title: Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting Supplementary breaks and stretching exercises for data entry operators: a follow-up field study. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness The Effect of Worksite Physical Activity Intervention on Physical Capacity, Health, and Productivity: A 1-Year Randomized Controlled Trial Job stress management and ergonomic intervention for work-related upper extremity symptoms. Reducing musculoskeletal disorders among computer operators: comparison between ergonomics interventions at the workplace A field study of supplementary rest breaks for data-entry operators The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users A Participatory Return-to-Work Intervention for Temporary Agency Workers and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders: Results of a Randomized Controlled Trial Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Effect of keyboard keyswitch design on hand pain. Effectiveness of a feedback signal in a computer mouse on upper extremity musculoskeletal symptoms: a randomised controlled trial with an 8-month follow-up Effectiveness of physical training for self-employed persons with musculoskeletal disorders: a randomized controlled trial Participatory ergonomics to reduce exposure to psychosocial and physical risk factors for low back pain and neck pain: results of a cluster randomised controlled trial A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators Effectiveness of an Educational and Physical Programme in Reducing Headache, Neck and Shoulder Pain: A Workplace Controlled Trial No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel. Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals The economic evaluation of a participatory ergonomics programme to prevent low back and neck pain. Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study Effectiveness of an at-work exercise program in the prevention and management of neck and low back complaints in nursery school teachers. Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: 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. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. A randomised controlled trial of postural interventions for prevention of musculoskeletal symptoms among computer users The effectiveness of participatory ergonomics to prevent low-back and neck pain--results of a cluster randomized controlled trial. Group Training with Healthy Computing Practices to Prevent Repetitive Strain Injury (RSI): A Preliminary Study The effect of a feedback signal in a computer mouse on hovering behaviour, productivity, comfort and usability in a field study The cost-effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on recovery from neck and upper limb symptoms and pain reduction in computer workers A new bricklayers' method for use in the construction industry. A test of two training interventions to prevent work-related musculoskeletal disorders of the upper extremity. The effect of forearm support on musculoskeletal discomfort during call centre work. Effect of an intervention addressing working technique on the biomechanical load of the neck and shoulders among hairdressers. Kettlebell training for musculoskeletal and cardiovascular health: a randomized controlled trial. 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Effect of Four Computer Keyboards in Computer Users with Upper Extremity Musculoskeletal Disorders A pilot randomised control trial of the effectiveness of a biofeedback mouse in reducing self-reported pain among office workers A Randomized Controlled Trial to Prevent Patient Lift and Transfer Injuries of Health Care Workers The effects of periodontal curette handle weight and diameter on arm pain: a four-month randomized controlled trial. Effects of physical activity programmes in the workplace (PAPW) on the perception and intensity of musculoskeletal pain experienced by garment workers. Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: A cluster randomized controlled cross-over trial Long-term benefits of an educational and physical program on headache, and neck and shoulder pain, in a working community. Effects of an active ergonomics training program on risk exposure, worker beliefs, and symptoms in computer users. Effects of ergonomic intervention in work with video display units. A randomized controlled intervention trial to relieve and prevent neck/shoulder pain. 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 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 Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: a randomised controlled trial. Health-related effects of worksite interventions involving physical exercise and reduced workhours. One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. A controlled study of the effect of neck school in medical secretaries. Musculoskeletal disorders and occupational exposures: How should we judge the evidence concerning the causal association? Multi dimensional system for evaluating preventive program for upper extremity disorders among computer operators.
abstract: Background Both low back pain ( LBP ) and neck pain ( NP ) are major occupational health problems . In the workplace , participatory ergonomics ( PE ) is frequently used on musculoskeletal disorders . However , evidence on the effectiveness of PE to prevent LBP and NP obtained from r and omised controlled trials ( RCTs ) is scarce . This study evaluates the process of the Stay@Work participatory ergonomics programme , including the perceived implementation of the prioritised ergonomic measures . Methods This cluster- RCT was conducted at the departments of four Dutch companies ( a railway transportation company , an airline company , a steel company , and a university including its university medical hospital ) . Directly after the r and omisation outcome , intervention departments formed a working group that followed the steps of PE during a six-hour working group meeting . Guided by an ergonomist , working groups identified and prioritised risk factors for LBP and NP , and composed and prioritised ergonomic measures . Within three months after the meeting , working groups had to implement the prioritised ergonomic measures at their department . Data on various process components ( recruitment , reach , fidelity , satisfaction , and implementation components , i.e. , dose delivered and dose received ) were collected and analysed on two levels : department ( i.e. , working group members from intervention departments ) and participant ( i.e. , workers from intervention departments ) . Results A total of 19 intervention departments ( n = 10 with mental workloads , n = 1 with a light physical workload , n = 4 departments with physical and mental workloads , and n = 4 with heavy physical workloads ) were recruited for participation , and the reach among working group members who participated was high ( 87 % ) . Fidelity and satisfaction towards the PE programme rated by the working group members was good ( 7.3 or higher ) . The same was found for the Stay@Work ergocoach training ( 7.5 or higher ) . In total , 66 ergonomic measures were prioritised by the working groups . Altogether , 34 % of all prioritised ergonomic measures were perceived as implemented ( dose delivered ) , while the workers at the intervention departments perceived 26 % as implemented ( dose received ) . Conclusions PE can be a successful method to develop and to prioritise ergonomic measures to prevent LBP and NP . Despite the positive rating of the PE programme the implementation of the prioritised ergonomic measures was lower than expected . Trial registration Current Controlled Trials IS RCT 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 BACKGROUND This study exp and ed previous NIOSH-IRS research examining the effects of rest breaks and stretching exercises on symptoms and performance in data -entry workers . METHODS All workers spent 4 weeks with conventional breaks ( two 15 min breaks per day ) and 4 weeks with supplementary breaks ( two 15 min breaks plus four 5 min breaks per day ) . One-half were assigned at r and om to a group instructed to perform brief stretching exercises during breaks . The remainder comprised the " no stretching " ( control ) group . RESULTS 51 workers ( stretch group n = 21 ; no stretch group n = 30 ) completed the study symptom question naires . Discomfort and eyestrain were significantly lower with supplementary breaks , and supplementary breaks attenuated accumulation of discomfort and eyestrain during work sessions . Data -entry speed was significantly faster with supplementary breaks so that work output was maintained , despite replacing 20 min of work time with break time . In the stretch group , workers reported  stretching  during only 25 % of conventional breaks and 39 % of supplementary breaks , and no significant effects of stretching on discomfort or performance were observed . CONCLUSIONS These results provide further converging evidence that supplementary breaks reliably minimize discomfort and eyestrain without impairing productivity . Low compliance in performing stretches prevented valid assessment of stretching effects . Further research on stretching exercises and exercise compliance is warranted Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity In practice the secondary prevention of work-related upper extremity ( WRUE ) symptoms generally targets biomechanical risk factors . Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability . The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone . Seventy office workers with WRUE symptoms were r and omly assigned to an ergonomics intervention group ( assessment and modification of work station and stretching exercises ) or a combined ergonomic and job stress intervention group ( ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress ) . Baseline , 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks , job stress , pain , symptoms , functional limitation , and general physical and mental health were obtained from all participants . While both groups experienced significant decreases in pain , symptoms , and functional limitation from baseline to three months with improvements continuing to 12 months post baseline , no significant differences between groups were observed for any outcome measures . Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone Typing is associated with musculoskeletal disorders ( MSDs ) caused by multiple risk factors . This control study aim ed to evaluate the efficacy of a workplace intervention for reducing  MSDs among computer workers . Sixty-six subjects with and without MSD were assigned consecutively to one of three groups : ergonomics intervention ( work site and body posture adjustments , muscle activity training and exercises ) accompanied with biofeedback training , the same ergonomics intervention without biofeedback and a control group . Evaluation of MSDs , body posture , psychosocial status , upper extremity ( UE ) kinematics and muscle surface electromyography were carried out before and after the intervention in the workplace and the motion lab . Our main hypothesis that significant differences in the reduction of MSDs will exist between subjects in the study groups and controls was confirmed ( χ2 = 13.3 ; p = 0.001 ) . Significant changes were found in UE kinematics and posture as well . Both ergonomics interventions effectively reduced MSD and improved body posture . Practitioner Summary : This study aim ed to test the efficacy of an individual workplace intervention programme among computer workers by evaluating musculoskeletal disorders ( MSDs ) , body posture , upper extremity kinematics , muscle activity and psychosocial factors were tested . The proposed ergonomics interventions effectively reduced MSDs and improved body posture This study examined the effects of supplementary rest breaks on musculoskeletal discomfort , eyestrain , mood , and performance in data -entry workers . Two rest break schedules were compared in a within-subjects design . Workers alternated between a ‘ conventional ’ and a ‘ supplementary ’ schedule in 4-week intervals . The conventional schedule contained a 15-min break during the first half of the work shift and a 15-min break during the second half of the shift . The supplementary schedule contained the same two 15-min breaks , and a 5-min break during each hour which otherwise did not contain a break , for a total of 20 extra minutes of break time . Results are based on data from 42 workers . They indicated that discomfort in several areas of the body , and eyestrain , were significantly lower under the supplementary than under the conventional schedule . While symptoms increased from pre- to post-work periods under both schedules , the magnitude of the increases was significantly less under the supplementary schedule . In addition , increases in discomfort of the right forearm , wrist and h and over the course of the work week under the conventional schedule were eliminated under the supplementary schedule . These beneficial effects were obtained without reductions in data -entry performance 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 Introduction Within the labour force workers without an employment contract represent a vulnerable group . In most cases , when sick-listed , these workers have no workplace/employer to return to . Therefore , the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers , sick-listed due to musculoskeletal disorders . Methods The workers , sick-listed for 2–8 weeks due to musculoskeletal disorders , were r and omly allocated to the participatory return-to-work program ( n = 79 ) or to usual care ( n = 84 ) . The new program is a stepwise procedure aim ed at making a consensus-based return-to-work plan , with the possibility of a temporary ( therapeutic ) workplace . Outcomes were measured at baseline , 3 , 6 , 9 and 12 months . The primary outcome measure was time to sustainable first return-to-work . Secondary outcome measures were duration of sickness benefit , functional status , pain intensity , and perceived health . Results The median duration until sustainable first return-to-work was 161 days in the intervention group , compared to 299 days in the usual care group . The new return-to-work program result ed in a non-significant delay in RTW during the first 90 days , followed by a significant advantage in RTW rate after 90 days ( hazard ratio of 2.24 [ 95 % confidence interval 1.28–3.94 ] P = 0.005 ) . No significant differences were found for the measured secondary outcomes . Conclusions The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers , sick-listed due to musculoskeletal disorders Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions This r and omized clinical trial evaluated the effects of keyboard keyswitch design on computer users with h and paresthesias . Twenty computer users were matched and r and omly assigned to keyboard A ( n = 10 ) or B ( n = 10 ) . The keyboards were of conventional layout and differed in keyswitch design . Various outcome measures were assessed during the 12 weeks of use . Subjects assigned keyboard A experienced a decrease in h and pain between weeks 6 and 12 when compared with keyboard B subjects ( P = 0.05 ) and demonstrated an improvement in the Phalen test time ( right h and , P = 0.006 ; left h and , P = 0.06 ) . Keyboard assignment had no significant effect on change in h and function or median nerve latency . We conclude that use of keyboard A for 12 weeks led to a reduction in h and pain and an improved physical examination finding when compared with keyboard B. There was no corresponding improvement in h and function or median nerve latency Objectives : To study the effectiveness of using a computer mouse with a feedback signal for upper extremity musculoskeletal symptoms in office workers . Methods : A r and omised controlled trial with 8 months of follow-up was carried out . The intervention consisted of a computer mouse with a feedback signal . In total , 354 subjects were allocated to the intervention group or the  control group . Measurements were performed with electronic question naires at baseline , after 4 months and after 8 months . Outcome variables were the prevalence and incidence of upper extremity musculoskeletal symptoms and disability in the upper extremities . The intervention process was evaluated by software registration . Results : The use of the mouse with a feedback signal result ed in a significant decrease in duration of mouse usage over time . No differences were found in the number of mouse usage rest breaks . No differences were found in the prevalence ( p = 0.29 ) or incidence ( p = 0.832 ) of upper extremity musculoskeletal symptoms between the groups 8 months after baseline . The prevalence decreased from 49 % at baseline to 44 % after 8 months in the control group , while it remained at 36 % in the intervention group . The incidence was 21 % in the control group and 22 % in the intervention group . Among the population with upper extremity musculoskeletal symptoms at baseline , the risk of experiencing symptoms after 8 months did not differ between the groups ( p = 0.49 ) . Minor disability was found in both groups . In the intervention group , a lower level of physical disability over time was reported than in the control group ( p = 0.02 ) . Conclusions : A feedback signal computer mouse does not affect the prevalence and incidence of upper extremity musculoskeletal symptoms , but it does lower disability scores . Given the high prevalence , study ing preventive interventions for upper extremity musculoskeletal symptoms is of high importance . Trial registration number : IS RCT N13222474 Background Despite the fact that the population of self-employed persons is still growing and at risk for long term disability due to a number of risk factors , there is still a lack of information on the effectiveness of interventions for this specific group . Methods To determine the effectiveness of physical training without a cognitive behavioral component and workplace specific exercises ( PT ) and physical training with a cognitive behavioral component and workplace specific exercises ( PTCBWE ) , we conducted a pragmatic R and omized Controlled Trial , stratified into two groups . Self-employed persons with a new work disability cl aim because of musculoskeletal disorders were r and omized to PT ( n = 53 ) or PTCBWE ( n = 76 ) , or to a corresponding usual care group ( n = 50 and n = 75 respectively ) . Both types of training consisted of cardiovascular training , strengthening , relaxation and posture exercises and took place two or three times a week , for 1–1.5 hours , during three months , also if someone had already returned to work full-time . The primary outcome measure was cl aim duration ( in days ) during 12 months follow-up . Pain severity and functional status were secondary outcome measures . All data were assessed at baseline and at 6 and 12 months follow-up . The data with regard to cl aim duration were analyzed by survival analysis and Cox regression analysis . Secondary outcome measures were analyzed by means of linear regression analysis . Results After 12 months of follow-up there was no difference in cl aim duration between PT and usual care ( Hazard Ratio 0.7 ; 95%CI , 0.4–1.1 ; p = 0.12 ) or PTCBWE and usual care ( Hazard Ratio 0.9 ; 95%CI , 0.6–1.4 ; p = 0.72 ) . Both types of physical training and usual care  improved in pain and functional status over time , but there was only a statistically significant difference in favor of PT on pain improvement at 6 months . Conclusion In this study , physical training with and without a cognitive behavioral component and workplace specific exercises for self-employed persons with musculoskeletal disorders was not shown to be effective on cl aim duration , pain severity and functional status at 12 months follow-up . Trial registration Current Controlled Trials IS RCT N67766245 Objectives This study investigated the effectiveness of the Stay@Work participatory ergonomics programme to reduce workers′ exposure to psychosocial and physical risk factors . Methods 37 departments ( n=3047 workers ) from four Dutch companies participated in this cluster r and omised controlled trial ; 19 ( n=1472 workers ) were r and omised to an intervention group ( participatory ergonomics ) and 18 ( n=1575 workers ) to a  control group ( no participatory ergonomics ) . During a 6 h meeting guided by an ergonomist , working groups devised ergonomic measures to reduce psychosocial and physical workload and implemented them within 3 months in their departments . Data on psychosocial and physical risk factors for low back pain and neck pain were collected at baseline and after 6 months . Psychosocial risk factors were measured using the Job Content Question naire and physical risk factors using the Dutch Musculoskeletal Question naire . Intervention effects were studied using multilevel analysis . Results Intervention group workers significantly increased on decision latitude ( 0.29 points ; 95 % CI 0.07 to 0.52 ) and decision authority ( 0.16 points ; 95 % CI 0.04 to 0.28 ) compared to control workers . However , exposure to awkward trunk working postures significantly increased in the intervention group ( OR 1.86 ; 95 % CI 1.15 to 3.01 ) compared to the control group . No significant differences between the intervention and control group were found for the remaining risk factors . After 6 months , loss to follow-up was 35 % in the intervention group and 29 % in the control group . Conclusion Participatory ergonomics was not effective in reducing exposure to psychosocial and physical risk factors for low back pain and neck pain among a large group of workers . Trial registration IS RCT N27472278 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 This study was an 8-month controlled trial to evaluate the effectiveness of a workplace educational and physical programme in reducing  headache and neck and shoulder pain . Central registry office employees ( n = 192 ; study group ) and 192 peripheral registry office and central tax office employees ( controls ) in the city of Turin , Italy were given diaries for the daily recording of pain episodes . After 2 months , the study group only began the educational and physical programme . The primary end-point was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain , and as the proportion of subjects with a ≥50 % reduction of frequency ( responder rate ) . The number of days of analgesic drug consumption was also recorded . Diaries completed for the whole 8 months were available for 169 subjects in the study group and 175 controls .  The baseline frequency of headache ( days per month ) was 5.87 and 6.30 in the study group and in controls ; frequency of neck and shoulder pain was 7.12 and 7.79 , respectively . Mean treatment effects [ days per month , 95 % confidence interval ( CI ) ] on comparing the last 2 months vs. baseline were : headache frequency −2.45 ( −3.48 , −1.43 ) ; frequency of neck pain −2.62 ( −4.09 , −1.16 ) ; responder rates ( odds ratio , 95 % CI ) 5.51 ( 2.75 , 11 ) for headache , 3.10 ( 1.65 , 5.81 ) for neck and shoulder pain , and 3.08 ( 1.06 , 8.90 ) for days with analgesic drug consumption . The study suggests that an educational and physical programme  reduces headache and neck and shoulder pain in a working community 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 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 This study was an economic evaluation conducted alongside a cluster r and omised controlled trial with a follow-up of 12 months . The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme ( PE ) compared to a control group ( no PE ) . In total , 37 departments ( n=3047 workers ) were r and omised into either the intervention ( PE ) or control group ( no PE ) . During a meeting , working groups followed the steps of PE , and composed and prioritized ergonomic measures aim ed to prevent low back pain ( LBP ) and neck pain ( NP ) . Working groups had to implement the ergonomic measures within three months in their department . Cost data included those directly related to LBP and NP . Cost-effectiveness analyses ( CEA ) and cost-benefit analyses ( CBA ) were performed . After 12 months , health care costs and costs of productivity losses were higher in the intervention group than in the control group ( the mean total cost difference was $ /euro$127 ; 95 % CI $ /euro$-164 - $ /euro$418 ) . From a societal perspective , the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence , work performance , and sick leave . The CBA from a company perspective showed a monetary loss of $ /euro$78 per worker . The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures Background Specific strength training can reduce neck and shoulder pain in office workers , but the optimal combination of exercise frequency and duration remains unknown . This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed . Methods A total of 447 office workers with and without neck and /or shoulder pain were r and omly allocated at the cluster-level to one of four groups ; 1 × 60 ( 1WS ) , 3 × 20 ( 3WS ) or 9 × 7 ( 9WS ) min a week of supervised high-intensity strength training for 20 weeks , or to a reference group without training ( REF ) . Primary outcome was self-reported neck and shoulder pain ( scale 0–9 ) and secondary outcome work disability ( Disability in Arms , Shoulders and H and s ( DASH ) ) . Results The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF . Among those with pain ≥3 at baseline ( n=256 ) , all three training groups achieved significant reduction in neck pain compared with REF ( p<0.01 ) . From a baseline pain rating of 3.2 ( SD 2.3 ) in the neck among neck cases , 1WS experienced a reduction of 1.14 ( 95 % CI 0.17 to 2.10 ) , 3WS 1.88 ( 0.90 to 2.87 ) and 9WS 1.35 ( 0.24 to 2.46 ) which is considered clinical ly significant . DASH was reduced in 1WS and 3WS only . Conclusion One hour of specific strength training effectively reduced neck and shoulder pain in office workers . Although the three contrasting training groups showed no statistical differences in neck pain reduction , only 1WS and 3WS reduced DASH . This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden . The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service . Methods The trial design was a population -based , r and omised study . Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospect ively for one 6-month term to determine the baseline incidence of injury . After this period , two new successive cohorts in the same four companies were r and omised into two groups and followed prospect ively for 6 months . Military service is compulsory for about 90 % of 19-year-old Finnish men annually , who comprised the cohort in this study . This r and omised , controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group .  A neuromuscular training programme was used to enhance conscripts ' motor skills and body control , and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries . The main outcome measures were acute injuries of the lower and upper limbs . Results In the intervention groups , the risk for acute ankle injury decreased significantly compared to control groups ( adjusted hazards ratio ( HR ) = 0.34 , 95 % confidence interval ( 95 % CI ) = 0.15 to 0.78 , P = 0.011 ) . This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels . In the latter group of conscripts , the risk of upper-extremity injuries also decreased significantly ( adjusted HR = 0.37 , 95 % CI 0.14 to 0.99 , P = 0.047 ) . In addition , the intervention groups tended to have less time loss due to injuries ( adjusted HR = 0.55 , 95 % CI 0.29 to 1.04 ) . Conclusions A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts . A similar programme could be useful for all young individuals by initiating a regular exercise routine . Trial registration Clinical Trials.gov identifier number NCT00595816 The aim of the study was to determine the effectiveness of an extension-oriented exercise program in the prevention and management of low back/neck pain in nursery school teachers . A Cluster R and omized Controlled Trial was utilized . Seventy-one nursery school teachers working in nine school buildings were r and omly divided into two groups , with each school as a unit of r and omization . All the teachers in both groups received an ergonomic brochure ; teachers in the experimental group also received an extension-oriented exercise program , conducted by a physical therapist . Data were collected at baseline and at a two-month follow-up . The primary outcome measure recorded was the level of disability ( Rol and Morris Disability Question naire and Oswestry Disability Index ) , while secondary outcome measure included the evaluation of cervical and lumbar physical discomfort ( Visual Analogue Scale ) . At follow-up , a significant improvement was registered in the experimental group as compared to the control group for all the outcomes evaluated . In conclusion an extension-oriented exercise program may be a useful strategy to prevent low back and neck complaints and to reduce consequent LBP functional disability among nursery school teachers 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 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 Although leisure-time physical activity is important for health , adherence to regular exercise is challenging for many adults . The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise . This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers . Methods Cluster-r and omized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain ( industrial production units ) . Participants were r and omized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week ( n = 282 ) or a control group receiving advice to stay physically active ( n = 255 ) . The strength training program followed principles of progressive overload and periodization . The primary outcome was changes in self-reported neck and shoulder pain intensity ( scale 0 - 9 ) . Results 85 % of the participants followed the strength training program on a weekly basis . In the training group compared with the control group , neck pain intensity decreased significantly ( -0.6 , 95 % CI -1.0 to -0.1 ) and shoulder pain intensity tended to decrease ( -0.2 , 95 % CI -0.5 to 0.1 , P = 0.07 ) . For pain-cases at baseline ( pain intensity > = 3 ) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up ( pain intensity < 3 ) was 2.0 ( 95 % CI 1.0 to 4.2 ) for the neck and 3.9 ( 95 % CI 1.7 to 9.4 ) for the shoulders . Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces , and results in significant reductions of neck and shoulder pain . Trial registration NCT01071980 OBJECTIVES This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care Aims : To examine the effect of two workstation and postural interventions on the incidence of  musculoskeletal symptoms among computer users . Methods : R and omised controlled trial of two distinct workstation and postural interventions ( an alternate intervention and a conventional intervention ) among 376 persons using computer keyboards for more than 15 hours per week . The incidence of neck/shoulder symptoms and h and /arm symptoms during six months of follow up among individuals in the intervention groups was compared to the incidence in computer users who did not receive an intervention ( comparison group ) . For individuals in the intervention groups , study staff adjusted workstations , where possible , and trained individuals to assume the intervention postures . Individuals reported musculoskeletal symptoms in a weekly diary . Participants who reported discomfort intensity of 6 or greater on a 0–10 visual analogue scale or who reported musculoskeletal symptoms requiring use of analgesic medication were considered symptomatic . Results : There were no significant differences in the incidence of musculoskeletal symptoms among the three intervention groups . Twenty two ( 18.5 % ) participants in the alternate intervention group , 25 ( 20.2 % ) in the conventional intervention group , and 25 ( 21.7 % ) in the comparison group developed incident arm or h and symptoms . Thirty eight ( 33.3 % ) participants in the alternate intervention group , 36 ( 31.0 % ) in the conventional intervention group , and 33 ( 30.3 % ) in the comparison group developed incident neck or shoulder symptoms . Compliance with all components of the intervention was attained for only 25–38 % of individuals , due mainly to the inflexibility of workstation configurations . Conclusions : This study provides evidence that two specific workplace postural interventions are unlikely to reduce the risk of upper extremity musculoskeletal symptoms among computer users OBJECTIVE The aim of this r and omized controlled trial ( RCT ) was to investigate the effectiveness of the Stay@Work participatory ergonomics ( PE ) program to prevent low-back and neck pain . METHODS A total of 37 departments were r and omly allocated to either the  intervention ( PE ) or control group ( no PE ) . During a six-hour meeting , working groups followed the PE steps and composed and prioritized ergonomic measures aim ed at preventing low-back and neck pain . Subsequently , working groups were requested to implement the ergonomic measures in the departments . The primary outcomes were low-back and neck pain prevalence and secondary outcomes were pain intensity and duration . Data were collected by question naires at baseline , and after 3- , 6- , 9- , and 12-months follow-up . Additionally , the course of low-back and neck pain ( transitions from no symptoms to symptoms and from symptoms to no symptoms ) was modeled . RESULTS The r and omization procedure result ed in 19 intervention departments ( N=1472 workers ) and 18 control departments ( N=1575 workers ) . After 12 months , the intervention was not more effective than the control group in reducing the prevalence of low-back and neck pain or reducing pain intensity and duration .  PE did not increase the probability of preventing low-back pain [ odds ratio ( OR ) 1.23 , 95 % confidence interval ( 95 % CI ) 0.97 - 1.57 ) or neck pain ( OR 1.01 , 95 % CI 0.74 - 1.40 ) . However , PE increased the probability of recovering from low-back pain ( OR 1.41 , 95 % CI 1.01 - 1.96 ) , but not from neck pain ( OR 0.95 , 95 % CI 0.72 - 1.26 ) . CONCLUSION PE neither reduced low-back and neck pain prevalence nor pain intensity and duration nor was it effective in the prevention of low-back and neck pain or the recovery from neck pain . However , PE was more effective in the recovery from low-back pain This pilot study investigated whether group training , in which participants become role models and coaches , would reduce discomfort as compared to a nontreatment Control Group . Sixteen experimental participants participated in 6 weekly 2-hr group sessions of a Healthy Computing program whereas 12 control participants received no training .  None of the participants reported symptoms to their supervisors nor were they receiving medical treatment for repetitive strain injury prior to the program . The program included training in ergonomic principles , psychophysiological awareness and control , sEMG practice at the workstation , and coaching coworkers . Using two-tailed t tests to analyze the data , the Experimental Group reported ( 1 ) a significant overall reduction in most body symptoms as compared to the Control Group and ( 2 ) a significant increase in positive work-style habits , such as taking breaks at the computer , as compared to the Control Group . This study suggests that employees could possibly improve health and work style patterns based on a holistic training program delivered in a group format followed by individual practice The aim of this study was to determine the effect of a tactile feedback signal on hovering behaviour , productivity , usability and comfort after 1 week of using an experimental mouse .  In a r and omized controlled trial , a regular computer mouse was compared to a new developed mouse with a tactile , vibrating feedback signal to prevent unnecessary hovering above the computer mouse . According to this study , participants do decrease their hovering behaviour when using a mouse with tactile feedback . Furthermore , the mouse with tactile feedback did not influence productivity . Usability was rated somewhat mixed . The use of a mouse with a tactile vibrating feedback signal seems promising for preventing neck , shoulder and arm complaints . Further research is needed to study long-term effects on ( prevention of ) neck , shoulder and arm complaints and development of learning effects Objectives To evaluate the cost-effectiveness of a work style ( WS ) intervention and a work style plus physical activity ( WSPA ) intervention in computer workers with neck and upper limb symptoms compared with usual care . Methods An economic evaluation was conducted from an employer 's perspective and alongside a r and omised controlled trial in which 466 computer workers with neck and upper limb symptoms were r and omised to a WS group ( N=152 ) , a WSPA group ( N=156 ) or a usual care group ( N=158 )  . Total costs were compared to the effects on recovery and pain intensity . In the primary analyses , missing effect data were imputed using multiple imputation techniques . Results Total costs during the 12-month intervention and follow-up period were € 1907 ( WS ) , € 2811 ( WSPA ) and € 2310 ( usual care ) . Differences between groups were not statistically significant . Neither intervention was more effective than usual care in improving overall recovery .  The WS intervention was more effective than usual care in reducing current pain , average pain and worst pain in the past 4 weeks , but the WSPA intervention was not . The acceptability curve showed that when a company is willing to pay approximately € 900 for a 1-point reduction in average pain ( scale from 0 to 10 ) , the probability of cost-effectiveness compared to usual care is 95 % . Similar results were observed for current and worst pain . Conclusions This study shows that the WS intervention was not cost-effective for improving recovery but was cost-effective for reducing pain intensity , although this reduction was not clinical ly significant . The WSPA intervention was not cost-effective compared with usual care . Trial registration number IS RCT N87019406 OBJECTIVES The aim of this study was to investigate the effect of raised bricklaying on physical workload , reported musculoskeletal disorders , sickness absence , and job satisfaction . METHODS A controlled intervention study with a follow-up period of 10 months was performed among 202 bricklayers from 25 construction companies . RESULTS The introduction of devices for raised bricklaying decreased the physical load on the lower back and , to a less extent , on the shoulders and upper extremities . Although raised bricklaying had no effect on the number of lifts , decreases in trunk bending lowered the biomechanical moment . The results showed no decrease in reported musculoskeletal symptoms as a result of the adoption of raised bricklaying . Irrespective of the reason(s ) , the percentage of bricklayers in the intervention group reporting sickness absence was significantly lower than the same percentage in the control group . The results also showed that , in general , the bricklayers in this study were very satisfied with the use of devices for raised bricklaying . CONCLUSIONS Controlled intervention studies on ergonomic improvements are rare . This study shows that the introduction of an ergonomic improvement in the construction industry may reduce physical load and the incidence of sickness absence We investigated , on behalf of a large electronics manufacturer , two types of worker training interventions  for their efficacy in preventing unnecessary muscle tension and the symptoms of work-related musculoskeletal disorders . The first intervention , Muscle Learning Therapy ( MLT ) , used electromyographic ( sEMG ) feedback and operant conditioning to decrease muscle tension during complex work tasks . The second intervention used adult learning and cognitive behavioral techniques in small group discussion to advance the worker 's capabilities for symptom and stress management and problem-solving . Workers were r and omly assigned to a control group or one of the two treatment conditions . Prior to training , baseline data were collected using symptom diaries and sEMG recordings of the trapezius and forearm muscles of the left and right arms . The training interventions were conducted for 6 weeks with reinforcement training provided at 18 and 32 weeks post-baseline . Follow-up data were collected after the initial 6-week training period and at 32 weeks , prior to the reinforcement training . Symptom outcomes demonstrated significant differences at 6 weeks , increasing in severity for the control group and declining modestly for the educational group , with little change for the MLT group . These differences were not maintained at further follow-up . The MLT group was consistently effective in reducing muscle tension in the trapezius areas after 6 and 32 weeks , and was partially effective for the forearms . Further testing is recommended of these training interventions , especially with the inclusion of strategic , periodic reinforcement of the worker 's learning Using a computer keyboard with the forearms unsupported has been proposed as a causal factor for  neck/shoulder and arm/h and diagnoses . Recent laboratory and field studies have demonstrated that forearm support might be preferable to working in the traditional " floating " posture . The aim of this study was to determine whether providing forearm support when using a normal computer workstation would decrease musculoskeletal discomfort in intensive computer users in a call centre . A r and omised controlled study ( n = 59 ) , of 6 weeks duration was conducted . Thirty participants ( Group 1 ) were allocated to forearm support using the desk surface with the remainder ( Group 2 ) acting as a control group . At 6 weeks , the control group was also set up with forearm support . Both groups were then monitored for another 6 weeks . Question naires were used at 1 , 6 and 12 weeks to obtain information about discomfort , workstation setup , working posture and comfort .  Nine participants ( Group 1 n = 6 , Group 2 n = 3 ) withdrew within a week of commencing forearm support either due to discomfort or difficulty in maintaining the posture . At 6 weeks , the group using forearm support generated significantly fewer reports of discomfort in the neck and back , although the difference between the groups was not statistically significant . At 12 weeks , there were fewer reports of neck , back and wrist discomfort when preintervention discomfort was compared with post intervention discomfort . These findings indicate that for the majority of users , forearm support may be preferable to the " floating " posture implicit in current guidelines for computer workstation setup 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 OBJECTIVE The aim of this trial was to investigate the effectiveness of a worksite intervention using kettlebell training to improve musculoskeletal and cardiovascular health . METHODS This single-blind r and omized controlled trial involved 40 adults from occupations with a high prevalence of reported musculoskeletal pain symptoms ( mean age 44 years , body mass index 23 kg/m² , 85 % women , with pain intensity of the neck/shoulders 3.5 and of the low back 2.8 on a scale of 0 - 10 ) . A blinded assessor took measures at baseline and follow-up . Participants were r and omly assigned to training -- consisting of ballistic full-body kettlebell exercise 3 times per week for 8 weeks -- or a control group . The main outcome measures were pain intensity of the neck/shoulders and low back , isometric muscle strength , and aerobic fitness . RESULTS Compared with the control group , pain intensity of the neck/shoulders decreased 2.1 points [ 95 % confidence interval ( 95 % CI ) -3.7- -0.4 ] and pain intensity of the low back decreased 1.4 points ( 95 % CI -2.7- -0.02 ) in the training group . Compared with the control group , the training group increased muscle strength of the trunk extensors ( P<0.001 ) , but not of the trunk flexors and shoulders . Aerobic fitness remained unchanged . CONCLUSIONS Worksite intervention using kettlebell training  reduces pain in the neck/shoulders and low back and improves muscle strength of the low back among adults from occupations with a high prevalence of reported musculoskeletal pain symptoms . This type of training does not appear to improve aerobic fitness BACKGROUND Musculoskeletal disorders are commonly reported among computer users . This study explored whether these disorders can be reduced by the provision of ergonomics education . METHODS A cluster r and omised controlled trial was conducted in which 3 units were r and omised for intervention and received training , and 3  units  were given a leaflet . The effect of intervention on workstation habits , musculoskeletal disorders , days and episodes of sick leave , and psychological well-being were assessed . RESULTS A significant improvement in workstation habits was found , and the differences remained significant at the follow-up time point for keyboard , mouse , chair , and desk use . The largest reduction in the percentage of musculoskeletal disorders was in the neck region ( -42.2 % , 95 % CI -60.0 to -24.4 ) . After adjusting for baseline values , significant differences were found at the follow-up time point in the neck , right shoulder , right and left upper limbs , lower back , and right and left lower limbs . No significant differences were found for the days and episodes of sick leave or the psychological well-being among workers after the intervention . CONCLUSION Consistent reductions were observed for all musculoskeletal disorders at the follow-up time point , although the difference was not statistically significant for the upper back . The improvements in the musculoskeletal disorders did not translate into fewer days lost from work or improved psychological well-being Microbreaks are scheduled rest breaks taken to prevent the onset or progression of cumulative trauma disorders in the computerized workstation environment . The authors examined the benefit of microbreaks by investigating myoelectric signal ( MES ) behavior , perceived discomfort , and worker productivity while individuals performed their usual keying work . Participants were r and omly assigned to one of three experimental groups . Each participant provided data from working sessions where they took no breaks , and from working sessions where they took breaks according to their group assignment : microbreaks at their own discretion ( control ) , microbreaks at 20 min intervals , and microbreaks at 40 min intervals . Four main muscle areas were studied : the cervical extensors , the lumbar erector spinae , the upper trapezius/supraspinatus , and the wrist and finger extensors . The authors have previously shown that when computer workers remained seated at their workstation , the muscles performing sustained postural contractions displayed a cyclic trend in the mean frequency ( MNF ) of the MES ( McLean et al. , J. Electrophysiol . Kinesiol . 10 ( 1 ) ( 2000 ) 33 ) . The data provided evidence ( p < 0.05 ) that all microbreak protocol s were associated with a higher frequency of MNF cycling at the wrist extensors , at the neck when microbreaks were taken by the control and 40 min protocol groups , and at the back when breaks were taken by the 20 and 40 min protocol groups . No significant change in the frequency of MNF cycling was noted at the shoulder . It was determined ( p < 0.05 ) that microbreaks had a positive effect on reducing discomfort in all areas studied during computer terminal work , particularly when breaks were taken at 20 min intervals . Finally , microbreaks showed no evidence of a detrimental effect on worker productivity . The underlying cause of MNF cycling , and its relationship to the development of discomfort or cumulative trauma disorders remains to be determined Objectives : To examine the efficacy of a participatory ergonomics intervention in preventing musculoskeletal disorders among kitchen workers .  Participatory ergonomics is commonly recommended to reduce musculoskeletal disorders , but evidence for its effectiveness is sparse . Methods : A cluster r and omised controlled trial among the 504 workers of 119 kitchens in Finl and was conducted during 2002–2005 . Kitchens were r and omised to an intervention ( n = 59 ) and control ( n = 60 ) group . The duration of the intervention that guided the workers to identify strenuous work tasks and to seek solutions for decreasing physical and mental workload , was 11 to 14 months . In total , 402 ergonomic changes were implemented . The main outcome measures were the occurrence of and trouble caused by musculoskeletal pain in seven anatomical sites , local fatigue after work , and sick leave due to musculoskeletal disorders . Individual level data were collected by a question naire at baseline and every 3 months during the intervention and 1-year follow-up period . All response rates exceeded 92 % . Results : No systematic differences in any outcome variable were found between the intervention and control groups during the intervention or during the 1-year follow-up . Conclusions : The intervention did not reduce perceived physical work load and no evidence was found for the efficacy of the intervention in preventing musculoskeletal disorders among kitchen workers . It may be that a more comprehensive re design of work organisation and processes is needed , taking more account of workers ’ physical and mental re sources OBJECTIVE Office-work poses a high-risk for musculoskeletal disorders ( MSDs ) , with consequences for workers , employers and society . The aims of this study were to determine the prevalence of musculoskeletal symptoms in a sample of Iranian office workers , to investigate the association between pain severity and job satisfaction and to investigate the association between MSDs and job satisfaction . MATERIAL S AND METHODS Iranian office workers from a university setting ( n=91 ) were r and omly selected and included in this cross-sectional study . The  Nordic musculoskeletal question naire plus visual analogue scale of pain  , and the Brayfield-Rothe Job Satisfaction Index  were used to study the prevalence of MSDs , pain intensity and job satisfaction , respectively . Descriptive analysis , Pearson 's correlation , and multiple regression analysis were performed for statistical assessment . RESULTS Eighty-nine percent of participants reported musculoskeletal symptoms during the past 12 months , most commonly in the neck ( 69.2 % ) , low back ( 58.2 % ) , knees ( 41.8 % ) , shoulders ( 35.2 % ) , and upper back ( 34.1 % ) . There was a significant negative correlation between pain intensity and job satisfaction . Pain intensity , low-back pain in the last week , wrist pain in the past 12 months and shoulder pain were significantly associated with job satisfaction ( p<0.05 ) . CONCLUSION This study provides evidence that musculoskeletal symptoms are common in Iranian office workers , associated with low job satisfaction . These findings indicate the need for more attention to MSDs among office workers and design ing effective preventive interventions Objectives : The aim of this intervention study was to determine the effects of an alternative mouse and /or a forearm support board on the change in upper body discomfort scores and the development of incident musculoskeletal disorders . Methods : This r and omised controlled intervention trial followed 206 engineers for one year . Participants were r and omised to receive ( 1 ) a conventional mouse only , ( 2 ) an alternative mouse only , ( 3 ) a forearm support board , or ( 4 ) an alternative mouse plus forearm support board . Outcome measures included weekly upper body discomfort scores and incident musculoskeletal disorders . Results : During the study , 42 participants were diagnosed with an incident musculoskeletal disorder . The group that received the forearm support board experienced a reduction in their right upper extremity discomfort ( beta-coefficient −0.35 , 95 % CI −0.67 to −0.03 ) in comparison to those who did not receive a forearm board . The group that received the alternative mouse had a protective , but non-significant ( p = 0.20 ) , effect on incident cases of right upper extremity musculoskeletal disorders ( HR 0.57 , 95 % CI 0.24 to 1.34 ) and a non-significant reduction in neck/shoulder discomfort ( beta-coefficient −0.23 , 95 % CI −0.056 to 0.10 ) in comparison to those who received a conventional mouse . Conclusions : In engineers who use a computer for more than 20 h per week , a forearm support board may reduce right upper extremity discomfort attributed to computer use The risk for the development of musculoskeletal disorders and associated conditions in clerical and office workers is well documented . The majority of work injury prevention programs for this population were single-faceted ( education , workstation re design , or task modification ) and yielded both positive and negative findings . This pilot study was conducted with 16 full-time clerical and office workers at a small private college . In a r and omized control trial , the intervention group received four hours of individualized training through a multi-faceted injury prevention program . Between group differences in musculoskeletal symptom frequency and intensity and perceived stress and energy levels existed , although were statistically insignificant . There was a statistically significant decrease in Lower Back ache/pain from pre to post measures for the intervention group OBJECTIVES The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders . METHODS In this r and omized controlled study , subjects aged 18 - 60 years ( N=177 ) seeking medical advice due to upper-extremity symptoms were included if their symptoms , or the exacerbation of symptoms , had started < 30 days prior to the medical consultation and immediate sick leave was not required .  Workplace ergonomic improvements were made in the intervention group . Data on symptoms and sickness absences were gathered during one-year follow-up . RESULTS Pain intensity , pain interference with work , leisure time , or sleep did not differ between the intervention and control group during the one-year follow-up . During the first three months of follow-up , the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention ( N=89 ) and control ( N=84 ) group , but the total number of sickness absence days in the intervention group was about half of that in the control group ( mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined ) . During 4 - 12 months of follow-up , the percentage of employees with sickness absence due to upper-extremity disorder ( 10.1 % versus 16.7 % , P=0.20 ) or upper-extremity and other musculoskeletal disorders combined ( 20.2 % versus 32.1 % , P=0.07 ) was lower in the intervention than the control group . CONCLUSIONS Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders Eighty computer users with musculoskeletal disorders participated in a six-month , r and omized , placebo-controlled trial evaluating the effects of four computer keyboards on clinical findings , pain severity , functional h and status , and comfort . The alternative geometry keyboards tested were : the Apple Adjustable Keyboard ™ [ kb1 ] , Comfort Keyboard System ™ [ kb2 ] , Microsoft Natural Keyboard ™ [ kb3 ] and placebo . Compared to placebo , kb3 and to a lesser extent kb1 groups demonstrated an improving trend in pain severity and h and function following six months of keyboard use . However , there was no corresponding consistent improvement in clinical findings in the alternative geometry keyboard groups compared to the placebo group . Overall , there was a significant correlation between improvement of pain severity and greater satisfaction with the keyboards . These results provide evidence that keyboard users may experience a reduction in h and pain after several months of use of some alternative geometry keyboards A pilot study examined the effectiveness of a biofeedback mouse in reducing  upper extremity pain and discomfort in office workers ; in addition , relative mouse use ( RMU ) , satisfaction and the feasibility of running a r and omised controlled trial ( RCT ) in a workplace setting were evaluated . The mouse would gently vibrate if the h and was idle for more than 12 s. The feedback reminded users to rest the arm in neutral , supported postures . Analysis showed a statistically significant reduction in shoulder pain and discomfort for the intervention group at T2 ( 38.7 % lower than controls ) . Statistically significant differences in RMU time between groups were seen post intervention ( −7 % at T1 and + 15 % at T2 for the intervention group ) . Fifty-five percent of the intervention group was willing to continue using the mouse . It appears feasible to perform an RCT for this type of intervention in a workplace setting . Further study including more participants is suggested . Practitioner Summary : The study findings support the feasibility of conducting r and omised control trials in office setting s to evaluate ergonomics interventions . The intervention result ed in reduced pain and discomfort in the shoulder . The intervention could be a relevant tool in the reduction of upper extremity musculoskeletal disorder . Further research will better explain the study 's preliminary findings Study Design . R and omized controlled trial ( RCT ) . Objectives . To compare the effectiveness of training and equipment to reduce musculoskeletal injuries , increase comfort , and reduce physical dem and s on staff performing patient lifts and transfers at a large acute care hospital . Summary of Background Data . Back injury to nursing staff during patient h and ling tasks is a major issue in health care . The value of mechanical assistive devices in reducing injuries to these workers is unclear . Methods . This three-armed RCT consisted of a “ control arm , ” a “ safe lifting ” arm , and a “ no strenuous lifting ” arm .  A medical , surgical , and rehabilitation ward were each r and omly assigned to each arm . Both intervention arms received intensive training in back care , patient assessment , and h and ling techniques . Hence , the “ safe lifting ” arm used improved patient h and ling techniques using manual equipment , whereas the “ no strenuous lifting ” arm aim ed to eliminate manual patient h and ling through use of additional mechanical and other assistive equipment . Results . Frequency of manual patient h and ling tasks was significantly decreased on the “ no strenuous lifting ” arm . Self-perceived work fatigue , back and shoulder pain , safety , and frequency and intensity of physical discomfort associated with patient h and ling tasks were improved on both intervention arms , but staff on the mechanical equipment arm showed greater improvements . Musculoskeletal injury rates were not significantly altered . Conclusions . The “ no strenuous lifting ” program , which combined training with assured availability of mechanical and other assistive patient h and ling equipment , most effectively improved comfort with patient h and ling , decreased staff fatigue , and decreased physical dem and s. The fact that injury rates were not statistically significantly reduced may reflect the less sensitive nature of this indicator compared with the subjective indicators BACKGROUND The design of periodontal curette h and les may cause or aggravate arm pain in dental practitioners . The authors conducted a four-month r and omized controlled trial to evaluate the effects of curette h and le diameter and weight on arm pain among dental hygienists and dentists . METHODS One hundred ten dental hygienists and dentists who performed scaling , root planing or dental prophylaxis procedures participated in this study . The authors assessed right wrist/h and , elbow/forearm and shoulder pain levels weekly . They r and omized participants to receive either a set of light ( 14 grams ) periodontal curettes with a large diameter ( 11 millimeters ) or a set of heavy ( 34 g ) periodontal curettes with a narrow diameter ( 8 mm ) . The authors compared changes in mean pain scores across the study period between intervention groups by using general linear models and controlling for covariates . RESULTS The improvement in pain scores across the three body regions was greater for participants who used the lighter , wider-diameter curettes . In the final adjusted model , the differences were statistically significant only for the shoulder region ( P = .02 ) . CONCLUSIONS The study results show that dental instrument design has an effect on upper-extremity pain in dental practitioners . Using a lighter instrument with a wider diameter may be an easy and cost-effective intervention to reduce or prevent upper-extremity pain associated with dental hygiene procedures . CLINICAL IMPLICATION S To prevent or reduce arm pain , practitioners should consider using lightweight instruments with large diameters when performing scaling and root planing procedures OBJECTIVE The physical activity programmes in the workplace ( PAPW ) are applied to minimize the prevalence , incidence and intensity of pain . This study evaluated the perception of pain and quantifies its intensity among garment workers before and after performing a PAPW . PARTICIPANTS We included 61 workers of a clothing company , who were classified r and omly into experimental group ( n = 44 ) 28.7 ± 8.8 years old and a control group ( n = 17 ) 27.8 ± 7.4 years ( 20 - 43 years ) . METHODS The Trigger Points test question naire was used to assess pain perception and quantify its intensity . The PAPW was conducted in 15-minute sessions per day , consisting of stretching exercises ( 40 % ) , muscular endurance ( 40 % ) , self-massage relaxation and massage techniques ( 10 % ) , and group dynamics ( 10 % ) . RESULTS The garment workers who participated in the PAPW showed a significant reduction of pain felt in the neck and wrists , and also a reduction in pain intensity in shoulders , arms , fingers and wrists that are most often strained during sewing . CONCLUSIONS Our findings suggest that PAPW that target muscle groups that are more tense in sewing tasks , may be considered by companies for supporting adaptation to the work environment and improving health by reducing muscle and joint pain & NA ; The purpose of the study was to examine the effects of a workplace physical exercise intervention on the perceived intensity of headache and the intensity of symptoms in the neck and shoulders , as well as on the extension and flexion strength of the upper extremities . The study was a cluster r and omized controlled trial . The cross‐over design consisted of physical exercise intervention ( 15 weeks ) and no‐intervention ( 15 weeks ) . The subjects ( n=53 ) were office workers ( mean age 46.6 ( SD 8.4 ) ) who reported headache ( n=41 ) symptoms in the neck ( n=37 ) or shoulders ( n=41 ) , which had restricted their daily activities during the last 12 months . Pain symptoms were measured using the Borg CR10 scale and muscular strength with a 5RM test . Statistical analyses were based on linear mixed models . Physical exercise intervention result ed in a slight , but statistically significant , decrease in the intensity of headache and neck symptoms , as well as an increase in the extension strength of the upper extremities . The mean decrease in headache during the 5‐week period was 0.64 CR10 ( 95 % CI 0.28–1.00 ) ( P=0.001 ) or 49 % ( 95 % CI 22–77 ) , and 0.42 CR10 ( 95 % CI 0.11–0.72 ) ( P=0.002 ) or 49 % ( 95 % CI 13–85 ) in the intensity of neck symptoms . The mean increase in the extension strength of the upper extremities was 1.3 kg ( 95 % CI 0.5–2.1 ) ( P=0.001 ) or 4 % ( 95 % CI 1–6 ) . The intervention had no effect on the intensity of shoulder symptoms or the flexion strength of the upper extremities . Specific exercise may be clinical ly important to alleviate headache and neck symptoms 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 OBJECTIVE The purpose of this study was to evaluate the effectiveness of an active ergonomics training ( AET ) program in computer users . Two constructs from the social-cognitive theory were adopted to provide a more comprehensive assessment of the proximal markers of behavior change . METHOD Eighty-seven symptomatic and asymptomatic employees who worked at a computer for a minimum of 10 hours per week took part in a prospect i ve r and omized controlled study . Subjects participated in a six-hour training intervention at their workplace . Key elements of the AET intervention were skill development in workstation analysis , active participation , and implementation of multiple prevention strategies . RESULTS After receiving AET , risk factor exposure was significantly reduced for participants at higher risk [ F(1,82 ) = 6.42 , p < 0.01 ] . Significant increases in knowledge [ F(1,74 ) = 8.39 , p < 0.01 ] , self-efficacy [ F(1,73 ) = 6.95 , p < 0.01 ] , and outcome expectations [ F(1,75 ) = 8.75 , p < 0.01 ] were found in the intervention group . When the participants were stratified according to the presence of symptoms at baseline , the group with pain that received the AET intervention had significantly less upper back pain intensity ( z = -2.03 , p < 0.05 ) , pain frequency ( z = -2.70 , p < 0.01 ) , and pain duration ( z = -3.25 , p < 0.01 ) post-intervention than the control group with pain . CONCLUSION Results from this study provide evidence that participative training in workstation ergonomics can improve work postures , work practice s , risk factor exposure , and pain OBJECTIVES This study evaluated the effect of an intensive ergonomic approach and education on workstation changes and  musculoskeletal disorders among workers who used a video display unit ( VDU ) . METHODS A r and omized controlled design was used . The subjects ( N=124 ) were allocated into three groups ( intensive ergonomics , ergonomic education , reference ) using stratified r and om sampling . The evaluation involved question naires , a diary of discomfort , measurements of workload , and an ergonomic rating of the workstations . The assessment s were made 2 weeks before the intervention and after 2 and 10 months of follow-up . RESULTS The intensive and training groups showed less musculoskeletal discomfort than the reference group after 2 months of follow-up . Positive effects on discomfort were seen primarily for the shoulder , neck , and upper back areas . No significant differences were found for the strain levels or prevalence of pain . After the intervention the ergonomic level was distinctly higher in the intensive ergonomic group than in the education or reference group . CONCLUSIONS Both the intensive ergonomics approach and education in ergonomics help reduce discomfort in VDU work . In attempts to improve the physical ergonomics of VDU workstations , the best result will be achieved with cooperative planning in which both workers and practitioners are actively involved PURPOSE The objective of this study is to investigate the effect of three different workplace interventions on long-term compliance , muscle strength gains , and neck/shoulder pain in office workers . METHODS A 1-yr r and omized controlled intervention trial was done with three groups :  specific resistance training ( SRT , n = 180 ) , all-round physical exercise ( APE , n = 187 ) , and reference intervention ( REF , n = 182 ) with general health counseling . Physical tests were performed and question naires answered at pre- , mid- , and postintervention . The main outcome measures were compliance , changes in maximal muscle strength , and changes in intensity of neck/shoulder pain ( scale 0 - 9 ) in those with and without pain at baseline . RESULTS Regular participation was achieved by 54 % , 31 % , and 16 % of those of the participants who answered the question naire in SRT ( 78 % ) , APE ( 81 % ) , and REF ( 80 % ) , respectively , during the first half of the intervention period , and decreased to 35 % , 28 % and 9 % , respectively , during the second half . Shoulder elevation strength increased 9 - 11 % in SRT and APE ( P < 0.0001 ) . Participants with neck pain at baseline decreased the intensity of neck pain through SRT , from 5.0 + /- 0.2 to 3.4 + /- 0.2 ( P < 0.0001 ) , and through APE , from 5.0 + /- 0.2 to 3.6 + /- 0.2 ( P < 0.001 ) , whereas REF caused no change . For participants without shoulder pain at baseline , there was a significantly greater increase in pain over the 1-yr period in REF compared with SRT and APE ( P < 0.01 ) . CONCLUSION Compliance was highest in SRT but generally decreased over time . SRT and APE caused increased shoulder elevation strength , were more effective than REF to decrease neck pain among those with symptoms at baseline , and prevent development of shoulder pain in those without symptoms at baseline 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 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 BACKGROUND AND OBJECTIVES Upper extremity musculoskeletal disorders ( MSD ) are very common in regular computer users and leading cause of work related illness . The objective of the present study is to evaluate effectiveness of yogic exercises in the improvement of symptoms of MSDs of upper limbs . MATERIAL S AND METHODS 60 study participants were r and omly divided into two groups that is yoga with counselling and only counselling group for 12 weeks . Symptom severity and functional status were assessed using the self administered Boston Carpal Tunnel Question naire and pre design ed symptom question naire before and after intervention . RESULTS There was significant reduction in symptom severity score ( P = 0.002 ) and improvement in functional status score in yoga with counselling group when compared to only counselling group . There is also a significant decrease in self reported symptoms like CT myalgia symptom ( P = 0.019 ) and improvement in weakness . CONCLUSION The present study showed a yoga based regimen is more effective than counselling alone in relieving symptoms of computer related musculoskeletal disorders OBJECTIVES This study examined the health-related effects of two worksite interventions , physical exercise and reduced workhours , on women employed in dentistry . METHODS Six workplaces were r and omized to one of the following three conditions : ( i ) 2.5 hours of weekly , m and atory physical exercise of middle-to-high intensity to be performed during workhours ( N=62 ) , ( ii ) a reduction of full-time weekly workhours from 40 to 37.5 hours ( N=50 ) , and ( iii ) reference . In all , 177 women participated . Biomarkers and self-ratings in question naires were obtained before the intervention ( T ( 1 ) ) , and six ( T ( 2 ) ) and 12 months ( T ( 3 ) ) after the intervention . RESULTS The results showed increased levels of physical activity and exercise in all of the groups , the level of physical exercise being significantly greater in the physical exercise group . Repeated- measures analyses of variance using data from T ( 1 ) and T (3)for biological measures and all three time points for self-ratings produced significant interaction effects for glucose , waist-to-hip ratio , and work ability and clear trends for general symptoms and upper-extremity disorders . Posthoc analyses showed that the results of the health-related measures differed between the interventions , decreased glucose and upper-extremity disorders in the exercise group , and increased high-density lipoprotein and waist-to-hip ratio among those working reduced hours . CONCLUSIONS These results show that the two interventions had small and varied effects on biomarkers and self-reports of different aspects of health among women . It is suggested that interventions involving a modest reduction in workhours seem to be more effective if these hours are used for physical exercise OBJECTIVES This study evaluates the effect of two different worksite physical-activity interventions on neck-shoulder symptoms , together with perceived work ability and sick leave  among office workers . METHODS An examiner-blinded r and omized controlled trial was conducted with 549 office workers allocated to one of three intervention groups : one with specific resistance training ( SRT ) of the neck-shoulder region ( N=180 ) , one with all-round physical exercise ( APE ) ( N=187 )  , and one which acted as a reference group , which was informed about general health-promoting activities but did not include a physical activity program ( N=182 ) . Question naires were filled out at baseline and after 1 year of training . RESULTS The duration and intensity of neck and shoulder symptoms was lower after the specified worksite physical-activity interventions than in the reference group . On an intervention group level , SRT was not more effective than APE in reducing the duration and intensity of neck and shoulder symptoms . However , those asymptomatic at baseline had a significant lower prevalence of neck-shoulder symptoms at follow-up when allocated to the SRT group than placed in the APE group or reference group . At baseline the work ability index ( WAI ) was close to 90 % of the maximum score , and the mean sick leave was 5 days per year , both being unaffected by the interventions . CONCLUSIONS Different physical-activity interventions were successful in reducing neck-shoulder symptoms , and SRT was superior to APE in the primary prevention of such symptoms . The initially relatively high WAI was the most probable reason for no further increase in WAI . Likewise the mean sick leave the year before the intervention was very low , and it was probably not possible to reduce it further The effect of " neck school " on neck and shoulder disorders was studied in medical secretaries . A  neck school reinforced with compliance enhancing measures ( group B ) was compared with a traditional neck school ( group A ) and a control group ( group C ) . The results show that ergonomical knowledge was good even before the secretaries attended the neck schools and that compliance was significantly higher for group B. When comparisons were made within groups some improvements on neck and shoulder fatigue and pain were noted , particularly for group B. When workload was controlled no significant group differences were found . No differences were noted for range of neck motion , or sick leave in any group . Our conclusion is that neck schools , despite good compliance , appear to be of limited clinical value for prevention of neck and shoulder disorders 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 Typing is associated with musculoskeletal complaints ( MSCs ) , caused by multiple risk factors . Although a wide variety of ergonomic intervention programs were conducted to reduce risk factors and MSC 's , only few of them were found evidence based . This study aim ed to test the efficacy of a workplace intervention in reducing MSC 's among computer workers . 66 computer workers were assigned r and omly to one of three intervention programs : ergonomic intervention including biofeedback , intervention without biofeedback and control group without intervention . The efficacy was tested by advanced assessment including ; pain location and severity , posture at work , upper extremity 3D kinematics , muscle activity and psychosocial status . Working hypothesis ; significant score differences will be found between the study groups which underwent ergonomic intervention and the control group on the following measures : pain complaints , upper extremity kinematics , muscle activity and psychosocial status . Significant differences were found between pre and post intervention and between research groups and the control group in pain , posture and motion . The ergonomic intervention with biofeedback had no unique contribution in comparison to other interventions . In conclusion ; the proposed intervention program was found efficient for reducing pain among computer workers
target: There was strong evidence for one intervention category , resistance training , leading to the recommendation : Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms .
  The synthesis also revealed moderate evidence for stretching programmes , mouse use feedback and forearm supports in preventing UEMSD or symptoms .
  There was also moderate evidence for no benefit for EMG biofeedback , job stress management training , and office workstation adjustment for UEMSD and symptoms .
background: The burden of disabling musculoskeletal pain and injuries ( musculoskeletal disorders , MSDs ) arising from work-related causes in many workplaces remains substantial .
  There is little consensus on the most appropriate interventions for MSDs .
  Our objective was to up date a systematic review of workplace-based interventions for preventing and managing  upper extremity MSD ( UEMSD ) .