title: The costs for persons sick-listed more than one month because of low back or neck problems. A two-year prospective study of Swedish patients The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Acute Treatment of Whiplash Neck Sprain Injuries: A Randomized Trial of Treatment During the First 14 Days After a Car Accident Prognostic Factors for Intervention Effect on Neck/Shoulder Symptom Intensity and Disability among Female Computer Workers Return to work after comparing outpatient multidisciplinary treatment programs versus treatment in general practice for patients with chronic widespread pain. A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators The Effect of a Job Placement and Support Program for Workers with Musculoskeletal Injuries: A Randomized Control Trial (RCT) Study No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel. The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers The immediate and long-term effects of exercise and patient education on physical, functional, and quality-of-life outcome measures after single-level lumbar microdiscectomy: a randomized controlled trial protocol Risk factors for neck pain in office workers: a prospective 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. Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial Improving Work Style Behavior in Computer Workers with Neck and Upper Limb Symptoms The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers The effect of a feedback signal in a computer mouse on hovering behaviour, productivity, comfort and usability in a field study High Quantitative Job Demands and Low Coworker Support As Risk Factors for Neck Pain: Results of a Prospective Cohort Study 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. Frequent short rest breaks from computer work: effects on productivity and well-being at two field sites. A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up Effects of an ergonomic training program on workers with video display units. A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain Predicting Persistent Neck Pain: A 1-Year Follow-up of a Population Cohort Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain Early Workplace Intervention for Employees With Musculoskeletal-Related Absenteeism: A Prospective Controlled Intervention Study Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up Evaluation of a participatory ergonomic intervention process in kitchen work. Multimodal cognitive behavioral treatment of patients sicklisted for musculoskeletal pain: a randomized controlled study. Perceived Job Insecurity, Job Predictability, Personality, and Health 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. Effects of keyboard tray geometry on upper body posture and comfort. Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?: A Randomized Controlled Trial Coordinated and Tailored Work Rehabilitation: A Randomized Controlled Trial with Economic Evaluation Undertaken with Workers on Sick Leave Due to Musculoskeletal Disorders The Integration of Electromyography (SEMG) at the Workstation: Assessment, Treatment, and Prevention of Repetitive Strain Injury (RSI) A controlled study of the effect of neck school in medical secretaries.
abstract: The total costs for patients who are sick-listed due to back and neck problems have not previously been determined prospect ively on an individual basis . This study aim ed to determine the total cost to a society , based on individually assessed costs of health services and loss of production in people who are sick-listed 28 days or more for back or neck problems . Detailed data on individuals ’ health-care consumption due to back or neck problems was collected through prospect ively entered diaries and question naires , after 4 weeks , 3 months , 1 and 2 years , in a consecutively selected cohort of 1,822 employed persons aged between 18 and 59 years .  Costs for health care and production losses due to work absenteeism were determined individually and combined to render total costs to society . The costs for all medical services during the 2-year study were 6.9 % of total costs for back and neck problems . The single most expensive medical service was surgery . Transferred to a national level , annual total costs for back and neck problems corresponded to 1 % of GNP . In conclusion , direct health-service costs were a small fraction of the total costs , consequently indirect costs offer the greatest potential for savings STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers Study Design . A single‐blinded , r and omized treatment study with a follow‐up period of 6 months . Objective . To study the long‐term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident . Patients in the first group were encouraged to act as usual , i.e. , continue to engage in their normal , pre‐injury activities ; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar . The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident . Summary of Background Data . Few r and omized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain . Method . Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim , Norway . The study group included 201 patients ( 47 % of the study group ) with neck sprain that result ed from a car accident .  Neck and shoulder movements and subjective symptoms , which were assessed using several different measurements , were assessed during the follow‐up period . Results . There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups . There was a significantly better outcome for the act‐as‐usual group in terms of subjective symptoms , including pain localization , pain during daily activities , neck stiffness , memory , and concentration , and in terms of visual analog scale measurements of neck pain and headache . Conclusions . The outcome was better for patients who were encouraged to continue engaging in their normal , pre‐injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury Introduction It has been suggested that treatments may be more effective when they are matched to patient characteristics . This study aim ed at investigating potential prognostic factors for clinical ly relevant improvement in symptom intensity and symptom-related disability among employees with symptoms in the neck/shoulder area , receiving either ergonomics counseling or such counseling in combination with myofeedback training .  Methods A r and omized controlled study was performed among female computer users aged 45 or older ( n = 36 ) . A clinical examination and a question naire survey were performed before inclusion in the study . Symptom intensity and disability was assessed using question naires before the start of the interventions ( baseline ) and at follow-ups directly after the end of the interventions ( T0 ) and after 3 ( T3 ) and 6 ( T6 ) months . Logistic regression analyses were performed in order to assess prognostic factors for clinical ly relevant improvement in symptom intensity and disability . Results Improvement in symptom intensity was consistently predicted by symptom intensity at baseline . Diagnosis and stress-induced lack of muscular rest were prognostic factors for improvement in symptom intensity at short term follow-up . Baseline disability and passive coping consistently served as prognostic factors for outcome in disability . Few substantial differences were found between the interventions in terms of prognostic factors . Conclusions Myofeedback training in combination with ergonomics counseling seem to be an especially beneficial tool for secondary prevention among employees with moderate levels of symptom intensity and symptom-related disability , who respond to work-related stress by increased/sustained muscle activation , and who tend to employ passive coping to deal with their neck/shoulder symptoms Former studies have question ed the quality and effectiveness of multidisciplinary rehabilitation for working-age adults with fibromyalgia and chronic widespread pain ( CWP ) . High- quality trials are needed , and return to work should also be included as an outcome variable . This r and omized study evaluated the return-to-work outcome of an extensive and a light multidisciplinary treatment program combining cognitive strategies and exercise versus treatment-as-usual initiated by a general practitioner , for CWP patients . The patients ( n=208 ) , on sick leave for 3 months on average , were r and omized to the extensive program including group sessions , a light and more individual program , and to treatment-as-usual . The number of days absent from work and full return to work were used as an outcome , and follow-up lasted 54 months after the programs ended . The regression analysis showed that the extensive program was associated with significantly fewer days absent from work among women . For women , the mean effect of extensive treatment versus treatment-as-usual on total number of days absent from work was estimated to -206.95 days . Among men , the light program was associated with significantly more days absent from work compared to treatment-as-usual . Both among men and women , independent of type of treatment , patients with poorer health ( poor prognosis ) were absent from work more days than patients with good prognosis . In our sample , higher age significantly increased the number of days absent from work , but only for women . The extensive outpatient multidisciplinary treatment program was effective in returning women to work 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 Background This is a r and omized clinical trial ( RCT ) to investigate the efficacy of a job placement and support program design ed for workers with musculoskeletal injuries and having difficulties in resuming the work role . The program was planned to help injured workers to successfully return to work ( RTW ) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach . Methodology A total of 66 injured workers were recruited and r and omly assigned into the job placement and support group ( PS group ) or the self-placement group ( SP group ) . A three-week job placement and support program was given to subjects in the PS group while subjects in the control group ( SP group ) were only given advice on job placement at a workers ’ health center . The PS program was comprised of an individual interview , vocational counseling , job preparation training , and assisted placement using the case management approach . The Chinese Lam Assessment of Stages of Employment Readiness ( C-LASER ) , the Chinese State Trait and Anxiety Inventory ( C-STAI ) , and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects ’ work readiness status , emotional status and their health related quality of life pre- and post-training program . The rate of return to work was measured for both groups of subjects after the training program . Results The results indicated that the rate of success in RTW ( 73 % ) was significantly higher in the job placement ( PS ) group than that of the self-placement ( SP ) group ( 51.6 % ) with P < 0.05 . Significant differences were also found in C-STAI ( P < 0.05 ) , SF-36 ( P < 0.05 ) and C-LASER scores on action ( P < 0.05 ) between the two groups . Conclusion The job placement ( PS ) program appeared to have enhanced the employability of injured workers . Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries 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 Neck and upper limb symptoms are frequently reported by computer workers .  Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms . A combined approach targeting work style and lifestyle physical activity seems promising , but little is known on the effectiveness of such combined interventions . Methods / design The RSI@Work study is a r and omised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers . Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and /or the last two weeks are r and omised into three groups : ( 1 ) work style group , ( 2 ) work style and physical activity group , or ( 3 ) control group . The work style intervention consists of six group meetings in a six month period that take place at the workplace , during work time , and under the supervision of a specially trained counsellor . The goal of this intervention is to stimulate workplace adjustment and to improve body posture , the number and quality of breaks and coping behaviour with regard to high work dem and s. In the combined ( work style and physical activity ) intervention the additional goal is to increase moderate to heavy physical activity . The control group receives usual care . Primary outcome measures are degree of recovery , pain intensity , disability , number of days with neck and upper limb symptoms , and number of months without neck and upper limb symptoms . Outcome measures will be assessed at baseline and six and 12 months after r and omisation . Cost-effectiveness of the group meetings will be assessed using an employer 's perspective . Discussion This study will be one of the first to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention in reducing neck and upper limb symptoms of computer workers . The results of the study are expected in 2007 Background Low back pain remains a costly quality -of-life-related health problem . Microdiscectomy is often the surgical procedure of choice for a symptomatic , single-level , lumbar disc herniation in younger and middle-aged adults . The question of whether a post-microdiscectomy exercise program enhances function , quality of life , and disability status has not been systematic ally explored . Thus , the overall purpose of this study is to assess immediate and long-term outcomes of an exercise program , developed at University of Southern California ( USC ) , targeting the trunk and lower extremities ( USC Spine Exercise Program ) for persons who have undergone a single-level microdiscectomy for the first time . Methods / design One hundred individuals between the ages of 18 and 60 who consent to undergo lumbar microdiscectomy will be recruited to participate in this study . Subjects will be r and omly assigned to one of two groups : 1 ) one session of back care education , or 2 ) a back care education session followed by the 12-week USC Spine Exercise Program . The outcome examiners ( evaluators ) , as well as the data managers , will be blinded to group allocation . Education will consist of a one-hour " one-on-one " session with the intervention therapist , guided by an educational booklet specifically design ed for post-microdiscectomy care . This session will occur four to six weeks after surgery . The USC Spine Exercise Program consists of two parts : back extensor strength and endurance , and mat and upright therapeutic exercises . This exercise program is goal -oriented , performance-based , and periodized . It will begin two to three days after the education session , and will occur three times a week for 12 weeks . Primary outcome measures include the Oswestry Disability Question naire , Rol and -Morris Disability Question naire , SF-36 ® quality of life assessment , Subjective Quality of Life Scale , 50-foot Walk , Repeated Sit-to-St and , and a modified Sorensen test . The outcome measures in the study will be assessed before and after the 12-week post-surgical intervention program . Long-term follow up assessment s will occur every six months beginning one year after surgery and ending five years after surgery . Immediate and long-term effects will be assessed using repeated measures multivariate analysis of variance ( MANOVA ) . If significant interactions are found , one-way ANOVAs will be performed followed by post-hoc testing to determine statistically significant pairwise comparisons . Discussion We have presented the rationale and design for a r and omized controlled trial evaluating the effectiveness of a treatment regimen  for people who have undergone a single-level lumbar microdiscectomy Background Persisting neck pain is common in society . It has been reported that the prevalence of neck pain in office workers is much higher than in the general population . The costs to the worker , employer and society associated with work-related neck pain are known to be considerable and are escalating . The factors that place office workers at greater risk of developing neck pain are not understood . The aim of this study is to investigate the incidence and risk factors of work-related neck pain in Australian office workers . Methods / design We will conduct a prospect i ve cohort study . A cohort of office workers without neck pain will be followed over a 12 month period , after baseline measurement of potential risk factors . The categories of risk factors being evaluated are physical ( cervical spine posture , range of movement , muscle endurance and exercise frequency ) , demographic ( age , sex ) , work environment ( sitting duration , frequency of breaks ) and psychosocial ( psychological distress and psychosocial work factors ) . Cox regression analysis will be used to identify risk factors associated with work-related neck pain , and will be expressed as hazard ratios with 95 % confidence intervals . The data will also enable the incidence of neck pain in this population to be estimated . Discussion In addition to clarifying the magnitude of this occupational health problem these data could inform policy in workplaces and provide the basis for primary prevention of neck pain in office workers , targeting the identified risk factors 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 cost effectiveness , cost utility , and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain . Design Economic evaluation alongside a r and omised controlled trial with 12 months ’ follow-up . Setting Primary care ( 10 physiotherapy practice s , one occupational health service , one occupational therapy practice ) and secondary care ( five hospitals ) in the Netherl and s , 2005 - 9 . Participants 134 adults aged 18 - 65 sick listed because of chronic low back pain : 66 were r and omised to integrated care and 68 to usual care . Interventions Integrated care consisted of a workplace intervention based on participatory ergonomics , with involvement of a supervisor , and a grade d activity programme based on cognitive behavioural principles . Usual care was provided by general practitioners and occupational physicians according to Dutch guidelines . Main outcome measures The primary outcome was duration until sustainable return to work . The secondary outcome was quality adjusted life years ( QALYs ) , measured using EuroQol . Results Total costs in the integrated care group ( £ 13 165 , SD £ 13 600 ) were significantly lower than in the usual care group ( £ 18 475 , SD £ 13 616 ) . Cost effectiveness planes and acceptability curves showed that integrated care was cost effective compared with usual care for return to work and QALYs gained . The cost-benefit analyses showed that every £ 1 invested in integrated care would return an estimated £ 26 . The net societal benefit of integrated care compared with usual care was £ 5744 . Conclusions Implementation of an integrated care programme for patients sick listed with chronic low back pain has a large potential to significantly reduce societal costs , increase effectiveness of care , improve quality of life , and improve function on a broad scale . Integrated care therefore has large gains for patients and society as well as for employers Introduction The goal of this study was to assess the effectiveness of a group-based interactive work style intervention in improving work style behavior . Methods Computer workers with neck and upper limb symptoms were r and omised into the work style group ( WS , N = 152 ) , the work style and physical activity group ( WSPA , N = 156 ) , or the usual care group ( N = 158 ) . Both intervention groups received the same work style intervention but the WSPA group also received a lifestyle physical activity intervention . Participants from the intervention groups attended six group meetings which focused on behavioral change with regard to body posture and workstation adjustment , breaks , and coping with high work dem and s in order to reduce work stress . Stage of change , breaks and exercise behavior , and stress outcomes were assessed by question naire at baseline ( T0 ) and after 6 ( T1 ) and 12 months ( T2 ) . Body posture and workstation adjustment were assessed by observation and by question naire at T0 , T1 , and T2 . Multilevel analyses were used to study differences in work style behavior between study groups . Results The work style intervention was effective in improving stage of change with regard to body posture , workstation adjustment , and the use of sufficient breaks during computer work . These findings were confirmed by higher self-reported use of breaks and exercise reminder software and less working hours without breaks . However , self-reported changes in body posture and workstation adjustment were less consistent . The work style intervention was ineffective in changing stress outcomes . Conclusion A group-based work style intervention seems to be effective in improving some elements of work style behavior . Future studies should investigate the effectiveness of work style interventions on all dimensions of the Feuerstein work style model Abstract This study assessed the effectiveness of a single intervention targeting work style and a combined intervention targeting work style and physical activity on the recovery from neck and upper limb symptoms . Computer workers with frequent or long‐term neck and upper limb symptoms were r and omised into the work style group ( WS , n = 152 ) , work style and physical activity group ( WSPA , n = 156 ) , or usual care group ( n = 158 ) . The WS and WSPA group attended six group meetings . All meetings focused on behavioural change with regard to body posture , workplace adjustment , breaks and coping with high work dem and s ( WS and WSPA group ) and physical activity ( WSPA group ) . Pain , disability at work , days with symptoms and months without symptoms were measured at baseline and after 6 ( T1 ) and 12 months ( T2 ) . Self‐reported recovery was assessed at T1/T2 . Both interventions were ineffective in improving recovery . The work style intervention but not the combined intervention was effective in reducing all pain measures . These effects were present in the neck/shoulder , not in the arm/wrist/h and . For the neck/shoulder , the work style intervention group also showed an increased recovery‐rate . Total physical activity increased in all study groups but no differences between groups were observed . To conclude , a group‐based work style intervention focused on behavioural change was effective in improving recovery from neck/shoulder symptoms and reducing pain on the long‐term . The combined intervention was ineffective in increasing total physical activity . Therefore we can not draw conclusions on the effect of increasing physical activity on the recovery from neck and upper limb symptoms The aim of this study was to determine 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 Study Design . A 3-year prospect i ve cohort study among 1334 workers was conducted . Objective . To determine whether the work-related psychosocial factors of quantitative job dem and s , conflicting job dem and s , skill discretion , decision authority , supervisor support , coworker support , and job security are risk factors for neck pain . Summary of Background Data . Among the various risk factors for neck pain , work-related psychosocial factors play a major role . Previous studies on risk factors for neck pain often had a cross-sectional design , and did not take both physical and psychosocial factors into account . Methods . At baseline , data on work-related psychosocial factors were collected by means of a question naire . During the 3-year follow-up period , data on the occurrence of neck pain were collected by means of postal question naires . Individuals without neck pain at baseline were selected for the analyses . Cox regression analysis was applied to examine the relation between the work-related psychosocial factors and the cumulative incidence of neck pain . Adjustments were made for various physical factors and individual characteristics . Results . The analysis included 977 patients . Altogether , 141 workers ( 14.4 % ) reported that they had experienced neck pain at least once during the 3-year follow-up period . The relation of neck pain to high quantitative job dem and s ( relative risk [ RR ] , 2.14 ; 95 % confidence interval [ CI ] , 1.28–3.58 ) and low coworker support ( RR , 2.43 ; 95 % CI , 1.11–5.29 ) was statistically significant . An increased risk was found for low decision authority in relation to neck pain ( RR , 1.60 ; 95 % CI , 0.74–3.45 ) , but this relation was not statistically significant . Conclusions . High quantitative job dem and s and low coworker support are independent risk factors for neck pain . There are indications that another risk factor for neck pain is low decision authority 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 Computer operators at two work sites ( n = 73 , n = 19 ) were prompted to take three 30-s and one 3-min break from computer work each hour in addition to conventional rest breaks . Some operators were asked to perform stretching exercises during the short breaks . Mood state and musculoskeletal discomfort were assessed at each work site over a 2- or 3-week baseline period and a 4- or 6-week treatment period , respectively . Operator productivity measures were obtained from company records . Operators complied with about half of the added breaks but favoured 3-min breaks over 30-s breaks . No improvement in productivity or well-being was found at the larger work site . At the smaller work site , productivity , eye , leg and foot comfort all improved when the short breaks included stretching exercises . These results provide evidence that frequent short breaks from continuous computer-mediated work can benefit worker productivity and well-being when the breaks integrate with task dem and 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 : To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints . Methods : A r and omized controlled trial with a 1-year follow-up was carried out . Thirty-eight subjects were allocated to multidisciplinary treatment ( intervention , n=23 ) , or to usual care provided by occupational health services ( n=15 ) . The intervention consisted of psychological and physical sessions provided by a medical specialist , a psychologist , a physiotherapist and an occupational therapist . It aims at reconditioning , “ de-medicalizing ” , unrestrained moving and return-to-work . The intervention process was evaluated on compliance to the protocol and the effectiveness of its components . The individual outcome variable was the severity of complaints . The societal outcomes included return-to-work and costs . Measurements were performed at baseline and after 2 , 6 and 12 months . Mixed model analyses were used for analysis . Results : The intervention achieves its aims : physical disabilities ( P=0.039 ) , kinesiophobia ( P<0.001 ) and physical functioning ( P=0.016 ) improved significantly as compared to usual care . In addition , the intervention was significantly more effective in reducing the severity of complaints than usual care . The intervention was equally effective compared to usual care in terms of return-to-work ( 86 % in the intervention group vs. 73 % in the usual care group ) . The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months . Conclusion : Multidisciplinary treatment affects individuals positively , but shows no significant difference in ( cost- ) effectiveness on the societal level as compared to usual care 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 & NA ; The aim of the present study was to evaluate the long‐term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components , compared to a ‘ treatment‐as‐usual ’ control group . The study employed a 4 × 5 repeated‐ measures design with four groups and five assessment periods during a 3‐year follow‐up . The group studied consisted of blue‐collar and service/care workers on sick leave , identified in a nationwide health insurance scheme in Sweden . After inclusion , the subjects were r and omised to one of the four conditions : behaviour‐oriented physiotherapy ( PT ) , cognitive behavioural therapy ( CBT ) , behavioural medicine rehabilitation consisting of PT+CBT ( BM ) and a ‘ treatment‐as‐usual ’ control group ( CG ) . Outcome variables were sick leave , early retirement and health‐related quality of life . A cost‐effectiveness analysis , comparing the programmes , was made . The results showed , consistently , the full‐time behavioural medicine programme being superior to the three other conditions . The strongest effect was found on females .  Regarding sick leave , the mean difference in the per‐ protocol analysis between the BM programme and the control group was 201 days , thus reducing sick leave by about two‐thirds of a working year . Rehabilitating women has a substantial impact on costs for production losses , whereas rehabilitating men seem to be effortless with no significant effect on either health or costs . In conclusion , a full‐time behavioural medicine programme  is a cost‐effective method for improving health and increasing return to work in women working in blue‐collar or service/care occupations and suffering from back/neck pain Study Design . A population cohort study to determine the 1-year persistence of neck pain . Objectives . The aim of this study was to determine the persistence of  neck pain  over a 12-month period among the general adult population and to explore socio-demographic , health-related , occupational , physical , and lifestyle factors that might be linked to such persistence . Summary of Background Data . Musculoskeletal clinicians report that neck patients frequently return to consult for recurring episodes of pain . However , the persistent nature of neck pain has been less research ed than other common chronic pain syndromes . Methods . First , to identify a cohort of current neck pain sufferers , a baseline cross-sectional survey was conducted in a general population of 7,669 adults , 18 to 75 years of age , registered with two primary care practice s in South Manchester , UK . The second phase was a follow-up survey , 12 months later , to determine the 1-year persistence of neck pain among those who had reported neck pain at baseline . Persistence of neck pain was compared across groups of responders stratified by potential prognostic factors measured at baseline . “ Persistent ” neck pain was defined according to shading within the region of the neck on a blank body mannequin . The term “ persistent ” neck pain could therefore reflect chronic , recurrent , or continuous pain . Results . There were 1,359 neck pain responders in the baseline survey , and these subjects formed the study population for the prospect i ve study . At follow-up , 786 ( 58 % ) subjects responded , of whom 48 % reported having neck pain lasting for more than 1 day , during the previous month . Significant baseline characteristics , which independently predicted persistent neck pain , were age ( odds ratio [ OR ] = 3.4 ) , being off work at the time of the baseline survey ( OR = 1.6 ) , comorbid low back pain ( OR = 1.6 ) , and cycling as a regular activity ( OR = 2.4 ) . Conclusion . Among the general population , neck pain persists at 12 months in around half of those who report neck pain at the start of the period . An increased risk of persistent neck pain was associated with age 45 to 59 years and low back pain , and also with cycling . The linkwith psychological distress and the absence of a link with occupational factors compares with other previous findings for common musculoskeletal syndromes in the community & NA ; In general , r and omized controlled studies concerning return to work have failed to demonstrate significant treatment effects for long‐lasting musculoskeletal pain , and most treatments examined have not been economically beneficial . Individuals ( n=654 ) sick‐listed for at least 8 weeks with musculoskeletal pain , selected from the Norwegian m and atory sickness insurance system and volunteering to participate , were categorized into three groups differing in a prognosis score ( good , medium , poor ) for return to work , based on a brief , st and ardized screening of psychological and physiotherapy findings . They were then r and omly assigned to three outpatient treatments with three different levels of intensity ( ordinary treatment , light multidisciplinary , and extensive multidisciplinary treatment ) . The evaluation was based on 14 months follow‐up data on return to work collected from social security records . The patients with good prognosis for return to work do equally well with ordinary treatment as with the two more intensive treatments . The patients with medium prognosis benefit equally from the two multidisciplinary treatments . The patients with poor prognosis receiving extensive multidisciplinary treatment returned to work at a higher rate than patients with poor prognosis receiving ordinary treatment , 55 vs. 37 % ( P<0.05 ) at 14 months . Multidisciplinary treatment  is effective concerning return to work , when given to patients who are most likely to benefit from that treatment . Measures of pain or quality of life are not included in this study . The cost – benefit analysis of the economic returns of the light multidisciplinary and the extensive multidisciplinary treatment programs yields a positive net present social value of the treatment . A simple , st and ardized , screening instrument including only psychological and physiotherapeutic observations may be a useful clinical tool for allocating patients with musculoskeletal pain to the right level of treatment Sickness absenteeism caused by musculoskeletal disorders ( MSDs ) is a persistent and costly occupational health challenge . In a prospect i ve controlled trial , we compared the effects on sickness absenteeism of a more proactive role for insurance case managers as well as workplace ergonomic interventions with that of traditional case management .  Patients with physician-diagnosed MSDs were r and omized either to the  intervention group or  the reference group offered the traditional case management routines . Participants filled out a comprehensive question naire at the initiation of the study and after 6 months . In addition , administrative data were collected at 0 , 6 , and 12 months after the initiation of the project . For the entire 12-month period , the total mean number of sick days for the intervention group was 144.9 ( SEM 11.8 ) days/person as compared to 197.9 ( 14.0 ) days in the reference group ( P < 0.01 ) . Compared with the reference group , employees in the intervention group significantly more often received a complete rehabilitation investigation ( 84 % versus 27 % ) . The time for doing this was reduced by half ( 59.4 ( 5.2 ) days versus 126.8 ( 19.2 ) , P < .01 ) . The odds ratio for returning to work in the intervention group was 2.5 ( 95 % confidence interval 1.2–5.1 ) as compared with the reference group . The direct cost savings were USD 1195 per case , yielding a direct benefit-to-cost ratio of 6.8 . It is suggested that the management of MSDs should to a greater degree focus on early return to work and building on functional capacity and employee ability . Allowing the case managers a more active role as well as involving an ergonomist in workplace adaptation meetings might also be beneficial Objectives : To identify risk factors for new episodes of sick leave due to neck or back pain . Methods : This prospect i ve study comprised an industrial population of 2187 employees who were followed up at 18 months and 3 years after a comprehensive baseline measurement . The potential risk factors comprised physical and psychosocial work factors , health-related and pain-related characteristics and lifestyle and demographic factors . The response rate at both follow-ups was close to 73 % . Results : At the 18-month follow-up , 151 participants reported at least one episode of sick-listing due to neck or back pain during the previous year . Risk factors assessed at baseline for sick leave due to neck or back pain at the follow-up were blue-collar work , back pain one or several times during the previous year , 1–99 days of cumulative sickness absence during the previous year ( all causes except neck or back pain ) , uncertainty of one ’s own working ability in 2 years ’ time and the experience of few positive challenges at work . After 3 years , 127 participants reported at least one episode of sick leave due to back or neck pain during the year previous to follow-up . The risk factors for this pain-related sick leave were blue-collar work , several earlier episodes of neck pain , no everyday physical activities during leisure time ( cleaning , gardening and so on ) , lower physical functioning and , for blue-collar workers separately , repetitive work procedures . Conclusion : The most consistent risk factors for new episodes of sick leave due to neck or back pain found during both the follow-ups were blue-collar work and several earlier episodes of neck or back pain assessed at baseline . Preventive efforts to decrease sick leave due to neck or back pain may include measures to increase the occurrence of positive challenges at work and to minimise repetitive work procedures . An evidence -based secondary prevention of neck and back pain including advice to stay active is also warranted We evaluated a participatory ergonomic intervention process applied in 59 municipal kitchens . In groups of three to five kitchens , the workers participated in eight workshops , and generated and evaluated solutions to optimize musculoskeletal load in their work . An ergonomist initiated and supported the process . By the end , 402 changes were implemented . Evaluative data were collected using research diaries , question naires , and focus group interviews . The intervention model proved feasible and the participatory approach was mostly experienced as motivating . The workers ' knowledge and awareness of ergonomics increased , which improved their ability to tackle ergonomic problems by themselves . The changes in ergonomics were perceived to decrease physical load and improve musculoskeletal health . As hindering factors for implementation , lack of time and motivation , and insufficient financial re sources were mentioned . In addition , the workers expressed a wish for more support from the management , technical staff , and ergonomists In a r and omized controlled study multimodal cognitive behavioral treatment ( MMCBT ) , including physical treatment , cognitive behavioral modification , education , and examination of the work situation for each patient , was given to patients sick-listed for musculoskeletal pain ( n = 469 ) . Patients were recruited through the National Insurance System . After a pre-test by an independent physiotherapist the patients were allocated at r and om to the  intervention group ( n = 312 ) or the control group ( n = 157 ) . The MMBCT program lasted for 4 weeks . The control group returned to their general practitioners , without any feedback or advice on therapy from the project . At the one year follow-up the MMCBT group had not returned to work at a higher rate than the control group receiving ordinary treatment available through their general practitioners . However , the MMCBT group had improved their ergonomic behavior , work potential , life quality , physical , and psychological health Objective : The present study sought to determine whether job insecurity is associated with personality traits and beliefs . In addition , it was tested whether aspects of personality confounded the relationships between job insecurity and health , or moderated this association . Methods : At the first data collection , 5163 persons participated , and at the second data collection , 1946 persons of a r and om sample participated . Data were obtained from Oslo Health Study . Results : The job insecurity aspect concerning confidence in having a good job in 2 years was more strongly related to the health variables , and particularly with mental distress , compared with other aspects of job insecurity . Type-A behavior predicted an increase in upper back pain ( & bgr ; 0.07 ) , while optimism predicted a change in lower back pain ( & bgr ; −0.07 ) . Conclusions : Job insecurity is associated with health ; this association is strongest for mental distress and self-reported health , and weaker for back-pain 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 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 Study design . Population -based r and omized controlled trial . Objective . To assess the effectiveness of workplace intervention and grade d activity , separately and combined , for multidisciplinary rehabilitation of low back pain ( LBP ) . Summary of Background Data . Effective components for multidisciplinary rehabilitation of LBP are not yet established . Methods . Participants sick-listed 2 to 6 weeks due to nonspecific LBP were r and omized to workplace intervention ( n = 96 ) or usual care ( n = 100 ) .  Workplace intervention consisted of workplace assessment , work modifications , and case management involving all stakeholders . Participants still sick-listed at 8 weeks were r and omized for grade d activity  ( n = 55 ) or usual care ( n = 57 ) . Grade d activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles . Outcomes were lasting return to work , pain intensity and functional status , assessed at baseline , and at 12 , 26 , and 52 weeks after the start of sick leave . Results . Time until return to work for workers with workplace intervention was 77 versus 104 days ( median ) for workers without this intervention ( P = 0.02 ) . Workplace intervention was effective on return to work ( hazard ratio = 1.7 ; 95 % CI , 1.2–2.3 ; P = 0.002 ) .  Grade d activity had a negative effect on return to work ( hazard ratio = 0.4 ; 95 % CI , 0.3–0.6 ; P < 0.001 ) and functional status . Combined intervention had no effect . Conclusion . Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP . Grade d activity or combined intervention is not advised Introduction In Denmark , the magnitude and impact of work disability on the individual worker and society has prompted the development of a new “ coordinated and tailored work rehabilitation ” ( CTWR ) approach . The aim of this study was to compare the effects of CTWR with conventional case management ( CCM ) on return-to-work of workers on sick leave due to musculoskeletal disorders ( MSDs ) . Methods The study was a r and omized controlled trial with economic evaluation undertaken with workers on sick leave for 4–12 weeks due to MSDs . CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan . The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up . Secondary outcomes were work status as well as pain intensity and functional disability , measured at baseline , 3 and 12 months follow-up . The economic evaluation ( intervention costs , productivity loss , and health care utilization costs ) was based on administrative data derived from national registries . Results For the time intervals 0–6 months , 6–12 months , and the entire follow-up period , the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group . The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up . Conclusions Workers on sick leave for 4–12 weeks due to MSD who underwent “ CTWR ” by an interdisciplinary team had fewer sickness absence hours than controls . The economic evaluation showed that — in terms of productivity loss — CTWR seems to be cost saving for the society This paper review s the ergonomic and psychosocial factors that affect musculoskeletal disorders at the workstation . First is a model of a physiological assessment protocol that incorporated SEMG monitoring while working at the computer . Next is a study that showed that participants lack awareness of their muscle tension as compared to the actual SEMG levels . The final study illustrated how an intervention program can reduce RSI symptoms , decrease respiration rate , and lower SEMG activity . Recommendations include suggestions that successful safety and prevention programs need multiple components and that participants should to be trained to control physiological responses with respiration and SEMG biofeedback . All participants should master these physiological skills just as they learn how to use the computer 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
target: Thus , WIs were seldom design ed to improve return-to-work .
  Overall , there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity .
  If present , significant results in favour of WIs were not sustained across follow-up times .
  Overall , this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term , which was not sustained over time .
background: BACKGROUND Musculoskeletal disorders are the most common cause of disability in many industrial countries .
  Recurrent and chronic pain accounts for a substantial portion of workers ' absenteeism .
  Neck pain seems to be more prominent in the general population than previously known .
  OBJECTIVES To determine the effectiveness of workplace interventions ( WIs ) in adult workers with neck pain .