Limitations
neck pain
HOLIDAYS, DISEASE
The high level of education, average earnings, employment by a local government, and gender distribution may have affected the transferability and comparability of our findings to other jurisdictions and samples of office workers. There may have been a selection bias as only those who had sufficient resources (e.g., time) and with mild to moderate burden of disease registered for the study participation. For our primary outcome, self-reported questionnaires were used, which are controversial because of their accuracy and potential social desirability bias. Some follow-up measurements were conducted close to holidays, so participants may not have reported neck pain or productivity losses due to vacation. Medication use or other forms of intervention (e.g., physiotherapy) were not recorded, which may have affected neck pain. Furthermore, making up for missed work hours (e.g., working overtime in another week) was not considered in the questionnaire of the primary outcome, which could lead to an overestimation of neck pain-related work productivity losses. Another limitation is the COVID-19 pandemic with the change in working conditions and the switch to a hybrid setting of our intervention, which might have biased the adherence to the intervention and the dose–response relationship, e.g., for deskwork or neck exercises. This, in turn, could lead to an underestimation of the treatment effect.