseline and after 6 ( T1 ) and 12 months ( T2 ) . Self‐reported recovery was assessed at T1/T2 . Both interventions were ineffective in improving recovery . The work style intervention but not the combined intervention was effective in reducing all pain measures . These effects were present in the neck/shoulder , not in the arm/wrist/h and . For the neck/shoulder , the work style intervention group also showed an increased recovery‐rate . Total physical activity increased in all study groups but no differences between groups were observed . To conclude , a group‐based work style intervention focused on behavioural change was effective in improving recovery from neck/shoulder symptoms and reducing pain on the long‐term . The combined intervention was ineffective in increasing total physical activity . Therefore we can not draw conclusions on the effect of increasing physical activity on the recovery from neck and upper limb symptoms The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders ( WRULD FCE ) . The study sample included 33 healthy adults , consisting of 14 males and 19 females with a mean age of 29.2 years . The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements , duration , working in awkward positions , forceful movements and static postures . Two FCE sessions were held with a 10-day interval . Means , 95 % confidence intervals , one-way r and om Intraclass Correlation Coefficients ( ICCs ) , 95 % limits of agreement and repeated measures were calculated . An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability . The results showed that 14 of 26 items ( 54 % ) had excellent reliability , 9 of 26 items ( 35 % ) had good reliability and 3 of 26 items ( 11 % ) had moderate reliability based on ICC values . Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test . It is concluded that the WRULD FCE is reliable in healthy adults OBJECTIVE To describe  sickness absence in patients with arm , neck and /or shoulder complaints and to evaluate determinants of sickness absence during 6 months follow-up . METHODS A prospect i ve cohort study in physical therapy practice with follow-up measurements at 3 and 6 months . The main outcome measure was the occurrence of sickness absence due to arm , neck and shoulder complaints during 6 months follow-up . Determinants were tested in univariate and multivariate GEE ( Generalized Estimating Equations ) analysis . RESULTS At baseline 161 patients ( 33 % ) reported absence from work . The multivariate analysis showed that self-reported work-relatedness of complaints , previous musculoskeletal trauma , higher severity of complaints at baseline , more somatization and low decision authority at work were associated with sickness absence during the follow-up period . CONCLUSION In physical therapy practice , social and psychological factors ( at work ) influence the occurrence of sickness absence in patients with arm , neck and /or shoulder complaints . These factors can be taken into account when developing and evaluating interventions to reduce sickness absence among these patients 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 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 Objectives To assess the influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users . Methods The study is a prospect i ve cohort study with an observation period of 10 months . A baseline question naire about symptoms in the neck , shoulder and arm/h and during previous month , individual factors , work content , physical and psychosocial work-related exposures was answered by 1,283 computer operators ( response rate 84 % ) . Incidence data were collected by ten monthly question naires regarding the occurrence of symptoms categorized into three gross body regions : neck , shoulders and arms/h and s. A case , in the specific gross body region , was defined as a subject who was classified as non-symptomatic in that region at baseline or during minimum one follow-up period and later reported symptoms ( ≥3 days ) . Univariable and multivariable incidence rate ratios with 95 % confidence intervals for first occurrence of neck , shoulder and arm/h and cases , respectively , were calculated with Cox regression analysis . Results The incidence rate was 67 , 41 and 47 cases per 100 person years for neck , shoulder and arm/h and symptoms , respectively . In the multivariable analyses , comfort of the computer work environment and gender were related to the incidence of symptoms in all body regions ( RR = 1.5–1.9 for low comfort and 1.8–2.1 for females , respectively ) . Duration of mouse use predicted arm/h and symptoms ( RR = 1.7 for ≥3 h/day ) and job strain ( high dem and s and low decision latitude ) predicted neck symptoms ( RR = 1.6 and 2.2 for medium and high strain , respectively ) . Additionally , age was related to neck and shoulder symptoms . Conclusion Preventive strategies to reduce neck and upper limb symptoms among computer users should include measures to reduce mouse use  , to increase the comfort of the work environment and to reduce job strain . Although the effect estimates were relatively weak to moderate , preventive measures may have a marked impact on the incidence of neck and upper limb symptoms in the general population because of the widespread use of computers in working life as well as at home 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 Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders ( WRULD ) . Aims To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints , both from health care and societal perspective . Methods Prospect i ve r and omized trial including cost-effectiveness analysis ; one year follow-up . Participants : Eighty-eight screen-workers with early non-specific WRULD ; six drop-outs . Interventions : A ten week postural exercise program versus regular physiotherapy .  Outcome measures : Effectiveness measures : Pain : visual analogous scale ( VAS ) , self-perceived WRULD ( yes/no ) . Functional outcome : Disabilities of Arm , Shoulder and H and - Dutch Language Version ( DASH-DLV ) . Quality of life outcome : EQ-5D.Economic measures : health care costs including patient and family costs and productivity costs result ing in societal costs . Cost-effectiveness measures : health care costs and societal costs related to the effectiveness measures . Outcome measures were assessed at baseline ; three , six and twelve months after baseline . Results At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs . No significant differences between the groups concerning effectiveness at one year follow-up were found . Effectiveness scores slightly improved over time . After one year 55 % of participants were free of complaints . After one year the postural exercise group had higher mean total health care costs , but lower productivity costs compared to the physiotherapy group . Mean societal costs after one year ( therefore ) were in favor of postural exercise therapy [ - € 622 ; 95 % CI -2087 ; + 590 ) ] . After one year , only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy ; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs  , postural exercise therapy had a probability of over 80 % to be cost-effective over a wide range of cost-effectiveness ceiling ratios ; however based on a marginal QALY-difference of 0.1 over a 12 month time frame . Conclusion Although our trial failed to find significant differences in VAS , QALYs and ICERs based on VAS and QALYs at one-year follow-up , CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy ; however further research is required . Trial registration IS RCT N QUESTION Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain , reducing disability and improving health-related quality of life in visual display unit workers with early non-specific work-related upper limb disorders than strength and fitness exercises delivered by physiotherapists ? DESIGN R and omised trial with concealed allocation and intention-to-treat analysis . PARTICIPANTS Eighty-eight ( 6 drop-outs ) visual display unit workers with early non-specific work-related upper limb disorders . INTERVENTION One group received 10 weeks of postural exercises while the other group received 10 weeks of strength and fitness exercises . OUTCOME MEASURES Pain was measured with a 10-cm visual analogue scale , disability was measured with the Disabilities of Arm , Shoulder and H and question naire , and health-related quality of life was measured with the Short Form-36 . Number of participants experiencing upper limb complaints was also collected . Outcome measures were collected at baseline and again at 3 , 6 , and 12 months . RESULTS There was no significant difference in decrease in pain between the groups at 3 months ( 0.6 cm , 95 % CI 0.0 to 1.2 ) , 6 months ( 0.2 , 95 % CI -0.3 to 0.7 ) , or at 12 months ( 0.1 , 95 % CI -0.6 to 0.8 ) . Differences between the groups in upper limb complaints , disability , and health related quality of life were also small and not significant at any measurement occasion . CONCLUSION Postural exercises did not result in a better outcome than strength and fitness exercises . However , 55 % of visual display unit workers with early non-specific work-related upper limb disorders reported being free of complaints one year after both interventions were commenced . TRIAL REGISTRATION IS RCT N15872455 BACKGROUND Chronic pain and disability of the arm , shoulder , and h and severely affect labor market participation . Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain . An alternative strategy could be to increase physical capacity of the worker by physical conditioning . OBJECTIVES To investigate the effect of 2 contrasting interventions , conventional ergonomic training ( usual care ) versus resistance training , on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual work . STUDY DESIGN Examiner-blinded , parallel-group r and omized controlled trial with allocation concealment . SETTING Slaughterhouses located in Denmark , Europe . METHODS Sixty-six adults with chronic pain in the shoulder , elbow/forearm , or h and /wrist and work disability were r and omly allocated to 10 weeks of specific resistance training for the shoulder , arm , and h and muscles for 3 x 10 minutes per week , or ergonomic training and education ( usual care control group ) .  Pain intensity ( average of shoulder , arm , and h and , scale 0 - 10 ) was the primary outcome , and disability ( Work module of DASH question naire ) as well as isometric shoulder and wrist muscle strength were secondary outcomes . RESULTS Pain intensity , disability , and muscle strength improved more following resistance training than usual care ( P < 0.001 , P = 0.05 , P < 0.0001 , respectively [ corrected ] ) . Pain intensity decreased by 1.5 points ( 95 % confidence interval -2.0 to -0.9 ) following resistance training compared with usual care , corresponding to an effect size of 0.91 ( Cohen 's d ) . LIMITATIONS Blinding of participants is not possible in behavioral interventions . However , at baseline outcome expectations of the 2 interventions were similar . CONCLUSION Resistance training at the workplace results in clinical relevant improvements in pain , disability , and muscle strength in adults with upper limb chronic pain exposed to highly repetitive and forceful manual work . TRIAL REGISTRATION NCT01671267 Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use . Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists . The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments . Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area . Our study investigates the effect of the latter approach . Methods / Design A r and omized controlled trial of 10 weeks duration is currently being conducted . Employed office workers with severe neck-shoulder pain are r and omized to  3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active . Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius . An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work . The first 100 positive replies entered the study . Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0 - 9 scale . Exclusion criteria were cardiovascular disease , trauma , hypertension , or serious chronic disease . Before and after the intervention period the participants replied to a question naire about musculoskeletal disorders and work disability , and underwent a st and ardized clinical examination of the neck and shoulder girdle . Further , on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week . The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination . Secondary outcomes are strength and work disability . Trial Registration Clinical Trials ( NCT ) : OBJECTIVES To identify predictors of non-recovery in non-traumatic complaints at the arm , neck and shoulder in general practice 6 months after the first consultation . METHODS A prospect i ve cohort study was set in 21 Dutch general practice s. Consulters with a first or new episode of non-traumatic arm , neck or shoulder complaints and age 18 through 64 yrs entered the cohort . Complaint , patient , physical , psychosocial and work characteristics were investigated as possible predictors of non-recovery at 6 months using multiple logistic regression analyses ( backward Wald ) . RESULTS At 6 months , 46 % of the total population ( n = 612 ) and 42 % of the working sub population ( n = 473 ) still reported complaints . Complaint characteristics ( long duration of the complaint before consultation , recurrent complaint , musculoskeletal comorbidity and complaint mainly located at wrist or h and ) were most predictive of non-recovery followed by psychosocial characteristics ( more somatization and experiencing less social support ) . Having a specific diagnosis was associated with recovery . In the working sub population , the same variables were predictors of non-recovery . Additionally , low supervisory support was associated with non-recovery . The models correctly classified 72 - 75 % of the patients ( explained variance 0.27 - 0.28 ) . CONCLUSIONS Besides questions on complaint characteristics , information on somatization and support can help a general practitioner to recognize patients at risk of persistent complaints There is limited research on the effects of different types of rest-break interventions for visual display unit ( VDU ) operators on neck and shoulder postures . This study examined the effect of rest-break interventions on the neck and shoulder postures of symptomatic VDU operators during prolonged computer work . Thirty subjects were r and omly and equally assigned to breaks with stretching , breaks with dynamic movement and passive breaks . Subjects performed the typing task for 60 min and received 3-min breaks after 20 min of work . The craniovertebral and forward shoulder angles were obtained from a 3D motion analysis system . Results showed that there were no significant differences in the craniovertebral and forward shoulder angles among any types of rest breaks . It can be concluded that the three types of rest-break interventions had positive effects on neck and shoulder posture during prolonged computer terminal work Background Arm , shoulder and neck symptoms are very prevalent among computer workers . In an attempt to reduce these symptoms , a large occupational health service in the Netherl and s developed a preventive programme on exposure to risk factors , prevalence of arm , shoulder and neck symptoms , and sick leave in computer workers . The purpose of this study was to assess the effectiveness of this intervention programme . Methods The study was a r and omised controlled trial . The participants were assigned to either the intervention group or the usual care group by means of cluster r and omisation . At baseline and after 12 months of follow-up , the participants completed the RSI QuickScan question naire on exposure to the risk factors and on the prevalence of arm , shoulder and neck symptoms . A tailor-made intervention programme was proposed to participants with a high risk profile at baseline . Examples of implemented interventions are an individual workstation check , a visit to the occupational health physician and an education programme on the prevention of arm , shoulder and neck symptoms . The primary outcome measure was the prevalence of arm , shoulder and neck symptoms . Secondary outcome measures were the scores on risk factors for arm , shoulder and neck symptoms and the number of days of sick leave . Sick leave data was obtained from the companies . Multilevel analyses were used to test the effectiveness . Results Of the 1,673 persons invited to participate in the study , 1,183 persons ( 71 % ) completed the baseline question naire and 741 persons participated at baseline as well as at 12-month follow-up . At 12-month follow-up , the intervention group showed a significant positive change ( OR = 0.48 ) in receiving information on healthy computer use , as well as a significant positive change regarding risk indicators for work posture and movement , compared to the usual care group . There were no significant differences in changes in the prevalence of arm , shoulder and neck symptoms or sick leave between the intervention and usual care group . Conclusions The effects of the RSI QuickScan intervention programme were small , possibly as a result of difficulties with the implementation process of the proposed interventions . However , some significant positive effects were found as to an increase in receiving education and a decrease in exposure to adverse postures and movements . With regard to symptoms and sick leave , only small and non-significant effects were found . Trial registration Netherl and s National Trial Register Introduction This study aims to investigate the relationship between work-related physical and psychosocial characteristics and complaints of the neck , shoulder and forearm/h and s. Methods Data were used from a prospect i ve Dutch cohort study among computer office workers with a follow-up period of 2 years . The study was conducted among 264 computer users . Physical and psychosocial risk factors were tested to predict the occurrence of neck , shoulder and forearm/h and s complaints . Bivariate and multivariable logistic regression was used to identify the association between risk factors and outcome variables . Results The 2 year follow-up prevalence rates with 95 % CI for neck complaints were 0.31 ( 0.28–0.37 ) , for shoulder complaints 0.33 ( 0.27–0.39 ) and for forearm/h and s complaints 0.21 ( 0.14–0.28 ) . Four main predictors for the occurrence of neck and shoulder complaints were identified : ( 1 ) Irregular head and body posture [ OR : 1.1 ( 1.0–1.2 ) P = 0.04 ] ; ( 2 ) task difficulty ( job dem and s ) [ OR : 1.2 ( 1.0–1.5 ) P = 0.01 ] ; ( 3 ) number of working hours/day with the computer [ OR : 1.20 ( 1.0–1.4 ) P = 0.03 ] ; and ( 4 ) having had a previous history of complaints [ OR : 7.2 ( 3.8–13.2 ) P = 0.01 ] . Two predictors were identified for forearm/h and s complaints : time pressure ( job dem and s ) [ OR : 1.20 ( 1.0–1.4 ) P = 0.03 ] and having had a previous history of complaints [ OR : 7.1 ( 3.5–14.1 ) P = 0.06 ] . Conclusion This longitudinal study suggests that risk factors of upper musculoskeletal complaints in computer workers consist of a mixture of physical and psychosocial characteristics Musculoskeletal disorders ( MSDs ) affecting the back , upper and lower extremities are widespread in the general population , implying a variety of causal factors . Multiple causes are not mutually exclusive , and a high background rate does not preclude associations with specific factors that are uncommon in the general population . MSDs have well-documented associations with occupational ergonomic stressors such as repetitive motion , heavy lifting , non-neutral postures , and vibration . Organizational features of the work environment , such as time pressure and low decision latitude , may also play a role , at least by potentiating the effects of physical loading . Numerous systematic review s have mostly concurred with these overall findings . Nevertheless , some continue to debate whether MSDs are sometimes work-related , even for those performing jobs with repetitive and routinized tasks , heavy lifting , and /or pronounced postural strain . This article discusses ( 1 ) some epidemiologic features of MSDs that underlie that debate ; and ( 2 ) the question of what should appropriately be considered a gold st and ard for scientific evidence on an etiological question such as the health effects of a non-voluntary exposure , such as an occupational or environmental agent . In particular , r and omized clinical trials have little relevance for determining the health effects of non-therapeutic risk factors Background Neck and upper limb symptoms are frequently reported by computer workers .  Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms . A combined approach targeting work style and lifestyle physical activity seems promising , but little is known on the effectiveness of such combined interventions . Methods / design The RSI@Work study is a r and omised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers . Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and /or the last two weeks are r and omised into three groups : ( 1 ) work style group , ( 2 ) work style and physical activity group , or ( 3 ) control group . The work style intervention consists of six group meetings in a six month period that take place at the workplace , during work time , and under the supervision of a specially trained counsellor . The goal of this intervention is to stimulate workplace adjustment and to improve body posture , the number and quality of breaks and coping behaviour with regard to high work dem and s. In the combined ( work style and physical activity ) intervention the additional goal is to increase moderate to heavy physical activity . The control group receives usual care . Primary outcome measures are degree of recovery , pain intensity , disability , number of days with neck and upper limb symptoms , and number of months without neck and upper limb symptoms . Outcome measures will be assessed at baseline and six and 12 months after r and omisation . Cost-effectiveness of the group meetings will be assessed using an employer 's perspective . Discussion This study will be one of the first to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention in reducing neck and upper limb symptoms of computer workers . The results of the study are expected in 2007 OBJECTIVE To investigate the clinical course and prognostic factors of complaints of arm , neck , and shoulder . STUDY DESIGN AND SETTING A prospect i ve cohort study in physical therapy practice . Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and /or upper extremities . Participants filled in question naires at baseline , 3 months , and 6 months . The main outcome measure was the persistence of complaints over 6-month follow-up . Possible predictors like social and psychological factors , physical factors , and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements . RESULTS Of the 624 participants at baseline 543 ( 87 % ) returned at least one follow-up question naire . At 6-month follow-up , 40 % had persisting pain and discomfort . Somatization , kinesiophobia , catastrophizing , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population . In those with paid work ( 77 % ) , catastrophizing , low decision authority at work , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months . CONCLUSION 40 % of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course Study Design . A combined cross‐sectional and longitudinal design . Objectives . To investigate relation between , on one h and , self‐reported neck‐shoulder symptoms and , on the other h and , low back symptoms and self‐reported work‐related physical load , psychosocial factors , and individual characteristics and to study the influence of physical capacity in adolescence on neck‐shoulder and low back symptoms in adulthood . Summary of Background Data . Heavy physical work and exposure to vibration constitute risk factors for low back problems , and repetitive and static work are risk factors for neck‐shoulder symptoms in many jobs . The interplay between individual factors and work‐related psychosocial and physical exposure , however , is not well documented . This study addresses effects of adolescent capacity on this interplay in a general population . Methods . A r and om sample of 425 Swedish students was investigated when the students were 16 years and 34 years of age . Sixty‐five percent participated in both examinations ; only those who worked ≥ 6 hours/week at the follow‐up period , 148 men and 90 women , were included in these analyses .  Data about musculoskeletal symptoms , work , and sociodemographic and individual characteristics were collected at the age of 34 years ; physical performance data were collected at the ages of 16 years and 34 years . Results . Among the men , self‐employment and worry were associated with neck‐shoulder symptoms ; among the women , monotonous work and high decision latitude were associated with neck‐shoulder symptoms . Low back problems were related to monotonous work among men and women and to exposure to vibration among men . Performance in certain fitness tests at the ages of 16 years and 34 years was negatively associated with musculoskeletal symptoms . Conclusions . The inverse relationships between performance at the age of 16 years and adult musculoskeletal symptoms may imply benefits of early fitness training Abstract Objective : To determine the aetiology of forearm pain . In particular to determine the relative contribution of ( a ) psychological factors , features of somatisation , and health anxiety and behaviour , ( b ) work related mechanical factors , and ( c ) work related psychosocial factors in the onset of forearm pain . Design : 2 year prospect i ve population based cohort study , with retrospective assessment of exposures at work . Setting : Altrincham , Greater Manchester . Participants : 1953 individuals aged 18 - 65 years . Outcome measures : Forearm pain of new onset . Results : At follow up , 105 ( 8.3 % ) participants reported forearm pain of new onset lasting at least one day in the past month . Among these , 67 % also reported shoulder pain , 65 % back pain , and 45 % chronic widespread pain . Increased risks of onset were associated with high levels of psychological distress ( relative risk 2.4 , 95 % confidence interval 1.5 to 3.8 ) , reporting at least two other somatic symptoms ( 1.7 , 0.95 to 3.0 ) , and high scores on the illness behaviour subscale of the illness attitude scales . The two work related mechanical exposures associated with the highest risk of forearm pain in the future were repetitive movements of the arm ( 4.1 , 1.7 to 10 ) or wrists ( 3.4 , 1.3 to 8.7 ) , whereas the strongest work related psychosocial risk was dissatisfaction with support from colleagues or supervisors ( 4.7 , 2.2 to 10 ) . Conclusions : Psychological distress , aspects of illness behaviour , and other somatic symptoms are important predictors of onset of forearm pain in addition to work related psychosocial and mechanical factors . Misleading terms such as “ cumulative trauma disorder ” or “ repetitive strain injury , ” implying a single uniform aetiology , should be avoided Objectives Complaints of the arms , neck , and shoulders in general and computer-related disorders in particular affect many office workers in economically developed countries . However , with the increased use of computer systems in developing countries , the associated musculoskeletal symptoms and risk factors are yet to be investigated . The study investigates the relationship between work-related physical and psychosocial characteristics and symptoms of the arms , neck , and shoulders in an African economically developed worksite . Methods A prospect i ve cohort study with 1-year follow-up was conducted . Data were used from 250 computer office workers in Khartoum , Sudan . Data were collected using the Arabic version of the Maastricht Upper Extremity Question naire . Prevalence rates for symptoms were calculated and the categories of risk factors being evaluated consisted of physical , psychological , and individual risk factors . Multivariable logistic regression analysis was used to identify risk factors associated with complaints that were expressed as odds ratios ( ORs ) with 95 % confidence intervals ( CIs ) . Results The 1-year follow-up prevalence rate was 0.63 ( 95 % CI : 0.58 - 0.70 ) for neck symptoms , 0.56 ( 95 % CI : 0.45 - 0.66 ) for shoulder symptoms , and 0.46 ( 95 % CI : 0.42 - 0.59 ) for symptoms of the forearms/h and s. Three main risk factors were significantly associated with the presence of symptoms : ( 1 ) time pressure [ OR : 1.31 ( 1.00 to 1.90 ) P=0.05 ] , ( 2 ) task difficulty [ OR : 1.85 ( 1.73 to 1.99 ) P=0.03 ] , and ( 3 ) previous history of symptoms [ OR : 4.62 ( 2.20 to 9.35 ) P=0.01 ] . Conclusions The targeted office workers in Sudan are reporting symptoms in the neck , shoulders , and forearms . Work-related psychological factors predicted more significantly the presence of symptoms in the targeted population BACKGROUND The aim of the present study is to explore factors affecting or modifying self-reported neck/shoulder pain in sewing machine operators . METHODS We investigated self-report neck/shoulder pain in 247 workers who participated in a 4-month prospect i ve intervention study for musculoskeletal disorders . All participants were immigrants . We examine the influence of individual and work-related factors on changes in neck/shoulder pain during follow-up employing linear mixed models with time-spline functions . RESULTS We observed a dramatic decline ( 72 % ) in self-reported pain intensity in the first month of follow-up , followed by a small increase from the first to fourth month ( 4 % per month ) . Workers who perceived and reported their physical workload as high or worked overtime experienced less overall pain reduction . Higher baseline pain intensity , being of Hispanic ethnicity ( vs. Asian ) , and taking cumulative daily rest time during work of 35 min or more allowing for muscles to rest were associated with a larger pain reduction in the first month , but not thereafter . CONCLUSION Our findings indicate that some work-related factors may be of clinical relevance for reducing neck/shoulder pain . Having lower physical workloads and less overtime work should be considered when treating patients or planning workplace interventions for managing work-related musculoskeletal disorders in this underserved immigrant population & NA ; The objective of our prospect i ve inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash‐associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident . The study was carried out in a primary health care setting in The Netherl and s and included 125 patients . The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use . The secondary outcome measures included neck pain intensity , work disability and sick leave . The outcomes were assessed at 4 , 12 and 52 weeks after the accident . Prognostic factors were identified by logistic regression analyses . One year after the injury , 64 % of the patients were recovered . Factors related to poor recovery were female gender , a low level of education , high initial neck pain , more severe disability , higher levels of somatisation and sleep difficulties . Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery . The accuracy of the predictions of the prognostic models was high , meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered . These findings add to the growing body of evidence , indicating that socio‐demographic , physical and psychological factors affect short‐ and long‐term outcome after whiplash injury . Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work‐related activities A joint study was conducted by a manufacturer of dental stools in the Midwest of the United States and Marquette University to measure the occupational postures of dentists and dental hygienists . The postures of 10 dentists and 10 dental hygienists were assessed using work sampling and video techniques .  Postural data of the neck , shoulders and lower back were recorded from video and categorized into 30-degree intervals : o ( neutral posture of respective joint ) , 30 , 60 and 90 degrees . Each subject 's postures were observed while they were treating patients during a four-hour period , during which 100 observations of postures were recorded at r and om times . Compared to st and ing , dentists and dental hygienists were seated 78 percent and 66 percent of the time , respectively . Dentists and dental hygienists flexed their trunk at least 30 degrees more than 50 percent of the time . They flexed their neck at least 30 degrees 85 percent of the time during the four-hour duration , and their shoulders were elevated to the side of their trunk ( abducted ) at least 30 degrees more half of the time . The postures of the trunk , shoulders , and neck were primarily static . This data base of postures can be used by dental professionals and ergonomists to assess the risk dentists and dental hygienists are exposed to musculoskeletal disorders , such as low back pain or shoulder tenosynovitis , from deviated joint postures . They could use these data to select dental furniture or dental devices that promote good body posture , i.e. , reduce the magnitude and duration of deviated joint postures , which , in theory , would decrease the risk of musculoskeletal disorders OBJECTIVES : To determine , in a population based study , the influence of occupational factors on the occurrence of  shoulder pain and disability .  METHODS : A r and om sample of patients was selected from the register of a general practice in the Greater Manchester area of the United Kingdom . Information was collected by a posted question naire with specific enquiries about symptoms in the shoulder region and related disability . A lifetime occupational history was obtained including physical exposures , working conditions , and psychosocial aspects of each workplace . Analysis has been conducted as a case-control study , comparing occupational exposures at the time of onset of symptoms in those with shoulder pain and disability with corresponding occupational exposures in those without shoulder pain and disability . RESULTS : An increased risk of shoulder pain and disability in men  was associated with carrying weights on one shoulder ( relative risk ( RR ) 5.5 , 95 % confidence interval ( 95 % CI ) 1.8 to 17 ) , whereas those who reported working with h and s above shoulder level , using wrists or arms in a repetitive way , or stretching down to reach below knee level had about twice the risk of shoulder pain and disability .  Men working frequently in very cold or damp conditions had a fourfold and sixfold risk respectively of shoulder pain and disability . Reporting of shoulder pain and disability was also more common among men and women who reported that their work caused a lot of stress ( RR 1.9 , 95 % CI 0.9 to 4.1 ) or was very monotonous ( RR 2.7 , 95 % CI 1.3 to 5.4 ) . The relations between physical exposures , working conditions , and psychosocial factors were independent . CONCLUSIONS : This population based study has shown that physical activities carried out at work , the physical conditions under which the work is conducted , psychosocial aspects of work , or the working environment are all independently related to the occurrence of shoulder symptoms and disability , emphasising the multifactorial nature of this condition OBJECTIVE Imbalance between work dem and s and individual re sources can lead to musculoskeletal disorders and reduced work ability . The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability . METHODS Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were r and omly allocated to 10 weeks of either strength training for the shoulder , arm , and h and muscles ( 3 times per week , 10 minutes per session ) or ergonomic training ( usual care control group ) from September to December 2012 . The outcome measure was the change from baseline to 10-week follow-up in the work ability index ( WAI ) . RESULTS A priori hypothesis testing showed a group × time interaction for WAI ( P<0.05 ) . Compared with the ergonomic training group , WAI increased 2.3 [ 95 % confidence interval ( 95 % CI ) 0.9 - 3.7 ] in the strength training group corresponding to a moderate effect size ( Cohen 's d 0.52 ) . Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group . Of the 7 items of WAI , item 2 ( work ability in relation to the dem and s of the job ) and item 7 ( mental re sources ) increased following strength training compared with ergonomic training ( P<0.05 ) . CONCLUSIONS Implementation of strength training at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks . Thus , strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se Study Design . Prospect i ve cohort study . Objective . To investigate the consequences of neck pain after motor vehicle accidents in terms of disability for work and the relationship this has with symptom and work-related factors . Summary of Background Data . Previous studies on work disability related to whiplash are very heterogeneous , are often limited in sample size and show a wide variability in terms of results . A relationship has been suggested between poor recovery from or persistent work disability after whiplash and female gender , older age , marital status , heavy manual work , self-employment , prior psychological problems , subjective complaints of poor concentration , pain catastrophizing , and kinesiophobia . Methods . Individuals with neck complaints after involvement in traffic accidents , who initiated compensation cl aim procedures with a Dutch insurance company ( n = 879 ) , were sent question naires ( Q1 ) concerning the accident , the injuries that they had sustained , their complaints at that time , and questions regarding work and disability . The course of complaints and work disability was monitored at 6 ( Q2 ) and 12 months ( Q3 ) after the accident . Results . A total of 58.8 % of the population with neck complaints studied was work-disabled after the accident . Age and impaired concentration complaints after 1 month were found to be related to work disability at 1 year , independent of physical complaints and work characteristics . Conclusion . Age and concentration complaints were important independent predictors of long-lasting work disability , whereas no evidence emerged to indicate that the degree of manual labor ( blue or white collar work ) or educational level was involved in persistent work disability in postwhiplash syndrome . The current results suggest that work disability could benefit most from interventions related to recovery from cognitive complaints and less from physically related interventions Objective : To investigate the effects of ambulant myofeedback training including ergonomic counselling ( Mfb ) and ergonomic counselling alone ( EC ) , on work-related neck-shoulder pain and disability .  Methods : Seventy-nine female computer workers reporting neck-shoulder complaints were r and omly assigned to Mfb or EC and received four weeks of intervention . Pain intensity in neck , shoulders , and upper back , and pain disability , were measured at baseline , immediately after intervention , and at three and six months follow-up . Results : Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC , and the effects remained at follow up . No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability . Conclusions : Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up . No differences were observed between the two intervention groups Abstract Objectives : To investigate in patients with repetitive strain injury ( RSI ) and in office workers using computer keyboard equipment  ( a ) whether the vibration threshold in the h and was altered , ( b ) the immediate effects of keyboard use on vibration thresholds and ( c ) whether the tolerance of suprathreshold vibration was normal . Method : A vibrametre ( Somedic Ab , Stockholm Sweden ) was used to obtain threshold vibration measurements , by the method of limits , for all peripheral-nerve cutaneous distributions in the h and . Tolerance of suprathreshold stimulation was obtained by stimulation of the soft tissues of the forearm by increasing the amplitude of vibration . Results : Thresholds for vibration were significantly raised for the median nerve in both the patient and office-worker groups . The patient group additionally had raised thresholds for the ulnar nerve . Following use of the keyboard , thresholds for the median nerve were further elevated in the patient group , but not in the other groups , demonstrating a work-related exacerbation . At suprathreshold stimulation , 14 members ( 82 % ) of the patient group experienced an allodynic response to vibration , indicating possible changes in the central processing of non-noxious sensory information . This changed sensory response was not seen in either the office-worker or control groups . Conclusion : Patients may have a minor polyneuropathy , whereas the office workers demonstrate early signs of the condition . Quantitative measurement of vibration perception may prove useful in patient assessment and for detection of the early onset of RSI in the work environment Objectives Knowledge regarding the working mechanism of an intervention is essential for obtaining a better underst and ing of the intervention and contributes to optimize its outcome . This study aim ed at investigating whether changes in cognitive-behavioral factors and muscle activation patterns after myofeedback training and ergonomic counseling were associated with outcome , in subjects with work-related musculoskeletal neck-shoulder complaints . Methods Seventy-nine symptomatic subjects received either myofeedback with ergonomic counseling ( Mfb/EC ) or ergonomic counseling alone ( EC ) . Outcome measures discomfort and disability , and process factors catastrophizing , pain control , fear-avoidance beliefs , and muscle activation patterns were assessed at baseline , after the interventions ( T0 ) , and at 3 months follow-up ( T3 ) . Mixed modeling techniques were used for analysis . Results Outcome in terms of discomfort and disability was generally comparable between both interventions . Catastrophizing was significantly reduced and fear-avoidance beliefs about work slightly increased after the interventions , but no consistent changes in muscle activation patterns were observed . Changes in discomfort were especially associated with changes in catastrophizing at T0 and T3 , but R2 was low ( < 0.14 ) . Reduced catastrophizing at T0 and T3 , and also reduced fear-avoidance beliefs about work at T3 , were related to reduced disability ( R2 between 0.30 and 0.40 ) . No differences between the two intervention groups were observed . Conclusions Intervention effects were generally non-specific and findings suggested that cognitive-behavioral factors underlie the outcome of these interventions rather than changes in muscle activation patterns . Emphasizing these factors during therapy may increase the beneficial outcome of occupational interventions BACKGROUND Submaximal eccentric exertions occur occupationally when rapidly rising tool-generated forces exceed the operator 's capacity to react against them . The purpose of this study was to investigate the effects of short duration repetitive submaximal eccentric forearm exertions at levels comparable to industrial power h and tool use on dynamic mechanical properties ( stiffness , effective mass and damping ) and on forearm edema . METHODS This study investigated changes following short term repetitive submaximal eccentric exertions comparable to occupational levels . Eight male participants  exercised eccentrically for 30 min at 50 % of isometric maximum voluntary contraction forearm supination in a posture and loading similar to power h and tool use in the workplace . Dynamic mechanical properties ( stiffness , effective mass and damping ) of the upper limb were measured before , immediately following , and daily for three days after the activity . An MRI scan to assess edema was also performed for five of the participants before , on day one and day three following the activity . FINDINGS Mechanical stiffness decreased 51 % ( P < 0.05 ) and effective mass decreased 43 % ( P = 0.052 ) immediately following eccentric exercise .  Average isometric strength also decreased 42 % immediately following exercise ( P < 0.01 ) and pain persisted for two days . The recovery of static strength however was not correlated with changes in mechanical stiffness ( r = 0.56 ) or effective mass ( r = 0.30 ) . The exercised arms had a 360 % increase ( P < 0.01 ) in supinator-extensor T(2 ) relaxation time difference , a quantifiable measure of edema , one day after exercise while the non-exercised arms had no significant changes . INTERPRETATION Changes in both T(2 ) relaxation time , indicative of edema , and forearm mechanical properties , were observed following short duration submaximal repetitive exercise . If similar changes in dynamic mechanical properties of the upper extremity occur following repetitive submaximal eccentric activity in the workplace , they could negatively impact the ability of the arm to react to rapid forceful loading during repetitive industrial work activities and increase mechanical loading of the upper limb Background The costs of arm , shoulder and neck symptoms are high . In order to decrease these costs employers implement interventions aim ed at reducing these symptoms . One frequently used intervention is the RSI QuickScan intervention programme . It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile . The purpose of this study was to perform an economic evaluation , from both the societal and companies ' perspective , of the RSI QuickScan intervention programme for computer workers . In this study , effectiveness was defined at three levels : exposure to risk factors , prevalence of arm , shoulder and neck symptoms , and days of sick leave . Methods The economic evaluation was conducted alongside a r and omised controlled trial ( RCT ) . Participating computer workers from 7 companies ( N = 638 ) were assigned to either the intervention group ( N = 320 ) or the usual care group ( N = 318 ) by means of cluster r and omisation ( N = 50 ) . The intervention consisted of a tailor-made programme , based on a previously established risk profile . At baseline , 6 and 12 month follow-up , the participants completed the RSI QuickScan question naire . Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle . To compare costs between groups , confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping . Results The mean intervention costs , paid by the employer , were 59 euro per participant in the intervention and 28 euro in the usual care group . Mean total health care and non-health care costs per participant were 108 euro in both groups . As to the cost-effectiveness , improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs . With regard to the other risk factors , symptoms and sick leave , only small and non-significant effects were found . Conclusions In this study , the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies ' perspective and , therefore , this study does not provide a financial reason for implementing this intervention . However , with a relatively small investment , the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement . Trial registration Trial registration number : 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 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 Study Design . One-year prospect i ve study of 141 acute whiplash patients ( WLP ) and 40 acute ankle-injured controls . Objective . This study investigates a priori determined potential risk factors to develop a risk assessment tool , for which the expediency was examined . Summary of Background Data . The whiplash-associated disorders ( WAD ) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors , for example , risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed . Methods . Consecutively , 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week , 1 , 3 , 6 , and 12 months obtaining neck/head visual analog scale score , number of nonpainful complaints , epidemiological , social , psychological data and neurological examination , active neck mobility , and furthermore muscle tenderness and pain response , and strength and duration of neck muscles . Risk factors derived ( reduced cervical range of motion , intense neck pain/headache , multiple nonpain complaints ) were applied in a risk assessment score and divided into seven risk strata . Results . A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90 . Risk strata and number of sick days showed a log-linear relationship . In stratum 1 full recovery was encountered , but for high-risk patients in stratum 6 only 50 % and 7 only 20 % had returned to work after 1 year ( P < 5.4 × 10−5 ) . Strength measures , psychophysical pain measurements , and psychological and social data ( reported elsewhere ) showed significant relation to risk strata . Conclusion . The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury . It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries OBJECTIVES A program called the Project on Research and Intervention in Monotonous Work ( PRIM ) was initiated in 1994 as a prospect i ve cohort study of work-related musculoskeletal disorders . The group-based exposure assessment strategy , focusing on task-related exposure and used to obtain baseline measures of physical exposures , is reported in this paper . METHODS Monotonous , repetitive worktasks were evaluated at 19 factories . Tasks with an estimated similarity in physical exposure were aggregated before 103 exposure groups were formed . Subjects from the exposure groups were r and omly sample d for measurements , and task-related exposure levels were quantified by 43 single exposure items using a real-time video-based observation method that allowed computerized estimates of repetitiveness , body postures , force , and velocity . In combination with question naire-based data on task distribution , the duration of exposure was calculated at the individual level . RESULTS The video-based observational method and the large number of exposure variables enabled the establishment of detailed quantitative exposure profiles in 103 task-based exposure groups . However , method ological problems associated with the use of grouped exposure assessment were revealed . Despite efforts to optimize group homogeneity , the within-group variance was larger than the between-group variance for several shoulder postural variables . CONCLUSIONS A task-based exposure- assessment strategy can be successful in solving some of the main problems associated with the assessment of physical workplace exposures . The large within-group variance in exposure to nonneutral shoulder postures may eventually require individual assessment or the inclusion of groups with maximal contrast in exposure or both The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey . A question naire was mailed to 21,201 subjects aged 16 - 64 years , selected at r and om from the registers of 34 British general practice s. Information was collected on occupation and on regular use of keyboards ( for > 4 h in an average working day ) , pain in the upper limbs and neck , numbness or tingling in the upper limbs , headaches , and feelings of tiredness or stress . Associations were explored by logistic regression , with the result ant odds ratios converted into prevalence ratios ( PRs ) . Among 12,262 respondents , 4899 held non-manual occupations . These included 1871 regular users of keyboards ( e.g. computer operators , data processors , clerks , administrators , secretaries and typists ) .  Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall ( with 1 week period prevalences of 30 and 15 % , respectively ) , and were associated with older age , smoking , headaches and tiredness or stress . After adjustment for these factors , regular keyboard use was significantly associated with pain in the past week in the shoulders ( PRs 1.2 - 1.4 ) and the wrists or h and s ( PR 1.4 ) , but not with elbow pain or sensory symptoms over the same period , or with neck or upper limb pain that prevented normal activities in the past year . Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers . We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or h and , but risk estimates were lower than generally reported in workplace surveys . Previous estimates of risk in the occupational setting may have been biased by shared expectations , concerns , or other aspects of illness behaviour OBJECTIVES This study concerned the influence of 6 positions of the computer mouse on the work table on posture , muscular load , and perceived exertion during text editing . METHODS An optoelectronic 3-dimensional motion analysis system was used to register the postures of 10 men and 10 women using  video display units . Muscular load was also registered ( with electromyography ) , as was perceived exertion ( with rating scales ) . RESULTS A neutral posture with a relaxed and supported arm showed the least perceived exertion , and the electromyographic results showed low activity in both trapezius muscles in this position . Short operators ( all women ) showed a numerically higher activity in the 4 examined muscles than the tall operators ( all men , except 1 ) . This finding could be related to lower muscle force among women and to anthropometric differences , which also influence biomechanic load moments . Narrow-shouldered operators ( 8 women and 1 man ) and short operators worked with larger outward rotation and abduction of the shoulder in a position of the mouse lateral to the keyboard than the broad-shouldered ( 7 men and 2 women ) and tall operators did . Arm support markedly reduced muscle load in the neck-shoulder region among the operators . CONCLUSIONS The operators using video display units in this study preferred to use the mouse on a table in a close to relaxed , neutral posture of the arm in combination with arm support . Short and narrow-shouldered operators worked in more strenuous postures of the arm when the mouse was located lateral to the keyboard OBJECTIVES This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks Background Shoulder pain is common in primary care , and has an unfavourable outcome in many patients . Information about predictors of shoulder pain related sick leave in workers is scarce and inconsistent . The objective was to develop a clinical prediction rule for calculating the risk of shoulder pain related sick leave for individual workers , during the 6 months following first consultation in general practice . Methods A prospect i ve cohort study with 6 months follow-up was conducted among 350 workers with a new episode of shoulder pain . Potential predictors included the results of a physical examination , sociodemographic variables , disease characteristics ( duration of symptoms , sick leave in the 2 months prior to consultation , pain intensity , disability , comorbidity ) , physical activity , physical work load , psychological factors , and the psychosocial work environment . The main outcome measure was sick leave during 6 months following first consultation in general practice . Results Response rate to the follow-up question naire at 6 months was 85 % . During the 6 months after first consultation 30 % ( 89/298 ) of the workers reported sick leave . 16 % ( 47 ) reported 10 days sick leave or more . Sick leave during this period was predicted in a multivariable model by a longer duration of sick leave prior to consultation , more shoulder pain , a perceived cause of strain or overuse during regular activities , and co-existing psychological complaints . The discriminative ability of the prediction model was satisfactory with an area under the curve of 0.70 ( 95 % CI 0.64–0.76 ) . Conclusion Although 30 % of all workers with shoulder pain reported sick leave during follow-up , the duration of sick leave was limited to a few days in most workers . We developed a prediction rule and a score chart that can be used by general practitioners and occupational health care providers to calculate the absolute risk of sick leave in individual workers with shoulder pain , which may help to identify workers who need additional attention . The performance and applicability of our model needs to be tested in other working population s with shoulder pain to enable valid and reliable use of the score chart in everyday practice 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 Objectives . This study investigated long-term effects and implementation processes of workplace strength training for musculoskeletal disorders . Methods . 333 and 140 laboratory technicians from private and public sector companies , respectively , replied to a 3-year follow-up question naire subsequent to a 1-year r and omized controlled trial ( RCT ) with high-intensity strength training for prevention and treatment of neck , shoulder , and arm pain . Being a natural experiment , the two participating companies implemented and modified the initial training program in different ways during the subsequent 2 years after the RCT . Results . At 3-year follow-up the pain reduction in neck , shoulder , elbow , and wrist achieved during the first year was largely maintained at both companies . However , the private sector company was rated significantly better than the public sector company in ( 1 ) training adherence , ( 2 ) training culture , that is , relatively more employees trained at the workplace and with colleagues , ( 3 ) self-reported health changes , and ( 4 ) prevention of neck and wrist pain development among initially pain-free employees . Conclusions . This natural experiment shows that strength training can be implemented successfully at different companies during working hours on a long-term basis with lasting effects on pain in neck , shoulder , and arm Objective : The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain . Methods : Sixty female subjects were r and omly assigned to an intervention group or a control group . The IG was administered of a 6-month , twice-a-week , tailored exercise program , whereas the CG received no intervention . Results : The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures . In addition , reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength . Conclusions : This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders , showing clinical ly meaningful reductions of pain symptoms and disability on upper limb and neck regions UNLABELLED We previously published the results of a controlled trial that showed the efficacy of a workplace educational and physical program in reducing  headache , and neck and shoulder pain . Participants recorded daily  pain episodes in diaries ; after 2 months of baseline observation , the program was administered to the intervention arm only , and comparison with the control arm was performed at month 8 . The objective of the present study was to confirm the long-term ( 14 months from the beginning of the study ) benefit of the program in the intervention arm of the study ( 192 office employees ) . Outcome measures of the present analyses were : 1 ) the number of days/month with headache , and neck and shoulder pain ; 2 ) the frequency of days with analgesic drug consumption ; 3 ) the proportion of subjects with 4 or more days/month with headache or neck and shoulder pain at baseline who achieved a > or = 50 % reduction in pain ( responder rate ) . Days/month with headache decreased from 5.50 at baseline ( months 1 - 2 ) to 3.11 at months 13 - 14 ( P < .001 ) ; from 6.79 to 3.88 ( P < .001 ) for neck and shoulder pain ; and from 1.72 to 0.86 ( P < .001 ) for analgesic consumption . Responder rates were 58.8 % ( 95%CI = 47.1 - 70.5 ) for headache , 60.9 % ( 49.4 - 72.4 ) for neck and shoulder pain , and 68.2 % ( 48.7 - 87.6 ) for drug consumption . These results confirm that the program may be effective at long term . PERSPECTIVE This article presents the results at long term of an educational and physical program in reducing headache , and neck and shoulder pain , in a working community . Since the benefits remained stable for a considerable period of time , a r and omized trial is ongoing to confirm these results on a larger , less-selected working population A group of routine data entry operators ( female ) was included in the Polish MEPS ( musculoskeletal — eyestrain— psychosocial — stress ) study . Before the intervention , ergonomic assessment revealed improper working conditions such as inadequate lighting , uncomfortable chairs , and lack of forearm and wrist support while medical examination revealed that trapezius muscle load along with upper arm , head and back angles were higher than advisable . Subjects complained about neck and shoulder pain , visual problems , and psychosocial conditions . The ergonomic intervention included installation of new luminaires and Venetian blinds , new chairs , repair of ventilators , and optometric corrections . The results after the intervention showed mainly improvement in chair comfort , lighting conditions , visual strain , and sitting posture . However , financial limitations did not allow satisfactory completion of the intervention leading to a mixed interpretation of the results Body-worn inertial sensors have enabled motion capture outside of the laboratory setting . In this work , an inertial measurement unit was attached to the upper arm to track and discriminate between shoulder motion gestures in order to help prevent shoulder over-use injuries in athletics through real-time preventative feedback . We present a detection and classification approach that can be used to count the number of times certain motion gestures occur . The application presented involves tracking baseball throws and volleyball serves , which are common overhead movements that can lead to shoulder and elbow overuse injuries . Eleven subjects are recruited to collect training , testing , and r and omized validation data , which include throws , serves , and seven other exercises that serve as a large null class of similar movements , which is analogous to a realistic usage scenario and requires a robust estimator BACKGROUND To compare risk factors for shoulder pain without and with rotator cuff syndrome ( RCS ) . METHODS A total of 3,710 workers of a French region were r and omly included in the cross-sectional study between 2002 and 2005 .  Personal and occupational risk factors were assessed during a physical examination and by a self-administered question naire . Multinomial logistic modeling was used for the following outcomes : no shoulder pain and no RCS ( reference ) , shoulder pain without RCS ( called " shoulder pain " ) and RCS , separately for men and women . RESULTS The prevalence rates of " shoulder pain " for men and women were 28.0 % and 31.1 % , respectively , and the prevalence rates of RCS were 6.6 % and 8.5 % , respectively . In men , " shoulder pain " and RCS were associated with age , high-perceived physical exertion , and arm abduction . Automatic work pace and low supervisor support were associated with " shoulder pain , " and high psychological dem and and low skill discretion with RCS . In women , " shoulder pain " and RCS were associated with age , repetitiveness of tasks , and low supervisor support . High perceived physical exertion and exposure to cold temperatures were associated with " shoulder pain . " CONCLUSIONS Age was more strongly associated with RCS than with shoulder pain without RCS for both genders . Biomechanical and psychosocial factors were associated with " shoulder pain " and RCS and differed between genders The effects of Ergorest ® arm supports on wrist angles and musculoskeletal strain in the neck-shoulder-arm region and electrical activity in the shoulder and arm muscles were studied during typing or the use of the mouse in work with a visual display unit ( VDU ) . Twenty-one women were r and omized into 3 groups ( 1 arm support , 2 arm supports , and control ) . Measurements were carried out before and after the 6-week intervention . The wrist extension of the mouse h and , the muscle activity of the trapezius muscle , and the subjective discomfort ratings indicated that 2 arm supports were better than 1 in work with a mouse . The Ergorest ® arm support alleviates muscle and joint strain in VDU work when used for both arms Study Design . This is a 4-month r and omized controlled trial to evaluate the effect of chair design on neck/shoulder pain  among sewing machine operators . Objective . Determine whether a chair with a curved seat pan leads to improved changes in monthly neck/shoulder pain scores compared with a control intervention . Summary of Background Data . Sewing machine operators experience a high prevalence and severity of neck and shoulder pain in comparison to other working population s probably due to the sustained shoulder abduction and neck and upper back flexion required of the task . An adjustable height task chair that supports a forward sitting posture may reduce these posture-related risk factors and reduce neck/shoulder pain . Material s and Methods . A total of 277 sewing machine operators with neck/shoulder pain were assigned to receive 1 ) miscellaneous items ( control group ) , 2 ) a chair with a flat seat pan plus miscellaneous items , or 3 ) a chair with a curved seat pan plus miscellaneous items . Participants completed a monthly question naire assessing neck/shoulder pain severity . Results . Based on estimates of pain score changes from a repeat- measures linear regression , participants who received the flat seat chair experienced a decline in pain of 0.14 ( 95 % confidence interval , 0.07–0.22 ) points per month compared with those in the control group , while those who received the curved seat experienced a decline of 0.34 ( 95 % confidence interval , 0.28–0.41 ) points per month compared with those in the control group . These estimates did not change after adjustment for potential covariates . Conclusions . These findings demonstrate that an adjustable height task chair with a curved seat pan can reduce neck and shoulder pain severity among sewing machine operators The purpose of this study was to describe , and analyse the effect of an intervention on , the biomechanical workload in the neck and shoulder region of female hairdressers . Arm elevation was measured by inclinometers and muscular load of m. trapezius by electromyography . The intervention comprised working technique recommendations , e.g. to work with less elevated arms and more relaxed muscles . The subjects were r and omised between two different intensity levels of the intervention , one with written information only and the other with additional personal follow-up . The effect of the intervention was evaluated after 1 - 2 months . The hairdressers worked with their arms elevated 60 degrees or more for approximately 13 % of the total working time and 16 % during the specific hairdressing tasks . The intervention group including personal follow-up instructions had a reduction in workload from 4.0 % to 2.5 % of hairdressing time with highly elevated right upper arm , i.e. above 90 degrees . No effect was detected on muscular load or neck and shoulder symptoms after the intervention This paper review s the ergonomic and psychosocial factors that affect musculoskeletal disorders at the workstation . First is a model of a physiological assessment protocol that incorporated SEMG monitoring while working at the computer . Next is a study that showed that participants lack awareness of their muscle tension as compared to the actual SEMG levels . The final study illustrated how an intervention program can reduce RSI symptoms , decrease respiration rate , and lower SEMG activity . Recommendations include suggestions that successful safety and prevention programs need multiple components and that participants should to be trained to control physiological responses with respiration and SEMG biofeedback . All participants should master these physiological skills just as they learn how to use the computer 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 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 Neck and shoulder disorders are a considerable health problem amongst frequent microscope users . We aim ed to investigate the neck and shoulder discomfort experienced during prolonged microscopic activity and to assess the benefits of minibreaks . A prospect i ve crossover study was performed on 17 healthy volunteers sitting still while looking down a bench with and without the Ipswich Microbreak Technique ( IMT ) .  We used a subjective measure of time to fatigue and pain in the neck and shoulder regions as well as objective readings from a surface electromyogram ( sEMG ) . The IMT delayed the sensation of pain in the neck and shoulder region while reducing the overall sEMG muscle activation . In conclusion , IMT is a useful strategy in reducing and delaying the pain in neck and shoulder from prolonged working under the microscope . This technique can be incorporated in other activities that involve a sustained stationary position OBJECTIVE To investigate the course of lateral epicondylitis and identify prognostic indicators associated with short- and longterm outcome of pain intensity . METHODS We prospect ively followed patients ( n = 349 ) from 2 r and omized controlled trials investigating conservative interventions for lateral epicondylitis in primary care .  Uni- and multivariate linear regression analyses were used to investigate the association between potential prognostic indicators and pain intensity ( 0 - 100 point scale ) measured at 1 , 6 , and 12 months after r and omization . Potential prognostic factors were duration of elbow complaints , concomitant neck pain , concomitant shoulder pain , previous elbow complaints , baseline pain scores , age , gender , involvement of dominant side , social class , and work status . The variables " study " and " treatment " were included as covariates in all models . RESULTS Pain scores at 1 month followup were higher in patients with severe pain  , a long duration of elbow complaints , and concomitant shoulder pain .  At 12 month followup , the only different prognostic indicator for poor outcome was concomitant neck pain , in place of shoulder pain . Patients from higher social classes reported lower pain scores at 12 month followup than patients from lower social classes . CONCLUSIONS Lateral epicondylitis seems to be a self-limiting condition in most patients . Long duration of elbow complaints , concomitant neck pain , and severe pain at presentation are associated with poor outcome at 12 months . Our results will help care providers give patients accurate information regarding their prognosis and assist in medical decision-making Background Insomnia and work-related stress often co-occur . Both are associated with personal distress and diminished general functioning , as well as substantial socio-economic costs due to , for example , reduced productivity at the work place and absenteeism . Insomnia complaints by people experiencing work-related stress are correlated with a deficient cognitive detachment from work . Diffuse boundaries between work and private life can additionally complicate the use of recreational activities that facilitate cognitive detachment . Cognitive behavioral therapy for insomnia is effective but rarely implemented . Internet-based cognitive behavioral therapy for insomnia could potentially reduce this deficit given its demonstrated effectiveness . Less is known , however , about the efficacy of internet-based cognitive behavioral therapy for insomnia in population s affected by high work stress . Thus , the aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed , guided online training which is based on Cognitive Behavioral Therapy for insomnia and tailored to teachers affected by occupational stress . Methods / Design In a two-arm r and omized controlled trial ( N = 128 ) , the effects of a guided online sleep training will be compared to a waitlist-control condition .  German teachers with significant clinical insomnia complaints ( Insomnia Severity Index ≥15 ) and work-related rumination ( Irritation Scale , subscale Cognitive Irritation ≥15 ) will be included in the study . The primary outcome measure will be insomnia severity . Additionally , an economic evaluation from a societal perspective will be conducted . Data from the intention-to-treat sample will be analyzed two and six months after r and omization . Discussion To the best of our knowledge , this is the first study to evaluate an online sleep training tailored to a specific population with work stress , that is , teachers . If this type of intervention is effective , it could reduce the paucity of cognitive behavioral therapy for insomnia and augment the support for teachers in coping with their insomnia problems . Trial registration German Clinical Trial Register The effects of two different prevention programmes on : ( 1 ) reported neck , shoulder and back pain , ( 2 ) perceived physical exertion at work and perceived work-related psychosocial factors , were evaluated by question naires after 12 and 18 months . Female nursing aides and assistant nurses ( n = 282 ) working in the home-care services , were r and omly assigned to one of three groups for : ( 1 ) individually design ed physical training programme , ( 2 ) work-place stress management , ( 3 ) control group . Results revealed no significant differences between the three groups . However , improvements in low back pain were registered within both intervention groups for up to 18 months . Perceived physical exertion at work was reduced in the physical training group . Improvements in neck and shoulder pain did not differ within the three groups . Dissatisfaction with work-related , psychosocial factors was generally increased in all groups . As the aetiology of neck , shoulder and back disorders is multifactorial , a combination of the two intervention programmes might be preferable and should be further studied Background : Repetitive or sustained elevated shoulder postures have been identified as a significant risk factor for occupationally related shoulder musculoskeletal disorders . Construction workers exposed to routine overhead work have high rates of shoulder pain that frequently progresses to functional loss and disability . Exercise interventions have potential for slowing this progression . Aims : To evaluate a therapeutic exercise programme intended to reduce pain and improve shoulder function . Methods : Construction worker volunteers were screened by history and clinical examination to test for inclusion /exclusion criteria consistent with shoulder pain and impingement syndrome . Sixty seven male symptomatic workers ( mean age 49 ) were r and omised into a treatment intervention group ( n = 34 ) and a control group ( n = 33 ) ; asymptomatic subjects ( n = 25 ) participated as an additional control group . Subjects in the intervention group were instructed in a st and ardised eight week home exercise programme of five shoulder stretching and strengthening exercises . Subjects in the control groups received no intervention . Subjects returned after 8–12 weeks for follow up testing . Results : The intervention group showed significantly greater improvements in the Shoulder Rating Question naire ( SRQ ) score and shoulder satisfaction score than the control groups . Average post-test SRQ scores for the exercise group remained below levels for asymptomatic workers . Intervention subjects also reported significantly greater reductions in pain and disability than controls . Conclusions : Results suggest a home exercise programme can be effective in reducing symptoms and improving function in construction workers with shoulder pain Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use .  Specific strength training is a promising type of physical exercise for relieving  neck and shoulder pain in office workers . However , the optimal combination of frequency and exercise duration , as well as the importance of exercise supervision , is unknown . The VIMS study investigates in a cluster r and omized controlled design the effectiveness of different time wise combinations of specific strength training with identical accumulated volume , and the relevance of training supervision for safe and effective training . Methods / design A cluster r and omized controlled trial of 20 weeks duration where employed office workers are r and omized to 1 × 60 min , 3 × 20 min , 9 × 7 min per week of specific strength training with training supervision , to 3 × 20 min per week of specific strength training with a minimal amount of training supervision , or to a reference group without training . A question naire will be sent to 2000 employees in jobs characterized by intensive computer work . Employees with cardiovascular disease , trauma , hypertension , or serious chronic disease will be excluded . The main outcome measure is pain in the neck and shoulders at week 20.Trial Registration The trial is registered at Clinical Trials.gov , number NCT01027390 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 Occupational stress in hospital cleaners ( n = 50 ) , and the effect of relaxation training ( n = 25 , age matched , r and omized ) , were studied by recording the electrical activity of the upper trapezius muscle at rest and during working conditions at the beginning , middle , and end of a 6-month follow-up period . A short ( 15-minute ) relaxation program was practice d daily at the workplace to provide stress management . The amount of sick leave was counted , and the extent of depression and some psychosocial working factors were screened . Intercorrelations were found between the neck-shoulder tension , psychosocial factors , depression , and the absentee rate . The relaxation training  diminished tension in the neck-shoulder region efficiently ; nevertheless , the decrease in absenteeism might have been related mainly to the social support offered by the research maneuver itself OBJECTIVES This study determined the prevalence of neck pain and its relation to occupation and occupational activities in the general population . METHODS A question naire was mailed to 21 201 subjects aged 16 - 64 years , r and omly selected from the patient registers of general practice s in Engl and , Scotl and , and Wales , and to 993 subjects r and omly selected from pay records of the armed services . Information was collected on occupation , workplace physical activities , neck pain in the past week and year , headaches , and feelings of tiredness or stress . Associations were explored by logistic regression , the result ant odds ratios being converted to prevalence ratios ( PR ) . RESULTS Among 12907 respondents , 4348 and 2528 reported neck pain  in past year ( 1421 with pain interfering with normal activities ) and week , respectively . Symptoms were the most prevalent among male construction workers [ past week and year 24 % and 38 % ( pain interfering with activities 11 % ) , respectively ] , followed by nurses , armed services members , and the unemployed . Generally the age-st and ardized prevalence of neck pain varied little by occupation . Work with arms above the shoulders for > 1 hours/day was associated with a significant excess of symptoms [ PR 1.3 - 1.7 ( women ) and 1.2 - 1.4 ( men ) ] , but no associations existed for typing , lifting , vibratory tool use , or professional driving . Stronger neck-pain associations were found with frequent headaches ( PR 2.3 - 2.8 ) and frequent tiredness or stress ( PR 2.2 - 2.5 ) than with occupational activities . CONCLUSIONS The data provide evidence against a strong association between neck pain and the examined occupational physical activities . They suggest that psychosocial factors may be more important BACKGROUND Shoulder pain is common in primary health care . Nevertheless , information on the outcome of shoulder disorders is scarce , especially for patients encountered in general practice . AIM To study the course of shoulder disorders in general practice and to determine prognostic indicators of outcome . METHOD For this prospect i ve follow-up study , 11 Dutch general practitioners recruited 349 patients with new episodes of shoulder pain . The participants filled out a question naire at presentation and further ones after 1 , 3 , 6 and 12 months ; these contained questions on the nature , severity and course of the shoulder complaints . The association between potential prognostic indicators and the status of shoulder complaints ( absence or presence of symptoms ) was evaluated after one and 12 months of follow-up . RESULTS After one month , 23 % of all patients showed complete recovery ; this figure increased to 59 % after one year . A speedy recovery seemed to be related to preceding overuse or slight trauma and early presentation . A high risk of persistent or recurrent complaints was found for patients with concomitant neck pain and severe pain during the day at presentation . CONCLUSION A considerable number of patients ( 41 % ) showed persistent symptoms after 12 months . It may be possible to distinguish patients who will show a speedy recovery from those with a high risk of long-st and ing complaints by determining whether there is a history of slight trauma or overuse , an early presentation or an absence of concomitant neck pain Background Persisting neck pain is common in society . It has been reported that the prevalence of neck pain in office workers is much higher than in the general population . The costs to the worker , employer and society associated with work-related neck pain are known to be considerable and are escalating . The factors that place office workers at greater risk of developing neck pain are not understood . The aim of this study is to investigate the incidence and risk factors of work-related neck pain in Australian office workers . Methods / design We will conduct a prospect i ve cohort study . A cohort of office workers without neck pain will be followed over a 12 month period , after baseline measurement of potential risk factors . The categories of risk factors being evaluated are physical ( cervical spine posture , range of movement , muscle endurance and exercise frequency ) , demographic ( age , sex ) , work environment ( sitting duration , frequency of breaks ) and psychosocial ( psychological distress and psychosocial work factors ) . Cox regression analysis will be used to identify risk factors associated with work-related neck pain , and will be expressed as hazard ratios with 95 % confidence intervals . The data will also enable the incidence of neck pain in this population to be estimated . Discussion In addition to clarifying the magnitude of this occupational health problem these data could inform policy in workplaces and provide the basis for primary prevention of neck pain in office workers , targeting the identified risk factors
None of the ergonomic interventions was more beneficial for any outcome measures when compared with another treatment or with no treatment or with placebo .
Behavioural interventions had inconsistent effects on pain and disability , with some subgroups showing benefit and others showing no significant improvement when compared with no treatment , minor intervention controls or other behavioural interventions .In the eight studies that evaluated various other interventions , there was no evidence of a clear beneficial effect of any of the interventions provided .
We found very low- quality evidence indicating that pain , recovery , disability and sick leave are similar after exercises when compared with no treatment , with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm , neck or shoulder .
Low- quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up .
There was no evidence of an effect on other outcomes .
For behavioural and other interventions , there was no evidence of a consistent effect on any of the outcomes .
BACKGROUND Work-related upper limb disorder ( WRULD ) , repetitive strain injury ( RSI ) , occupational overuse syndrome ( OOS ) and work-related complaints of the arm , neck or shoulder ( CANS ) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements , awkward postures and impact of external forces such as those associated with operating vibrating tools .
Work-related CANS , which is the term we use in this review , severely hampers the working population .
OBJECTIVES To assess the effects of conservative interventions for work-related complaints of the arm , neck or shoulder ( CANS ) in adults on pain , function and work-related outcomes .