title: Supplementary breaks and stretching exercises for data entry operators: a follow-up field study. Job stress management and ergonomic intervention for work-related upper extremity symptoms. Effects of a participatory ergonomics team among hospital orderlies. A field study of supplementary rest breaks for data-entry operators Office ergonomics education: a comparison of traditional and participatory methods. A Cross-Country Comparison of Short-and Long-Term Effects of an Ergonomic Intervention on Musculoskeletal Discomfort, Eyestrain and Psychosocial Stress in VDT Operators: Selected Aspects of the International Project Effect of keyboard keyswitch design on hand pain. The Effect of an Ergonomic Intervention on Musculoskeletal, Psychosocial and Visual Strain of VDT Data Entry Work: The Polish Part of the International Study A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel. A comprehensive work injury prevention program with clerical and office workers: Phase II. Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals The Effect of an Ergonomie Intervention on Musculoskeletal, Psychosocial and Visual Strain of VDT Data Entry Work: The Norwegian Part of the International Study Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders. Evaluation of a program to reduce back pain in nursing personnel. The Effectiveness of Standard Care, Early Intervention, and Occupational Management in Worker’s Compensation Claims Musculoskeletal, visual and psychosocial stress in VDU operators before and after multidisciplinary ergonomic interventions. A 6 years prospective study--Part II. A randomised controlled trial of postural interventions for prevention of musculoskeletal symptoms among computer users Group Training with Healthy Computing Practices to Prevent Repetitive Strain Injury (RSI): A Preliminary Study The Effect of an Ergonomic Intervention on Musculoskeletal, Psychosocial and Visual Strain of VDT Data Entry Work: The United States Part of the International Study 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. Computer terminal work and the benefit of microbreaks. Effects of an ergonomic training program on workers with video display units. A randomised controlled trial evaluating an alternative mouse and forearm support on upper body discomfort and musculoskeletal disorders among engineers Workplace upper limb disorders: a prospective study with intervention. A comprehensive work injury prevention program with clerical and office workers: phase I. Effect of Four Computer Keyboards in Computer Users with Upper Extremity Musculoskeletal Disorders Work-related musculoskeletal pain among reindeer herding Sami in Sweden - a pilot study on causes and prevention A Randomized Controlled Trial to Prevent Patient Lift and Transfer Injuries of Health Care Workers The effect of pain reduction on perceived tension and EMG-recorded trapezius muscle activity in workers with shoulder and neck pain. 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 The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders Self-administered preventive programme for sedentary workers: reducing musculoskeletal symptoms or increasing awareness? Does group gymnastics at the workplace help in neck pain? A controlled study. 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 Trial Evaluating the Effects of New Task Chairs on Shoulder and Neck Pain Among Sewing Machine Operators: The Los Angeles Garment Study Musculoskeletal, visual and psychosocial stress in VDU operators before and after multidisciplinary ergonomic interventions. 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 Effects of keyboard tray geometry on upper body posture and comfort. A controlled study of the effect of neck school in medical secretaries. Effects of different psychological interventions on neck, shoulder and low back pain in female hospital staff.
abstract: 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 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 BACKGROUND High rates of work-related injuries are seen among health care workers involved in lifting and transferring patients . We studied the effects of a participatory worker-management ergonomics team among hospital orderlies . METHODS This prospect i ve intervention trial examined work injuries and other outcomes before and after the intervention , with other hospital employees used as a concurrent control . All orderlies in a 1,200-bed urban hospital were studied using passively collected data ( mean employment during study period 100 - 110 orderlies ) ; 67 orderlies ( preintervention ) and 88 orderlies ( postintervention ) also completed a question naire . The intervention was the formation of a participatory ergonomics team with three orderlies , one supervisor , and technical advisors . This team design ed and implemented changes in training and work practice s. RESULTS The 2-year postintervention period was marked by decreased risks of work injury ( RR = 0.50 , 95 % CI 0.35 - 0.72 ) , lost time injury ( RR = 0.26 , 95 % CI 0.14 - 0.48 ) , and injury with three or more days of time loss ( RR = 0.19 , 95 % CI 0.07 - 0.53 ) . Total lost days declined from 136.2 to 23.0 annually per 100 full-time worker equivalents ( FTE ) . Annual workers ' compensation costs declined from $ 237/FTE to $ 139/FTE . The proportion of workers with musculoskeletal symptoms declined and there were statistically significant improvements in job satisfaction , perceived psychosocial stressors , and social support among the orderlies . CONCLUSION Substantial improvements in health and safety were seen following implementation of a participatory ergonomics program 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 Health and safety literature stresses the value of programs aim ed at preventing musculoskeletal injuries . The concepts of empowerment learning are often recommended as guidelines for worker education yet these approaches are largely untested . The present study compares the traditional approach involving lecture and discussion with a participatory method .  A sample of 102 participants employed at a central ized reservation facility was used . Participants were r and omly assigned to either the  traditional education group or  the participatory education group . Data collection utilized surveys completed by study participants and observational checklists completed by a trained observer . Data were collected prior to intervention and at approximately 3 , 6 , and 12 months post intervention . Results of data analysis provide no evidence that participatory methods are more effective than traditional methods in encouraging workers to position their work equipment correctly or to maintain good working postures to prevent musculoskeletal injuries Three groups of data entry female visual display terminal ( VDT ) workers from Norway ( n = 30 ) , Pol and ( n = 33 ) and the USA ( n = 29 ) were compared . Before intervention , the Norwegian group reported more neck pain compared with the Polish group . The Polish group reported less shoulder pain than both the U.S. and the Norwegian groups . The clinical examination documented fewer symptoms and signs of musculoskeletal illness among the Polish participants compared with the Norwegian and the U.S. groups . After intervention , the Norwegian group reported a reduction in neck pain while the U.S. group reported a reduction in shoulder pain . The Polish group reported an increase in neck , shoulder and forearm pain at follow-up compared to after intervention . The Polish group recorded higher flexion of the upper arm at follow-up parallel with an increase of pain in the upper part of the body . Visual discomfort showed variable results in the 3 countries 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 A group of routine data entry operators ( female ) was included in the Polish MEPS ( musculoskeletal — eyestrain— psychosocial — stress ) study . Before the intervention , ergonomic assessment revealed improper working conditions such as inadequate lighting , uncomfortable chairs , and lack of forearm and wrist support while medical examination revealed that trapezius muscle load along with upper arm , head and back angles were higher than advisable . Subjects complained about neck and shoulder pain , visual problems , and psychosocial conditions . The ergonomic intervention included installation of new luminaires and Venetian blinds , new chairs , repair of ventilators , and optometric corrections . The results after the intervention showed mainly improvement in chair comfort , lighting conditions , visual strain , and sitting posture . However , financial limitations did not allow satisfactory completion of the intervention leading to a mixed interpretation of the results 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 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 Sixteen full-time clerical and office workers participated in this prospect i ve parallel-r and omized trial . Intervention consisted of four hours of individualized training through a multi-faceted injury prevention program . In Phase I , musculoskeletal symptoms , stress , and energy levels were measured before and after intervention . Differences between Group A ( intervention ) and Group B ( control ) were described ; pre to post differences between members within each group were also described . In Phase II , there were a greater number of statistically and clinical ly relevant differences within Group A at week 16 ( eleven weeks following intervention ) than at week five ( immediately post-intervention ) . The eyes , neck , shoulder , elbow-forearm , and wrist-h and were impacted most positively by intervention , however , the frequency and intensity of headaches increased . Stress and energy level differences were minimal . Group B workers received intervention during weeks 18 - 21 . Differences in average measures from pre to immediately post-intervention were greater within Group B than Group A. Both groups reported fewer sick days during the month of intervention than during pre and post-intervention months 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 The Norwegian MEPS ( musculoskeletal — eyestrain — psychosocial — stress ) study included 3 groups : data entry , data dialogue ( female ) and data dialogue  ( male ) . Before intervention , the data entry group reported significantly more symptoms and signs of musculoskeletal illness and had longer periods in front of the video display terminal ( VDT ) without a break . The ergonomic intervention consisted mainly of ergonomic information and training . After intervention , the data dialogue female group reported a significant reduction in shoulder pain in parallel with a reduction in trapezius load . Increasing the underst and ing in how to adjust the work st and and chair may have been contributing factors to reducing the pain level . There was a significant reduction in eye problems in all groups ; the greatest reduction in eye symptoms was seen in the groups who had new optometric corrections 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 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 evaluate the effectiveness of a program design ed to reduce back pain in nursing aides . METHODS Female nursing aides from a university hospital who had suffered episodes of back pain for at least six months were included in the study . Participants were r and omly divided into a control group and an intervention group . The intervention program involved a set of exercises and an educational component stressing the ergonomic aspect , administered twice a week during working hours for four months . All subjects answered a structured question naire and the intensity of pain was assessed before and after the program using a visual analogue scale ( VAS ) . Student 's t-test or the Wilcoxon Rank Sum Test for independent sample s , and Chi-square test or the Exact Fisher test for categorical analysis , were used . The McNemar test and the Wilcoxon matched pairs test were used to compare the periods before and after the program . RESULTS There was a statistically significant decrease in the frequency of cervical pain in the last two months and in the last seven days in the intervention group . There was also a reduction in cervical pain intensity in the two periods ( 2 months , 7 days ) and lumbar pain intensity in the last 7 days . CONCLUSIONS The results suggest that a program of regular exercise with an emphasis on ergonomics can reduce musculoskeletal symptoms in nursing personnel Study Design . A retrospective and prospect i ve cohort . Objectives . To compare the effectiveness of occupational intervention , early intervention , and st and ard care in the management of Worker ’s Compensation injury cl aims . Summary of Background Data . The current management of occupational back pain and work-related upper extremity disorders with either st and ard care or early intervention appears to be ineffective . Methods . A retrospective cohort compared injury cl aim incidence , duration ,  and costs  between one company with access to st and ard care and another similar company with access to early intervention .  A prospect i ve cohort looked at the effect of one company changing from  st and ard care to occupational management  in comparison with the control group with early intervention .  Survival analysis was used to attempt to explain differences in injury cl aim duration . Results . St and ard care result ed in lower injury cl aim incidence , duration , and costs than early intervention , whereas occupational management result ed in lower injury cl aim incidence , duration , and costs than st and ard care . The covariates of physical therapist involvement , chiropractor involvement , injury severity , and relationship between Worker ’s Compensation and the employer were associated with delayed time to cl aim closure in the company with access to early intervention with the most important covariate being physical therapist involvement ( hazard rate ratio 19.88 , 95 % confidence interval 7.95–39.77 ) . Only the covariate of injury severity was associated with delayed time to cl aim closure in the company with access to occupational management ( hazard rate ratio 1.67 , 95 % confidence interval 1.05–27.20 ) . Conclusions . It is recommended that an occupational management approach , in comparison with st and ard care or early intervention , be considered for management of occupational injuries A prospect i ve epidemiological field study covering a 2 years period has earlier been published . The study has a parallel group design with two intervention groups ( T and S ) and one  control group ( C ) of Visual Display Unit ( VDU ) operators . The present paper covers the period from 2 to 6 years of the study . After 3.5 years , the C group got the same intervention in terms of new lighting system , new workplaces and at last an optometric examination and corrections if needed . The C group reported a significant reduction in visual discomfort after interventions while the two groups ( T and S ) continued to report significant reduction of visual discomfort after 6 years . By supporting the forearm on the table top , the C group reported significant reduction of shoulder and neck pain while the T group reported significant reduction in shoulder and back pain after 6 years . Organizational and psychosocial factors at work and outside work did not show any significant changes during the study period 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 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 United States MEPS ( musculoskeletal — eyestrain — psychosocial — stress ) study consisted of 1 group of 28 female data entry operators . The intervention was in 3 parts : workstation re design ( including advanced ergonomic chairs , motorized adjustable workstations , advanced adjustable keyboards , adjustable copyholders , adjustable footrests , monitor support surfaces ) and ergonomic training/coaching and corrective lenses . After the intervention , statistically significant reductions in physical signs ( trigger points , neck and shoulder mobility ) , subjective reports of intensity and frequency of musculoskeletal pain , and subjective reports of visual problems were observed . Static load during the work sample , as assessed by experts , improved after the intervention as did measured postural angles of head and trunk and subjective assessment of users of ergonomic characteristics of the workplaces . For all of these measures , improvements observed 1 month after intervention were also observed in the 1-year follow-up . Trapezius load , as assessed by electromyography ( EMG ) , decreased after intervention , but then increased in the follow-up . The increase was interpreted as a calibration problem 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 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 This study evaluated the effect of an ergonomic training program on workstation changes and on the prevalence of  musculoskeletal disorders among video display unit ( VDU ) users at a large university . METHODS A pretest-posttest design with a reference group was used with r and om allocation of administrative and geographic units . In each group , the measurements involved direct observation of the workstations , a self-administered question naire , and a physical examination . The measurements were performed 2 weeks before and 6 months after the training in parallel in both groups . The study population was composed of 627 workers ( 81 % of those eligible ) . RESULTS The prevalence of all 3 of the postural stressors evaluated decreased in the experimental group after the training . In the reference group , 2 of the 3 stressors decreased in frequency but to a less extent . Some of these beneficial changes were more frequent in workers under 40 years of age . The prevalence of musculoskeletal disorders decreased among the workers under 40 years of age in the experimental group , from 29 % to 13 % determined by question naire and from 19 % to 3 % determined by physical examination . In other groups , there was no significant change in the prevalence of musculoskeletal disorders . CONCLUSIONS Improvements in postural stressors occurred more frequently in the experimental group , and these beneficial changes tended to be more frequent in workers under 40 years of age . Improvements in musculoskeletal disorders occurred in the experimental group among the workers under 40 years of age 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 A prospect i ve longitudinal study was carried out to investigate the occurrence of upper limb disorders in an electromechanical plant between 1980 and 1988 . It included clinical and epidemiological studies , measurement of  vibration produced by the power tools used , ergonomic assessment of the works and time and motion studies . Simultaneously during the same period remedial actions were taken through multidisciplinary interventions when the specific causal factors were known . The study shows the clinical entities of the disorder , identifies the risk factors and evaluates the results of the interventions . It assists in establishing a cause and effect relationship for the condition and demonstrates the way a preventive strategy could be developed 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 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 Objective . To investigate the prevalence and to identify causes of  musculoskeletal pain ( MSP ) among reindeer herding Sami , and to evaluate the impact on the MSP symptoms elicited by an intervention-prevention programme ( IP programme ) . Study Design . A prospect i ve cohort study in which alterations in MSP symptoms were documented over a two-year period . Methods . Data were collected from 51 reindeer herders ( 26 men , 25 women ) before and after a two-year IP programme .  Information on MSP characteristics ( affected body regions , pain duration and pain intensity ) and exposure to a number of physical and psychosocial risk factors were collected as part of comprehensive health examinations . Clinical examinations and interviews complemented self-reported data collected through question naires . Results . MSP symptoms were prevalent , both among women and men . High exposure to physical risk factors , to a large extent related to extensive use of snowmobiles and motorcycles , was the main cause of MSP among men , while psychosocial risk factors were suggested to be more important among women . About one-third of the reindeer herders reported fewer MSP symptoms as a result of the IP programme . Conclusions . This pilot study suggests that it is possible to reduce the number and the severity of the MSP symptoms among reindeer herders by implementing suitably tailored intervention-prevention measures 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 The study was initiated to evaluate the effect of pain-reducing therapies on factors previously associated with work-related shoulder and neck pain , namely increased muscle activity in the upper trapezius and perceived general tension . Thirty-three women in three groups were assessed before and after an intervention period and by question naire 6 months later . The purpose of this study was primarily to investigate associations between upper trapezius muscle activity , perceived general tension and pain , and secondly , to compare effects of individually based physiotherapy and group exercise for workers with shoulder and neck myalgia . All three groups reported a significant alleviation of pain and perceived general tension , while the electromyographically ( EMG ) recorded upper trapezius muscle activity level remained unchanged or increased . Improvements were similar in all three treatment groups , but individual-based therapies were rated more beneficial on subjective measures . Significant correlation was found between pain and perceived general tension ( r = 0.66 , p < 0.01 ) , while there was no correlation between pain or perceived general tension and recorded muscle activity & 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 There is evidence that performing job tasks involving repetition , vibration , sustained posture or forceful movement may contribute to symptoms of work related upper extremity disorders . Typing is one such activity ; symptoms that develop as a result of this activity can affect performance of work , self-care and leisure occupations . Studies investigating the impact of ergonomic keyboards on symptom reduction are limited , and little research exists regarding the reduction of key activation force as an intervention . Methods : This r and omized , prospect i ve study used a sample of 68 symptomatic workers employed by a single company . One group received a commercially available ergonomic keyboard , a second group used a modified version of the same keyboard design ed to reduce activation force , vibration and key travel . We measured symptoms and clinical signs , functional status , and device satisfaction in both groups over a six-month study period . Results : Between-groups analyses indicated that the groups performed similarly on the outcomes of interest . Repeated-measure analysis identified a reduction of symptoms , an improvement in functional status , preference for and increased satisfaction with the intervention keyboards , and maintenance of typing speed and accuracy for both groups . Conclusions The objective of this study was to evaluate an auto-instructional preventive programme design ed to allow the subjects to identify critical aspects related to their work and musculoskeletal comfort , and provide them with some simple alternatives for controlling the identified problems . The programme was evaluated by 36 secretaries and bank clerks through their symptom perception before and after the programme . The results showed that the symptoms increased in number and severity . The programme seemed to have helped the participants to become aware of the ergonomic problems present in their job and to link these problems to physical symptoms . Self-administered preventive programmes can lead to clearly negative results when applied as the only measure to control musculoskeletal symptoms The effects of group  gymnastics  on  neck pain were studied among 44 women in a printing company . A r and omized cross-over design was used with two groups matched according to the work task , frequency of symptoms , and age . The treatment consisted of gymnastics for 45 min once a week for 10 weeks . Neck pain was rated by  visual analogue scale  and pressure pain sensitivity of the neck muscles was measured with an algometer . The results showed no clear effects of the group gymnastics program . An equal and significant reduction in pain ratings was seen in both groups after the first intervention in the spring . Recurrence of symptoms was seen in both groups in September , and no significant reduction in pain occurred during the second intervention in the autumn . The results suggest a seasonal variation in neck symptoms which has to be considered when planning or evaluating intervention studies 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 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 study has a parallel group design with two intervention groups ( T and S ) and one control group ( C ) of VDU operators . Three serial interventions were carried out in the T and S groups , first a new lighting system , then new workplaces and last an optometric examination and corrections if needed . The new lighting gave significantly increased illuminance levels , increased luminances of the room surfaces and better luminance distribution . The two intervention groups reported significant improvement of the lighting conditions , as well as of the visual conditions and significantly reduced visual discomfort and glare . Significant reduction of headache was found in one of the intervention groups . Optometric corrections reduced the visual discomfort in both the intervention groups . When looking at those given new corrections , a significant reduction was found in the T group and a clear tendency was also found in the S group . The C group reported no improvements for any of these health outcomes . The workplace intervention gave the operator the possibility to support the whole forearm and h and on the table top . Before the intervention there were no significant differences between the three groups regarding shoulder pain and static trapezius electromyographic ( EMG ) load . Two years after the intervention , a significant reduction of shoulder pain was reported in the T and S groups in parallel with a significant reduction in static trapezius load , while no such reduction was found in the C group . At the same time , both static trapezius load and shoulder pain were significantly lower in the T and S groups compared with the C group . Pain in the forearm and h and showed no significant changes in any of the groups during the study period . However , there seem to be a relationship between pain in the forearm and h and and the time the operator used the mouse . The C group reported significantly higher intensity of pain and used the mouse significantly more than the S group 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 The effects of a downward-tilting ( DT ) keyboard tray on wrist posture , seated posture and self-assessed musculoskeletal discomfort were investigated in a field experiment . Thirty-eight professional office workers were studied . A pretest assessed how they typed using either a conventional keyboard on a desk or on an articulating keyboard tray , and with or without wrist rests . Workers were r and omly allocated to a control ( n = 15 ) or test group ( n = 23 ) that used their existing keyboard in a DT system . A post-test was conducted 3 weeks later . Results showed no significant changes in wrist posture , seated posture or reports of musculoskeletal discomfort for the control group , and approximately 50 % of typing wrist movements put the h and in a neutral zone . There were significant improvements in wrist posture , seated posture and upper body musculoskeletal discomfort for the test group using the DT system . Over 80 % of typing wrist movements put the h and into a neutral zone with the DT arrangement . Reactions to using a conventional keyboard on a DT system were positive 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 One hundred and eleven females volunteered to take part in this intervention study of musculoskeletal pain . They all completed a survey of pain among five hundred and eighty-six female hospital staff and presented mild to severe pain in the neck , shoulder and /or low back . They were r and omly assigned to one of the following groups ; Focus on job-stress and psychosocial coping ( Cognitive ) , relaxation training ( Relaxation ) , the combination of the two ( Combined ) or to a control group ( Control ) .  Musculoskeletal pain ( intensity and duration ) was assessed by self-report prior to interventions , immediately after interventions , and at a four months follow-up . Results from multivariate analyses of variance as well as covariance ( pre-intervention levels of pain as covariate ) showed that magnitude of pain reduction was dependent upon the interaction between area of the back and type of intervention . These trends were more significant for intensity than for duration scores . They were due to reductions of pain in ( 1 ) neck and shoulders for the Cognitive and Combined groups and ( 2 ) in the low back and shoulders for the Relaxation group . The four month follow-up assessment revealed a significant risk of relapse only for duration of low back pain among subjects in the Combined group . Results from the Cognitive approach to intervention may reflect a causal role for ability to cope with psychosocial job stress in the development of neck and shoulder pain in female hospital staff
target: Levels of evidence for interventions associated with positive effects were : Moderate evidence for arm supports ; and Limited evidence for ergonomics training plus workstation adjustments , new chair and rest breaks .
  Levels of evidence for interventions associated with “ no effect ” were : Strong evidence for workstation adjustment alone ; Moderate evidence for biofeedback training and job stress management training ; and Limited evidence for cognitive behavioral training .
  No interventions were associated with “ negative effects ” .
  Conclusion It is difficult to make strong evidence d-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs .
  There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace m and ated pre-placement screening exams .
background: Background Little is known about the most effective occupational health and safety ( OHS ) interventions to reduce  upper extremity musculoskeletal disorders ( MSDs ) and injuries .
  Methods A systematic review used a best evidence synthesis approach to address the question : “ do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms , signs , disorders , injuries , cl aims and lost time ? ”