title: Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Effectiveness of an ergonomic intervention on the productivity of workers with upper-extremity disorders--a randomized controlled trial. Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting Supplementary breaks and stretching exercises for data entry operators: a follow-up field study. The Effect of Worksite Physical Activity Intervention on Physical Capacity, Health, and Productivity: A 1-Year Randomized Controlled Trial Effect of contrasting physical exercise interventions on rapid force capacity of chronically painful muscles. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial. An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study Musculoskeletal work disability for clinicians: time course and effectiveness of a specialized intervention program by diagnosis. Effect of keyboard keyswitch design on hand pain. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial Integrated health programme: a workplace randomized controlled trial. Randomized Controlled Trial of Workplace-based Rehabilitation for Work-related Rotator Cuff Disorder Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial 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 Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders Cost-effectiveness of postural exercise therapy versus physiotherapy in computer screen-workers with early non-specific work-related upper limb disorders (WRULD); a randomized controlled trial Effects on physical performance and pain from three dynamic training programs for women with work-related trapezius myalgia. Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders. Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial. Hypnotically-induced vasodilation in the treatment of repetitive strain injuries. Reduction of Pain-Related Disability in Working Populations: A Randomized Intervention Study of the Effects of an Educational Booklet Addressing Psychosocial Risk Factors and Screening Workplaces for Physical Health Hazards Effects of Training on Female Trapezius Myalgia: An Intervention Study With a 3-Year Follow-up Period 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 Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. The cost-effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on recovery from neck and upper limb symptoms and pain reduction in computer workers Prognostic indicators for non-recovery of non-traumatic complaints at arm, neck and shoulder in general practice--6 months follow-up. Low-dose amitriptyline for treatment of persistent arm pain due to repetitive use Office ergonomics training and a sit-stand workstation: effects on musculoskeletal and visual symptoms and performance of office workers. Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. Dose-response relationship of specific training to reduce chronic neck pain and disability. Active or passive physiotherapy for occupational cervicobrachial disorders? A comparison of two treatment methods with a 1-year follow-up. Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up Effect of two contrasting types of physical exercise on chronic neck muscle pain. Quantitative Synthesis in Systematic Reviews Responsiveness of functional status in low back pain: a comparison of different instruments Changes in Cognitive-Behavioral Factors and Muscle Activation Patterns after Interventions for Work-Related Neck-Shoulder Complaints: Relations with Discomfort and Disability Treatment of Hand and Wrist Pain The effect of workplace intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders. A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. Health-related effects of early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Effects of intermittent stretching exercises at work on musculoskeletal pain associated with the use of a personal computer and the influence of media on outcomes. 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 Follow-up of neck and shoulder pain among sewing machine operators: The Los Angeles garment study. Cognitive-behaviour therapy in the treatment of chronic, occupational pain of the upper limbs: a 2 yr follow-up. The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders Does group gymnastics at the workplace help in neck pain? A controlled study. Cluster trials in implementation research: estimation of intracluster correlation coefficients and sample size. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Effects of ergonomic intervention in work with video display units. A randomized controlled intervention trial to relieve and prevent neck/shoulder pain. A Randomized Controlled Trial Evaluating the Effects of New Task Chairs on Shoulder and Neck Pain Among Sewing Machine Operators: The Los Angeles Garment Study Social and psychological factors influenced the course of arm, neck and shoulder complaints. Perceived pain before and after three exercise programs – a controlled clinical trial of women with work-related trapezius myalgia Rehabilitation of neck-shoulder pain in women industrial workers: a randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training. Cognitive-behavior therapy in the management of chronic, occupational pain of the upper limbs. Health-related effects of worksite interventions involving physical exercise and reduced workhours. One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. A controlled study of the effect of neck school in medical secretaries. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. Effects of different psychological interventions on neck, shoulder and low back pain in female hospital staff.
abstract: OBJECTIVE To compare the effects of manual therapy and stretching exercise on neck pain and disability . DESIGN An examiner-blinded r and omized cross-over trial . PATIENTS A total of 125 women with non-specific neck pain . METHODS PATIENTS were r and omized into 2 groups . Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week . After 4 weeks the treatments were changed . The follow-up times were after 4 and 12 weeks . Neck pain ( visual analogue scale ) and disability indices were measured . RESULTS Mean value ( st and ard deviation ) for neck pain was 50 mm ( 22 ) and 49 mm ( 19 ) at baseline in Group 1 and Group 2 , respectively , and decreased during the first 4 weeks by 26 mm ( 95 % Confidence Interval 20 - 33 ) and 19 mm ( 12 - 27 ) , respectively . There was no significant difference between groups . Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy ( p=0.01 ) as well as neck stiffness ( p=0.01 ) . CONCLUSION Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain . The difference in effectiveness between the 2 treatments was minor . Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain , at least in the short-term STUDY DESIGN A prospect i ve r and omized clinical trial . OBJECTIVE To compare the effectiveness of 2 physical therapy treatment approaches for impingement syndrome of the shoulder . BACKGROUND Manual physical therapy combined with exercise is a commonly applied but currently unproven clinical treatment for impingement syndrome of the shoulder . METHODS AND MEASURES Thirty men and 22 women ( age 43 years + /- 9.1 ) diagnosed with shoulder impingement syndrome were r and omly assigned to 1 of 2 treatment groups . The exercise group performed supervised flexibility and strengthening exercises . The manual therapy group performed the same program and received manual physical therapy treatment . Both groups received the selected intervention 6 times over a 3-week period . The testers , who were blinded to group assignment , measured strength , pain , and function before treatment and after 6 physical therapy visits . Strength was a composite score of isometric strength tests for internal rotation , external rotation , and abduction . Pain was a composite score of visual analog scale measures during resisted break tests , active abduction , and functional activities . Function was measured with a functional assessment question naire . The visual analog scale used to measure pain with functional activities and the functional assessment question naire were also measured 2 months after the initiation of treatment . RESULTS Subjects in both groups experienced significant decreases in pain and increases in function , but there was significantly more improvement in the manual therapy group compared to the exercise group . For example , pain in the manual therapy group was reduced from a pretreatment mean ( + /- SD ) of 575.8 ( + /- 220.0 ) to a posttreatment mean of 174.4 ( + /- 183.1 ) . In contrast , pain in the exercise group was reduced from a pretreatment mean of 557.1 ( + /- 237.2 ) to a posttreatment mean of 360.6 ( + /- 272.3 ) . Strength in the manual therapy group improved significantly while strength in the exercise group did not . CONCLUSION Manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial is better than exercise alone for increasing strength , decreasing pain , and improving function in patients with shoulder impingement syndrome OBJECTIVES The aim of this study was to investigate the effectiveness of an ergonomic intervention on  productivity loss at work caused by upper-extremity disorders ( UED ) . METHODS Workers with medically verified UED were invited to participate . The intervention consisted of a physician contacting the worker 's supervisor and an occupational physiotherapist conducting an ergonomic assessment at the worksite . Before and after the intervention , the employees self-assessed UED-related productivity loss ( ie , decreased quality and quantity of the daily work output ) . We tested for differences between groups at 8 and sub-sequently 12 weeks . We also applied generalized estimating equation ( GEE ) to analyze repeated measures data . RESULTS Altogether 177 employees were r and omized . The overall participation rate was 88 % . At baseline , 54 % of the intervention group and 58 % of the control group reported productivity loss . The magnitude of productivity loss was 17 % and 20 % , respectively . At 8 weeks , both the proportion and magnitude of productivity loss were lower in the intervention than the control group , but the differences were statistically significant only at 12 weeks ( proportion 25 % versus 51 % , magnitude 7 % versus 18 % , P=0.001 for both ) . Using GEE analyses , we also found the differences to be statistically significant ( proportion 38 % versus 52 % , magnitude 12 % versus 18 % ) . The intervention only benefitted employees with 0 - 20 % loss of productivity at baseline , not those with a higher initial productivity loss . CONCLUSIONS Early ergonomic intervention , in addition to adequate medical care , is effective in preventing and restoring self-reported productivity loss associated with UED Background Arm , shoulder and neck symptoms are very prevalent among computer workers . In an attempt to reduce these symptoms , a large occupational health service in the Netherl and s developed a preventive programme on exposure to risk factors , prevalence of arm , shoulder and neck symptoms , and sick leave in computer workers . The purpose of this study was to assess the effectiveness of this intervention programme . Methods The study was a r and omised controlled trial . The participants were assigned to either the intervention group or the usual care group by means of cluster r and omisation . At baseline and after 12 months of follow-up , the participants completed the RSI QuickScan question naire on exposure to the risk factors and on the prevalence of arm , shoulder and neck symptoms . A tailor-made intervention programme was proposed to participants with a high risk profile at baseline . Examples of implemented interventions are an individual workstation check , a visit to the occupational health physician and an education programme on the prevention of arm , shoulder and neck symptoms . The primary outcome measure was the prevalence of arm , shoulder and neck symptoms . Secondary outcome measures were the scores on risk factors for arm , shoulder and neck symptoms and the number of days of sick leave . Sick leave data was obtained from the companies . Multilevel analyses were used to test the effectiveness . Results Of the 1,673 persons invited to participate in the study , 1,183 persons ( 71 % ) completed the baseline question naire and 741 persons participated at baseline as well as at 12-month follow-up . At 12-month follow-up , the intervention group showed a significant positive change ( OR = 0.48 ) in receiving information on healthy computer use , as well as a significant positive change regarding risk indicators for work posture and movement , compared to the usual care group . There were no significant differences in changes in the prevalence of arm , shoulder and neck symptoms or sick leave between the intervention and usual care group . Conclusions The effects of the RSI QuickScan intervention programme were small , possibly as a result of difficulties with the implementation process of the proposed interventions . However , some significant positive effects were found as to an increase in receiving education and a decrease in exposure to adverse postures and movements . With regard to symptoms and sick leave , only small and non-significant effects were found . Trial registration Netherl and s National Trial Register BACKGROUND This study exp and ed previous NIOSH-IRS research examining the effects of rest breaks and stretching exercises on symptoms and performance in data -entry workers . METHODS All workers spent 4 weeks with conventional breaks ( two 15 min breaks per day ) and 4 weeks with supplementary breaks ( two 15 min breaks plus four 5 min breaks per day ) . One-half were assigned at r and om to a group instructed to perform brief stretching exercises during breaks . The remainder comprised the " no stretching " ( control ) group . RESULTS 51 workers ( stretch group n = 21 ; no stretch group n = 30 ) completed the study symptom question naires . Discomfort and eyestrain were significantly lower with supplementary breaks , and supplementary breaks attenuated accumulation of discomfort and eyestrain during work sessions . Data -entry speed was significantly faster with supplementary breaks so that work output was maintained , despite replacing 20 min of work time with break time . In the stretch group , workers reported  stretching  during only 25 % of conventional breaks and 39 % of supplementary breaks , and no significant effects of stretching on discomfort or performance were observed . CONCLUSIONS These results provide further converging evidence that supplementary breaks reliably minimize discomfort and eyestrain without impairing productivity . Low compliance in performing stretches prevented valid assessment of stretching effects . Further research on stretching exercises and exercise compliance is warranted Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity Rapid force capacity of chronically painful muscles is inhibited markedly more than maximal force capacity and is therefore relevant to assess in rehabilitation setting s. Our objective was to investigate the effect of two contrasting types of physical exercise on rapid force capacity , as well as neural and muscular adaptations in women with chronic neck muscle pain . A group of employed women ( n = 42 ) with a clinical diagnosis of trapezius myalgia participated in a 10-wk r and omized controlled trial ; specific strength training of the neck/shoulder muscles , general fitness training performed as leg-bicycling ; or a reference intervention without physical activity . Maximal voluntary shoulder abductions were performed at static angles of 35 degrees and 115 degrees with simultaneous recording of electromyography ( EMG ) in the trapezius and deltoid . Maximal muscle strength and activation ( peak torque and peak EMG ) as well as rapid muscle strength and activation [ rate of torque development ( RTD ) and rate of EMG rise ] were subsequently determined . Trapezius muscle fiber characteristics were determined with ATPase histochemistry . Significant changes were observed only in the specific strength training group . Whereas peak torque increased 18 - 29 % ( P < 0.01 ) , RTD increased 61 - 115 % ( P < 0.001 ) . Peak EMG and rate of EMG rise increased correspondingly ( P < 0.05 - 0.001 ) , and trapezius type II muscle fibers hypertrophied 20 % ( P < 0.001 ) . In conclusion , rapid force capacity of chronically painful muscles is highly responsive to rehabilitation with specific strength training . The underlying mechanisms were related to both pain reduction and general neuromuscular adaptations to strength training . Potentially , the present method can be a useful clinical screening tool of muscle function in rehabilitation setting UNLABELLED We investigated the effectiveness of cupping , a traditional method of treating musculoskeletal pain , in patients with carpal tunnel syndrome ( CTS ) in an open r and omized trial . n = 52 out patients ( 58.5 + /- 8.0 years ) with neurologically confirmed CTS were r and omly assigned to either a verum ( n = 26 ) or a control group ( n = 26 ) . Verum patients were treated with a single application of wet cupping , and control patients with a single local application of heat within the region overlying the trapezius muscle . Patients were followed up on day 7 after treatment . The primary outcome , severity of CTS symptoms ( VAS ) , was reduced from 61.5 + /- 20.5 to 24.6 + /- 22.7 mm at day 7 in the cupping group and from 67.1 + /- 20.2 to 51.7 + /- 23.9 mm in the control group [ group difference -24.5 mm ( 95%CI -36.1 ; -2.9 , P < .001 ) ] . Significant treatment effects were also found for the Levine CTS-score ( -.6 pts : 95%CI -.9 ; -.2 , P = .002 ) , neck pain ( -12.6 mm ; 95%CI -18.8 ; -6.4 , P < .001 ) , functional disability ( DASH-Score ) ( -11.1 pts ; 95%CI -17.1 ; -5.1 , P < .001 ) , and physical quality of life ( .3 ; 95%CI .0 ; .3 , P = .048 ) . The treatment was safe and well tolerated . We conclude that cupping therapy may be effective in relieving the pain and other symptoms related to CTS . The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified . PERSPECTIVE The results of a r and omized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented . Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome Objective : To investigate the effect of noxious level electrical stimulation on pain , grip strength and functional abilities in subjects with chronic lateral epicondylitis . Design : R and omized , placebo-control , double-blinded study . Setting : Physical Therapy Department , North Georgia College and State University . Subjects : Eighteen subjects with chronic lateral epicondylitis between the ages of 24 and 72 years participated in this study . Subjects were r and omly assigned into treatment or placebo groups . Interventions : Subjects received six sessions of low-frequency electrical stimulation over the palpated tender points . The intensity of electrical stimulation was set at 0 in the placebo group . Main measurements : Grip strength , functional status , pain intensity and limited activity due to pain were assessed before and after treatment . Six-month follow-up data were collected in treatment group only . Results : Both clinical ly and statistically significant improvements in average grip strength were found ( treatment group : 28 % increase ; placebo group : 2.5 % decrease ; P=0.04 ) , functional activity ( treatment group : 110 % increase ; placebo group : 22 % increase ; P= 0.003 ) , pain intensity ( treatment group : 3.1 point decrease ; placebo group : 0.2 point increase ; P=0.01 ) and activity limitation due to pain ( treatment group : 4.1 points increase ; placebo group : 1.9 point decrease ; P= 0.003 ) between the treatment and placebo groups . Follow-up data showed that 100 % of subjects maintained the improved function , and 83 % remained pain-free for at least six months post treatment . Conclusion : The results of this study indicated that symptoms of chronic lateral epicondylitis could be effectively treated by noxious level low-frequency electrical stimulation OBJECTIVE To evaluate how an intervention program modifies the clinical course of work disability in musculoskeletal diagnoses . METHODS All patients with temporary work disability related to musculoskeletal disorders ( MSDs ) in 3 health districts of Madrid , Spain were r and omized into st and ard care ( control group ) or the intervention group . Intervention consisted of a specific program , run by rheumatologists , following detailed proceedings . Inclusion and followup lasted 12 months each . According to the cause , every temporary work disability episode was classified into 11 syndrome categories . For each we calculated efficacy , as the difference between groups in the number of days on sick leave per temporary work disability episode ; relative efficacy , or the percentage of days saved in the intervention group ; and time of maximum program effect . Analyses were performed on an intent-to-treat basis . Survival techniques were run and results were expressed as the hazard ratio ( HR ) in the intervention versus control group . RESULTS A total of 13,077 patients were included , generating 16,297 temporary work disability episodes .  The most frequent cause was back pain . Temporary work disability episodes were significantly shorter in the intervention group than in the controls in all syndrome categories except knee pain ( excluding osteoarthritis ) . Program relative efficacy varied from 28 - 72 % . The program was highly efficacious in carpal tunnel syndrome ( HR 2.09 , 95 % confidence interval [ 95 % CI ] 1.17 - 3.75 ) , peripheral osteoarthritis ( HR 1.58 , 95 % CI 1.14 - 2.19 ) , and inflammatory diseases ( HR 1.52 , 95 % CI 1.09 - 2.12 ) . The maximum effect of the program always took place within the first 2 months . CONCLUSION The implementation of this type of specialist-run , protocol -based early intervention program would be very beneficial in the treatment of patients with work disability related to MSDs , except for those with knee pain ( excluding osteoarthritis ) 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 Abstract Objective To determine the effectiveness of dynamic muscle training and relaxation training for  chronic neck pain .  Design R and omised controlled trial . Setting Five occupational healthcare centres , Tampere , Finl and . Participants 393 female office workers ( mean age 45 years ) with chronic non-specific neck pain r and omly assigned to 12 weeks of dynamic muscle training ( n = 135 ) or relaxation training ( n = 128 ) , plus one week of reinforcement training six months after baseline ; or ordinary activity ( control group ; n = 130 ) . Main outcome measure Change in intensity of neck pain at three , six , and 12 months . Results No significant difference was found in neck pain between the groups at follow up . However , the range of motion for cervical rotation and lateral flexion increased more in the training groups than in the control group . Conclusions Dynamic muscle training and relaxation training do not lead to better improvements in neck pain compared with ordinary activity AIM This paper is the report of a pilot study to assess if an Integrated Health Programme would reduce sick leave and subjective health complaints , and increase coping in a population of nursing personnel . BACKGROUND . The work group in Norway with most sick leave is healthcare workers . More than 50 % of the sick leave is because of subjective health complaints . Work place physical exercise interventions have a documented positive effect on sick leave . METHOD After baseline screening , employees who had agreed to participate ( n=40 ) were r and omized to an intervention or control group . The intervention group participated in an Integrated Health Programme twice weekly during working hours . The programme consisted of physical exercise , stress management training , health information and an examination of the participants ' workplace . The control group was offered the same intervention after the project was finished . This study was carried out from 2001 to 2002 . FINDINGS There were no statistically significant effects on sick leave or health-related quality of life . The intervention group reported fewer neck complaints compared to the control group , but otherwise there were no effects on subjective health complaints . However , the subjective effects were large and highly statistically significant , the intervention group reporting improvement in health , physical fitness , muscle pain , stress management , maintenance of health and work situation . CONCLUSION The Integrated Health Programme was not effective in reducing sick leave and subjective health complaints , but may be of use to employers wanting to increase employee job satisfaction and well-being Introduction Return to work following an occupational injury is a multifactoral process although many traditional clinic-based rehabilitation programs do not appreciate the importance of workplace factors . A r and omized controlled trial was conducted to investigate the effect of workplace-based rehabilitation program on the return to work outcome of work-related rotator cuff disorder , which is based on the therapeutic use of actual work facilities and work environment . Methods A total of 103 workers were recruited and r and omly assigned into Clinic-based Work Hardening ( CWH ) or Workplace-based Work Hardening ( WWH ) groups . The CWH group were given traditional generic work hardening training while WWH group received workplace-based work hardening training with rehabilitative principles of athletic rotator cuff pathology , biomechanics and specific job activities . Results After four weeks , a higher return to work rate was obtained in WWH group compared to CWH group ( 71.4 % vs. 37 % , p < 0.01 ) . A statistically significant difference ( p < 0.05 ) was also noted in lowering of self-reported shoulder problems and functional work capabilities in the WWH group versus the CWH group . Conclusion Workplace-based rehabilitation program appeared to be more effective in facilitating the return to work process of the injured worker as assessed immediately following intervention . In particular this approached was associated with many of the psychosocial workplace factors related to separation from the work routine . The influence of peer group and /or employer could be minimized . This initial attempt with rotator cuff injuries appears promising however long-term outcome needs to be determined Purpose The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders ( WUEMSDs )  among computer workers . Methods Four hundred computer workers answered a question naire on work-related upper extremity musculoskeletal symptoms ( WUEMSS ) . Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospect i ve , r and omized controlled 6-month intervention . Body posture and workstation layouts were assessed by the Ergonomic Question naire . We used the Visual Analogue Scale to assess the intensity of WUEMSS . The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities . Health-related quality of life was assessed with the Short Form-36 . After baseline assessment , those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions , an ergonomic training brochure , and workplace visits with workstation adjustments . Follow-up assessment was conducted after 6 months . Results In the intervention group , body posture ( p < 0.001 ) and workstation layout ( p = 0.002 ) improved over 6 months ; furthermore , intensity ( p < 0.001 ) , duration ( p < 0.001 ) , and frequency ( p = 0.009 ) of WUEMSS decreased significantly in the intervention group compared with the control group . Additionally , the functional status ( p = 0.001 ) , and physical ( p < 0.001 ) , and mental ( p = 0.035 ) health-related quality of life improved significantly compared with the controls . There was no improvement of work day loss due to WUEMSS ( p > 0.05 ) . Conclusions Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs 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 & NA ; This study examined the relative effectiveness of EMG biofeedback , applied relaxation training and a combined procedure in the management of  chronic , upper extremity cumulative trauma disorder . Forty‐eight patients with a history of about 5–6 years of upper extremity pain were r and omly assigned to 1 of 4 treatment conditions , namely applied relaxation training , EMG biofeedback , a combined approach or a wait‐list control . Treatments were conducted on an individual basis , twice per week for 4 weeks . Patients in all 3 treatment conditions showed significant short‐term reductions in pain and psychopathology in comparison to the wait‐list group who showed minimal change . Six‐month follow‐up data were obtained for patients in the treatment conditions , but not the wait‐list group . There was some evidence of relapse on measures Of depression , anxiety and pain beliefs for treated patients during the 6‐month follow‐up period , although measures remained significantly below pre‐treatment levels for most outcome indices . Self‐monitored pain continued to decrease for the treatment groups through follow‐up . Contrary to predictions , however , the strongest short‐term treatment benefits were shown by patients receiving  applied relaxation training on measures of pain , distress , interference in daily living , depression and anxiety . By 6‐month follow‐up , differences between treatment groups were no longer evident Background Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders ( WRULD ) . Aims To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints , both from health care and societal perspective . Methods Prospect i ve r and omized trial including cost-effectiveness analysis ; one year follow-up . Participants : Eighty-eight screen-workers with early non-specific WRULD ; six drop-outs . Interventions : A ten week postural exercise program versus regular physiotherapy .  Outcome measures : Effectiveness measures : Pain : visual analogous scale ( VAS ) , self-perceived WRULD ( yes/no ) . Functional outcome : Disabilities of Arm , Shoulder and H and - Dutch Language Version ( DASH-DLV ) . Quality of life outcome : EQ-5D.Economic measures : health care costs including patient and family costs and productivity costs result ing in societal costs . Cost-effectiveness measures : health care costs and societal costs related to the effectiveness measures . Outcome measures were assessed at baseline ; three , six and twelve months after baseline . Results At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs . No significant differences between the groups concerning effectiveness at one year follow-up were found . Effectiveness scores slightly improved over time . After one year 55 % of participants were free of complaints . After one year the postural exercise group had higher mean total health care costs , but lower productivity costs compared to the physiotherapy group . Mean societal costs after one year ( therefore ) were in favor of postural exercise therapy [ - € 622 ; 95 % CI -2087 ; + 590 ) ] . After one year , only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy ; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs  , postural exercise therapy had a probability of over 80 % to be cost-effective over a wide range of cost-effectiveness ceiling ratios ; however based on a marginal QALY-difference of 0.1 over a 12 month time frame . Conclusion Although our trial failed to find significant differences in VAS , QALYs and ICERs based on VAS and QALYs at one-year follow-up , CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy ; however further research is required . Trial registration IS RCT N To compare training programs for women with trapezius myalgia regarding physical performance and pain , 102 women were r and omized to strength , endurance , co-ordination and non-training groups . Before and after the intervention , static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer . Muscle activity in shoulder muscles was monitored via surface EMG . The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax . Pain at present , pain in general and pain at worst were measured on visual analogue scales . After training , within group comparisons showed that the training groups rated less pain , and in the strength training group ratings of pain at worst differed from the non-training group . Using the non-training group as a reference , static strength increased in the strength and endurance training groups and muscular endurance in all training groups . The study indicates that regular exercises with strength , endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia 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 The theoretical framework is that muscle tension in the neck is related to insufficient muscular rest and is a risk factor for chronic pain and reduced work ability . Promoting muscle strength and muscle rest may increase work ability and reduce neck pain . Objectives To test whether myofeedback training or intensive strength training leads to decreased pain and increased work ability in women on long-term sick leave . Methods This is a r and omized controlled trial of two 1-month interventions with myofeedback or muscular strength training in the home environment . Female human service organization workers ( n = 60 ) on long-term ( > 60 days ) sick leave and with chronic neck pain were followed with self-reported and laboratory-observed data of health , pain , muscular activation , and work ability , at baseline , immediately after the intervention and 3 months after baseline . Results For both intervention groups , pain was lowered over time compared with the control group . Decreased pain and muscular activity was associated with increased self-rated work ability and with laboratory-observed work ability at 3-month follow-up . Decreased pain was also associated with increased self-rated work ability at 1-month follow-up . Muscular strength training was associated with increased self-rated work ability and mental health . Myofeedback was associated with increased observed work ability and self- rated vitality . Conclusions The two interventions showed positive results , suggesting that they could be developed for use in health care practice to address pain and work ability . The intensive muscular strength training program , which is both easy to conduct at home and easy to coach , was associated with increased work ability QUESTION Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain , reducing disability and improving health-related quality of life in visual display unit workers with early non-specific work-related upper limb disorders than strength and fitness exercises delivered by physiotherapists ? DESIGN R and omised trial with concealed allocation and intention-to-treat analysis . PARTICIPANTS Eighty-eight ( 6 drop-outs ) visual display unit workers with early non-specific work-related upper limb disorders . INTERVENTION One group received 10 weeks of postural exercises while the other group received 10 weeks of strength and fitness exercises . OUTCOME MEASURES Pain was measured with a 10-cm visual analogue scale , disability was measured with the Disabilities of Arm , Shoulder and H and question naire , and health-related quality of life was measured with the Short Form-36 . Number of participants experiencing upper limb complaints was also collected . Outcome measures were collected at baseline and again at 3 , 6 , and 12 months . RESULTS There was no significant difference in decrease in pain between the groups at 3 months ( 0.6 cm , 95 % CI 0.0 to 1.2 ) , 6 months ( 0.2 , 95 % CI -0.3 to 0.7 ) , or at 12 months ( 0.1 , 95 % CI -0.6 to 0.8 ) . Differences between the groups in upper limb complaints , disability , and health related quality of life were also small and not significant at any measurement occasion . CONCLUSION Postural exercises did not result in a better outcome than strength and fitness exercises . However , 55 % of visual display unit workers with early non-specific work-related upper limb disorders reported being free of complaints one year after both interventions were commenced . TRIAL REGISTRATION IS RCT N15872455 Background Although leisure-time physical activity is important for health , adherence to regular exercise is challenging for many adults . The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise . This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers . Methods Cluster-r and omized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain ( industrial production units ) . Participants were r and omized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week ( n = 282 ) or a control group receiving advice to stay physically active ( n = 255 ) . The strength training program followed principles of progressive overload and periodization . The primary outcome was changes in self-reported neck and shoulder pain intensity ( scale 0 - 9 ) . Results 85 % of the participants followed the strength training program on a weekly basis . In the training group compared with the control group , neck pain intensity decreased significantly ( -0.6 , 95 % CI -1.0 to -0.1 ) and shoulder pain intensity tended to decrease ( -0.2 , 95 % CI -0.5 to 0.1 , P = 0.07 ) . For pain-cases at baseline ( pain intensity > = 3 ) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up ( pain intensity < 3 ) was 2.0 ( 95 % CI 1.0 to 4.2 ) for the neck and 3.9 ( 95 % CI 1.7 to 9.4 ) for the shoulders . Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces , and results in significant reductions of neck and shoulder pain . Trial registration NCT01071980 OBJECTIVES This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks OBJECTIVES To compare the effects of biofeedback with those of active exercise and passive treatment in treating work-related neck and shoulder pain . DESIGN A r and omized controlled trial with 3 intervention groups and a control group . SETTING Participants were recruited from outpatient physiotherapy clinics and a local hospital . PARTICIPANTS All participants reported consistent neck and shoulder pain related to computer use for more than 3 months in the past year and no severe trauma or serious pathology . A total of 72 potential participants were recruited initially , of whom a smaller group of individuals ( n=60 ) completed the r and omized controlled trial . INTERVENTIONS The 3 interventions were applied for 6 weeks . In the biofeedback group , participants were instructed to use a biofeedback machine on the bilateral upper trapezius ( UT ) muscles daily while performing computer work . Participants in the exercise group performed a st and ardized exercise program daily on their own . In the passive treatment group , interferential therapy and hot packs were applied to the participants ' necks and shoulders . The control group was given an education booklet on office ergonomics . MAIN OUTCOME MEASURES Pain ( visual analog scale ) , neck disability index ( NDI ) , and surface electromyography were assessed preintervention and postintervention . Pain and NDI were reassessed after 6 months . RESULTS Postintervention , average pain and NDI scores were reduced significantly more in the biofeedback group than in the other 3 groups , and this was maintained at 6 months . Cervical erector spinae muscle activity showed significant reductions postintervention in the biofeedback group , and there were consistent trends of reductions in the UT muscle activity . CONCLUSIONS Six weeks of biofeedback training produced more favorable outcomes in reducing pain and improving muscle activation of neck muscles in patients with work-related neck and shoulder pain The study examined the effectiveness of behaviorally-induced vasodilation ( hypnosis with biofeedback and autogenics ) in the treatment of upper extremity repetitive strain injuries ( RSI ) . Thirty patients with recent onset of upper extremity RSI symptoms were r and omly assigned to 1 of 2 treatment conditions , i.e. , hypnotically-induced vasodilation or a waiting-list control . Treatments were given on an individual basis , once a week for 6 weeks . Patients in the treatment condition showed highly significant increases in h and temperature between pre- and post-treatment . Patients in the treatment condition also showed highly significant reductions in pain in comparison to the waiting list condition Study Design . Cluster r and omized controlled trial with 6 and 8 quarters of follow-up . Objective . To test the effects of giving evidence -based information addressing psychosocial risk factors for pain-related disability and of screening workplaces for physical health hazards at work on reducing new episodes and duration of pain-related and general absence taking . Summary of Background Data . The “ flag strategy ” for h and ling low back pain problems is recommended in many Western countries but , so far , r and omized intervention studies addressing psychosocial risk factors for disability related to low back pain show mixed results . Methods . We followed employees from 39 different work sites in western Denmark , who had received interventions consisting of either a carefully prepared booklet providing evidence -based information on common musculoskeletal pain problems alone or in combination with systematic workplace screening for physical work hazards .  Absence due to pain for at least 7 days and the cumulative numbers of absence days were the main outcome measures . General absence taking was analyzed , too . Company registration s of sickness absence in combination with self-report on the cause of a given absence spell was used to inform absence spells . Results . A total of 3808 of 4006 eligible employees provided information . Among 1063 participants in the control arm , 1458 in the information arm , and 1287 in the  information and workplace screening  arm , 4.6 % , 6.9 % , and 4.6 % , respectively , experienced pain-related absence , and 27.8 % , 27.2 % , and 24.0 % , respectively , experienced general absence taking during follow-up . No positive effect on the risk of the 2 measures of absence or on the cumulative duration of absence among cases was seen . Conclusion . Results did not support population -based interventions addressing psychosocial risk factors for pain-related disability alone or in combination with workplace screening as effective in reducing the risk of pain-related absence taking or the duration of absence Study Design . A prospect i ve r and omized clinical trial was conducted . Objective . To evaluate the long-term effects of three training interventions on women with work-related trapezius myalgia . Summary of Background Data . Studies with long-term follow-up evaluation of interventions for neck pain are scarce and usually cover fewer than 12 months . Methods . For this study , 126 women with work-related trapezius myalgia were r and omized into strength , muscular endurance , or coordination training or into a nontraining reference group . Intervention training occurred three times a week for 10 weeks . Assessment of pain intensity , pressure pain thresholds , symptom frequency , perceived health , and work and exercise habits was performed before and immediately after interventions , then at clinical examinations 8 months and 17 months after the interventions . Participation rates at these follow-up assessment s were 84 % and 81 % . At 3 years after the interventions , a question naire was answered by 94 % of the participants , 17 of whom were dropouts that never participated in any of the four intervention groups . Results . All the training programs showed similar pain reducing effects immediately after the interventions . Pain reductions were maintained at follow-up evaluations , but at the 8-month follow-up assessment , there were no differences between the training groups and the reference group on any variable . At 3 years after the interventions , the intervention groups did not differ from the dropout group . Almost half ( 49 % ) of the women had persistent symptoms at the 3-year follow-up assessment . Conclusions . The long-term effect of all the training programs was low . Pain in neck and shoulder muscles was persistent in a large proportion of the women over the 3 years 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 Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Objectives To evaluate the cost-effectiveness of a work style ( WS ) intervention and a work style plus physical activity ( WSPA ) intervention in computer workers with neck and upper limb symptoms compared with usual care . Methods An economic evaluation was conducted from an employer 's perspective and alongside a r and omised controlled trial in which 466 computer workers with neck and upper limb symptoms were r and omised to a WS group ( N=152 ) , a WSPA group ( N=156 ) or a usual care group ( N=158 )  . Total costs were compared to the effects on recovery and pain intensity . In the primary analyses , missing effect data were imputed using multiple imputation techniques . Results Total costs during the 12-month intervention and follow-up period were € 1907 ( WS ) , € 2811 ( WSPA ) and € 2310 ( usual care ) . Differences between groups were not statistically significant . Neither intervention was more effective than usual care in improving overall recovery .  The WS intervention was more effective than usual care in reducing current pain , average pain and worst pain in the past 4 weeks , but the WSPA intervention was not . The acceptability curve showed that when a company is willing to pay approximately € 900 for a 1-point reduction in average pain ( scale from 0 to 10 ) , the probability of cost-effectiveness compared to usual care is 95 % . Similar results were observed for current and worst pain . Conclusions This study shows that the WS intervention was not cost-effective for improving recovery but was cost-effective for reducing pain intensity , although this reduction was not clinical ly significant . The WSPA intervention was not cost-effective compared with usual care . Trial registration number IS RCT N87019406 OBJECTIVES To identify predictors of non-recovery in non-traumatic complaints at the arm , neck and shoulder in general practice 6 months after the first consultation . METHODS A prospect i ve cohort study was set in 21 Dutch general practice s. Consulters with a first or new episode of non-traumatic arm , neck or shoulder complaints and age 18 through 64 yrs entered the cohort . Complaint , patient , physical , psychosocial and work characteristics were investigated as possible predictors of non-recovery at 6 months using multiple logistic regression analyses ( backward Wald ) . RESULTS At 6 months , 46 % of the total population ( n = 612 ) and 42 % of the working sub population ( n = 473 ) still reported complaints . Complaint characteristics ( long duration of the complaint before consultation , recurrent complaint , musculoskeletal comorbidity and complaint mainly located at wrist or h and ) were most predictive of non-recovery followed by psychosocial characteristics ( more somatization and experiencing less social support ) . Having a specific diagnosis was associated with recovery . In the working sub population , the same variables were predictors of non-recovery . Additionally , low supervisory support was associated with non-recovery . The models correctly classified 72 - 75 % of the patients ( explained variance 0.27 - 0.28 ) . CONCLUSIONS Besides questions on complaint characteristics , information on somatization and support can help a general practitioner to recognize patients at risk of persistent complaints & NA ; Amitriptyline is sometimes used to treat arm pain related to repetitive use , but rigorous evidence of its benefit is lacking . This r and omized controlled trial investigated whether amitriptyline provided greater pain relief or improved arm function than a placebo pill in adults with arm pain associated with repetitive use that had persisted for at least 3 months . Participants ( N = 118 ) were r and omly assigned to receive 25 mg of amitriptyline or a placebo pill for 6 weeks . The primary outcome was intensity of pain ( 10‐point numerical rating scale ) and secondary outcomes were arm symptoms , arm function , grip strength , mood , and sleep . Assessment s were done at baseline , 3 and 6 weeks of treatment , and 1 month after the treatment ended . Changes in arm pain were not statistically significant . However , the amitriptyline group improved more than the placebo group in arm function ( p = 0.023 ) and sense of well being ( p = 0.034 ) . In a longitudinal analysis , the amitriptyline group 's arm function score improved 0.45 points per week faster than placebo after adjusting for subject characteristics ( p = 0.015 ) . At the treatment 's midpoint , the amitriptyline group reported more “ troublesome side‐effects ” than the placebo group ( 52.5 % vs. 27.1 % , p = 0.005 ) , but this difference decreased by the end of the treatment ( 30.5 % vs. 22.0 % , p = 0.30 ) . The most frequent side effect was drowsiness . In conclusion , this study found that low‐dose amitriptyline did not significantly decrease arm pain among these participants but did significantly improve arm function and well being . Future research is needed to explore the effects of higher doses and longer duration of treatment Work Related Musculoskeletal Disorders ( WMSDs ) among office workers with intensive computer use is widespread and the prevalence of symptoms is growing . This r and omized controlled trial investigated the effects of an office ergonomics training combined with a sit-st and workstation on musculoskeletal and visual discomfort , behaviors and performance .  Participants performed a lab-based customer service job for 8 h per day , over 15 days and were assigned to :  Ergonomics Trained ( n = 11 ) or Minimally Trained ( n = 11 ) . The training consisted of : a 1.5-h interactive instruction , a sit/st and practice period , and ergonomic reminders . Ergonomics Trained participants experienced minimal musculoskeletal and visual discomfort across the 15 days , varied their postures , with significantly higher performance compared to the Minimally Trained group who had a significantly higher number of symptoms , suggesting that training plays a critical role . The ability to mitigate symptoms , change behaviors and enhance performance through training combined with a sit-st and workstation has implication s for preventing discomforts in office workers This study investigated effects of physical exercise on  musculoskeletal pain symptoms in all regions of the body , as well as on other musculoskeletal pain in association with neck pain . A single blind r and omized controlled trial testing a one-year exercise intervention was performed among 549 office workers ;  specific neck/shoulder resistance training , all-round physical exercise , or a reference intervention . Pain symptoms were determined by question naire screening of twelve selected body regions . Case individuals were identified for each body region as those reporting pain intensities at baseline of 3 or more ( scale of 0 - 9 ) during the last three months . For neck cases specifically , the additional number of pain regions was counted . Intensity of pain decreased significantly more in the neck , low back , right elbow and right h and in cases of the two exercise groups compared with the reference group ( P<0.0001 - 0.05 ) . The additional number of pain regions in neck cases decreased in the two exercise groups only ( P<0.01 - 0.05 ) . In individuals with no or minor pain at baseline , development of pain was minor in all three groups . In conclusion , both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body PURPOSE To examine the dose-response relationship of specific strength- and endurance-training regimes for the cervical muscles , which have been shown to be effective among women with chronic neck pain and disability . METHODS A total of 180 female office workers , aged 25 to 53 yr , with chronic neck pain and disability were r and omized into a strength-training , an endurance-training , and a control group . The training groups participated in a 12-d rehabilitation period , in which instructions for the exercises were given by an experienced physical therapist . Both training groups continued with exercises at home for 12 months . Physical activity was measured with a training diary and a 1-month all-time recall question naire . All activities were registered and converted into metabolic equivalents ( METs ) . RESULTS Specific neck , shoulder , and upper-extremity training for more than 8.75 MET.h.wk was an effective training dose for decreasing neck pain . One MET-hour of training per week accounted for an 0.8-mm decrease of neck pain on a visual analog scale ( VAS ) and a 0.5-mm decrease on a disability index . Both strength and endurance training decreased perceived neck pain and disability . Declines in neck pain and disability correlated positively with the amount of specific training . CONCLUSION This study revealed that the described specific exercise protocol s were associated with decreases in chronic neck pain and disability . The effective dose of training was feasible and safe to perform among female office workers In this study 169 female office employees were interviewed and examined to determine the occurrence and severity of neck and shoulder symptoms . Forty-seven of those with symptoms who fulfilled the criteria taken as indicating need for treatment were enrolled in a controlled clinical trial and divided into two groups . One group participated in dynamic muscle training of neck and shoulder muscles ( active physiotherapy ) . The other patients were treated by means of surface heat , massage , and stretching ( passive physiotherapy ) .  Pain in the neck and shoulder regions disappeared significantly more often just after active treatment as compared to passive treatment . Symptoms returned within three months in both groups . However , after 12 months , the incidence of headache was significantly less in the group that had received active physiotherapy . Maximal isometric muscle strength in relation to cervical lateral flexion and extension and grip strength and endurance force of shoulder muscles improved significantly after active physiotherapy , but only maximal isometric extension force increased significantly after passive physiotherapy .  Numbers of tender points in neck and shoulder muscles decreased significantly after both types of physiotherapy . Pressure threshold levels increased but not significantly in both groups during treatment 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 OBJECTIVE The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work . Physical exercise is generally recommended as treatment , but it is unclear which type of training is most effective . Our objective was to determine the effectiveness of specific strength training of the painful muscle versus general fitness training without direct involvement of the painful muscle ( leg bicycling ) on work-related neck muscle pain . METHODS We conducted a r and omized controlled trial and recruited subjects from 7 workplaces characterized by monotonous jobs ( e.g. , computer-intensive work ) . Forty-eight employed women with chronic neck muscle pain ( defined as a clinical diagnosis of trapezius myalgia ) were r and omly assigned to 10 weeks of specific strength training locally for the affected muscle , general fitness training performed as leg bicycling with relaxed shoulders , or a reference intervention without physical activity . The main outcome measure was an acute and prolonged change in intensity of neck muscle pain ( 100-mm visual analog scale [ VAS ] ) . RESULTS A decrease of 35 mm ( approximately 79 % ; P<0.001 ) in the worst VAS pain score over a 10-week period was seen with specific strength training , whereas an acute and transient decrease in pain ( 5 mm ; P<0.05 ) was found with general fitness training . CONCLUSION Specific strength training had high clinical relevance and led to marked prolonged relief in neck muscle pain .  General fitness training showed only a small yet statistically significant acute pain reduction A quantitative systematic review , or meta- analysis , uses statistical methods to combine the results of multiple studies . Meta-analyses have been done for systematic review s of therapeutic trials , diagnostic test evaluations , and epidemiologic studies . Although the statistical methods involved may at first appear to be mathematically complex , their purpose is simple : They are trying to answer four basic questions . Are the results of the different studies similar ? To the extent that they are similar , what is the best overall estimate ? How precise and robust is this estimate ? Finally , can dissimilarities be explained ? This article provides some guidance in underst and ing the key technical aspects of the quantitative approach to these questions . We have avoided using equations and statistical notations ; interested readers will find implementations of the described methods in the listed references . We focus here on the quantitative synthesis of reports of r and omized , controlled , therapeutic trials because far more meta-analyses on therapeutic studies than on other types of studies have been published . For practical reasons , we present a stepwise description of the tasks that are performed when statistical methods are used to combine data . These tasks are 1 ) deciding whether to combine data and defining what to combine , 2 ) evaluating the statistical heterogeneity of the data , 3 ) estimating a common effect , 4 ) exploring and explaining heterogeneity , 5 ) assessing the potential for bias , and 6 ) presenting the results . Deciding Whether To Combine Data and Defining What To Combine By the time one performs a quantitative synthesis , certain decisions should already have been made about the formulation of the question and the selection of included studies . These topics were discussed in two previous articles in this series [ 1 , 2 ] . Statistical tests can not compensate for lack of common sense , clinical acumen , and biological plausibility in the design of the protocol of a meta- analysis . Thus , a reader of a systematic review should always address these issues before evaluating the statistical methods that have been used and the results that have been generated . Combining poor- quality data , overly biased data , or data that do not make sense can easily produce unreliable results . The data to be combined in a meta- analysis are usually either binary or continuous . Binary data involve a yes/no categorization ( for example , death or survival ) . Continuous data take a range of values ( for example , change in diastolic blood pressure after antihypertensive treatment , measured in mm Hg ) . When one is comparing groups of patients , binary data can be summarized by using several measures of treatment effect that were discussed earlier in this series [ 3 ] . These measures include the risk ratio ; the odds ratio ; the risk difference ; and , when study duration is important , the incidence rate . Another useful clinical measure , the number needed to treat ( NNT ) , is derived from the inverse of the risk difference [ 3 ] . Treatment effect measures , such as the risk ratio and the odds ratio , provide an estimate of the relative efficacy of an intervention , whereas the risk difference describes the intervention 's absolute benefit . The various measures of treatment effect offer complementary information , and all should be examined [ 4 ] . Continuous data can be summarized by the raw mean difference between the treatment and control groups when the treatment effect is measured on the same scale ( for example , diastolic blood pressure in mm Hg ) , by the st and ardized mean difference when different scales are used to measure the same treatment effect ( for example , different pain scales being combined ) , or by the correlation coefficients between two continuous variables [ 5 ] . The st and ardized mean difference , also called the effect size , is obtained by dividing the difference between the mean in the treatment group and the mean in the control group by the SD in the control group . Evaluating the Statistical Heterogeneity of the Data This step is intended to answer the question , Are the results of the different studies similar ( homogeneous ) ? It is important to answer this question before combining any data . To do this , one must calculate the magnitude of the statistical diversity ( heterogeneity ) of the treatment effect that exists among the different sets of data . Statistical diversity can be thought of as attributable to one or both of two causes . First , study results can differ because of r and om sampling error . Even if the true effect is the same in each study , the results of different studies would be expected to vary r and omly around the true common fixed effect . This diversity is called the within- study variance . Second , each study may have been drawn from a different population , depending on the particular patients chosen and the interventions and conditions unique to the study . Therefore , even if each study enrolled a large patient sample , the treatment effect would be expected to differ . These differences , called r and om effects , describe the between- study variation with regard to an overall mean of the effects of all of the studies that could be undertaken . The test most commonly used to assess the statistical significance of between- study heterogeneity is based on the chi-square distribution [ 6 ] . It provides a measure of the sum of the squared differences between the results observed and the results expected in each study , under the assumption that each study estimates the same common treatment effect . A large total deviation indicates that a single common treatment effect is unlikely . Any pooled estimate calculated must account for the between- study heterogeneity . In practice , this test has low sensitivity for detecting heterogeneity , and it has been suggested that a liberal significance level , such as 0.1 , should be used [ 6 ] . Estimating a Common Effect The questions that this step tries to answers are , 1 ) To the extent that data are similar , what is their best common point estimate of a therapeutic effect , and 2 ) how precise is this estimate ? The mathematical process involved in this step generally involves combining ( pooling ) the results of different studies into an overall estimate . Compared with the results of individual studies , pooled results can increase statistical power and lead to more precise estimates of treatment effect . Each study is given a weight according to the precision of its results . The rationale is that studies with narrow CIs should be weighted more heavily than studies with greater uncertainty . The precision is generally expressed by the inverse of the variance of the estimate of each study . The variance has two components : the variance of the individual study and the variance between different studies . When the between- study variance is found to be or assumed to be zero , each study is simply weighted by the inverse of its own variance , which is a function of the study size and the number of events in the study . This approach characterizes a fixed-effects model , as exemplified by the Mantel-Haenszel method [ 7 , 8 ] or the Peto method [ 9 ] for dichotomous data . The Peto method has been particularly popular in the past . It has the advantage of simple calculation ; however , although it is appropriate in most cases , it may introduce large biases if the data are unbalanced [ 10 , 11 ] . On the other h and , r and om-effects models also add the between- study variance to the within- study variance of each individual study when the pooled mean of the r and om effects is calculated . The r and om-effects model most commonly used for dichotomous data is the DerSimonian and Laird estimate of the between- study variance [ 12 ] . Fixed- and r and om-effects models for continuous data have also been described [ 13 ] . Pooled results are generally reported as a point estimate and CI , typically a 95 % CI . Other quantitative techniques for combining data , such as the Confidence Profile Method [ 14 ] , use Bayesian methods to calculate posterior probability distributions for effects of interest . Bayesian statistics are based on the principle that each observation or set of observations should be viewed in conjunction with a prior probability describing the prior knowledge about the phenomenon of interest [ 15 ] . The new observations alter this prior probability to generate a posterior probability . Traditional meta- analysis assumes that nothing is known about the magnitude of the treatment effect before r and omized trials are performed . In Bayesian terms , the prior probability distribution is noninformative . Bayesian approaches may also allow the incorporation of indirect evidence in generating prior distributions [ 14 ] and may be particularly helpful in situations in which few data from r and omized studies exist [ 16 ] . Bayesian analyses may also be used to account for the uncertainty introduced by estimating the between- study variance in the r and om-effects model , leading to more appropriate estimates and predictions of treatment efficacy [ 17 ] . Exploring and Explaining Heterogeneity The next important issue is whether the common estimate obtained in the previous step is robust . Sensitivity analyses determine whether the common estimate is influenced by changes in the assumptions and in the protocol for combining the data . A comparison of the results of fixed- and r and om-effects models is one such sensitivity analysis [ 18 ] . Generally , the r and om-effects model produces wider CIs than does the fixed-effects model , and the level of statistical significance may therefore be different depending on the model used . The pooled point estimate per se is less likely to be affected , although exceptions are possible [ 19 ] . Other sensitivity analyses may include the examination of the residuals and the chi-square components [ 13 ] and assessment of the effect of deleting each study in turn . Statistically significant results that depend on a single study may require further exploration . Cumulative Meta- Analysis & NA ; This study compares the responsiveness of three instruments of functional status : two disease‐specific question naires ( Oswestry and Rol and Disability Question naires ) , and a patient‐specific method ( severity of the main complaint ) . We compared changes over time of functional status instruments with pain rated on a visual analog scale . Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used : effect size statistics and receiver‐operating characteristic method . We chose global perceived effect as external criterion . A cohort of 81 patients with non‐specific low back pain for at least 6 weeks assessed these measures before and after 5 weeks of treatment . According to the external criterion 38 patients improved . The results of both strategies were the same . All instruments were able to discriminate between improvement and non‐improvement . The effect size statistics of the instruments were higher in the improved group than in the non‐improved group . For each instrument the receiver‐operating characteristic curves showed some discriminative ability . The curves for the Rol and Question naire and pain were closer to the upper left than the curves for the other instruments . The sensitivity to change of the rating of Oswestry Question naire was lower than that of the other instruments . The main complaint was not very specific to change . The two strategies for evaluating the responsiveness were very useful and appeared to complement each other Objectives Knowledge regarding the working mechanism of an intervention is essential for obtaining a better underst and ing of the intervention and contributes to optimize its outcome . This study aim ed at investigating whether changes in cognitive-behavioral factors and muscle activation patterns after myofeedback training and ergonomic counseling were associated with outcome , in subjects with work-related musculoskeletal neck-shoulder complaints . Methods Seventy-nine symptomatic subjects received either myofeedback with ergonomic counseling ( Mfb/EC ) or ergonomic counseling alone ( EC ) . Outcome measures discomfort and disability , and process factors catastrophizing , pain control , fear-avoidance beliefs , and muscle activation patterns were assessed at baseline , after the interventions ( T0 ) , and at 3 months follow-up ( T3 ) . Mixed modeling techniques were used for analysis . Results Outcome in terms of discomfort and disability was generally comparable between both interventions . Catastrophizing was significantly reduced and fear-avoidance beliefs about work slightly increased after the interventions , but no consistent changes in muscle activation patterns were observed . Changes in discomfort were especially associated with changes in catastrophizing at T0 and T3 , but R2 was low ( < 0.14 ) . Reduced catastrophizing at T0 and T3 , and also reduced fear-avoidance beliefs about work at T3 , were related to reduced disability ( R2 between 0.30 and 0.40 ) . No differences between the two intervention groups were observed . Conclusions Intervention effects were generally non-specific and findings suggested that cognitive-behavioral factors underlie the outcome of these interventions rather than changes in muscle activation patterns . Emphasizing these factors during therapy may increase the beneficial outcome of occupational interventions To determine the effectiveness of high voltage pulsed current ( HVPC ) in reducing chronic h and edema  , 120 individuals were r and omly assigned to one of two treatment groups . Group I clients were given an appropriate sized wrist splint , incorporating an energized , high voltage pulsed unit Group II clients were given an identical  splint with a non-energized unit . Each client received daily treatments at the worksite consisting of 30 minute sessions totaling 20 treatments during a 35 day period . Pre-treatment and post-treatment evaluations included measurements of pain , grip strength , and edema volume ; repetitive task testing ; and Semmes-Weinstein Monofilament sensory testing . In the energized group , post-treatment evaluation showed statistically significant decreases in the amount of stimulation required to stimulate the median nerve and the amount of h and edema and pain . The energized group also had improved repetitive task times . None of these improvements occurred in the non-energized group . Based on these results , HVPC appears to be an effective method for minimizing the severity of repetitive stress injuries of the wrist OBJECTIVES The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders . METHODS In this r and omized controlled study , subjects aged 18 - 60 years ( N=177 ) seeking medical advice due to upper-extremity symptoms were included if their symptoms , or the exacerbation of symptoms , had started < 30 days prior to the medical consultation and immediate sick leave was not required .  Workplace ergonomic improvements were made in the intervention group . Data on symptoms and sickness absences were gathered during one-year follow-up . RESULTS Pain intensity , pain interference with work , leisure time , or sleep did not differ between the intervention and control group during the one-year follow-up . During the first three months of follow-up , the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention ( N=89 ) and control ( N=84 ) group , but the total number of sickness absence days in the intervention group was about half of that in the control group ( mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined ) . During 4 - 12 months of follow-up , the percentage of employees with sickness absence due to upper-extremity disorder ( 10.1 % versus 16.7 % , P=0.20 ) or upper-extremity and other musculoskeletal disorders combined ( 20.2 % versus 32.1 % , P=0.07 ) was lower in the intervention than the control group . CONCLUSIONS Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders Context Nonoccupational musculoskeletal disorders account for a large proportion of work disability and represent a major financial burden on society . Contribution A voluntary , r and omized , controlled intervention study consisted of avoidance of bed rest , early mobilization , avoidance of splints , stretching exercises , ergonomic training , provision of educational booklets , and suggestions for optimal levels of physical activity . Although return to work was never forced , temporary work disability , long-term disability , and costs were significantly decreased in the intervention group . Implication s The personal and financial impact of work disability due to musculoskeletal disorders ( not related to work injury ) may be mitigated by a voluntary program of education and rehabilitation . The Editors Musculoskeletal disorders ( MSDs ) are prevalent and potentially disabling conditions ( 1 ) that consume a large proportion of health care re sources ( 2 - 4 ) and together are the leading cause of functional loss in adults ( 3 - 8 ) . The social costs of MSDs are enormous , often overshadowing those of other chronic conditions ( 9 , 10 ) . In industrialized societies , MSDs are one of the most common causes of temporary work disability and the chief cause of permanent work disability ( 11 ) , accounting for productivity losses equivalent to 1.3 % of the U.S. gross national product ( 12 ) . Work disability related to MSDs is a challenge to employability , business productivity , and the capacity of health and social security systems . Various strategies for addressing MSD-related work disability have been promoted in the field of occupational health , including strategies involving legislation , risk management , ergonomics , prevention , education , and social work ( 13 ) . However , the role of health systems remains ill-defined in this field . The purpose of this study was to evaluate whether an intervention program , integrated into the health system and offered to the working population , could reduce the impact of recent-onset MSD-related temporary work disability . Methods Setting Of the 5.5 million persons in Madrid , Spain , 98 % receive health coverage from the Instituto Madrileo de Salud . Care is organized into 11 health districts . Patients have direct access to primary care physicians , who refer patients to specialized care if needed . Disability compensation payments are made by the Instituto Nacional de la Seguridad Social ( INSS ) , a division of the Ministry of Work . Any worker who requires sick leave is given a temporary work disability initiation form that states the diagnosis made by the primary care physician and entitles the worker to receive INSS compensation payments . The form is renewed weekly by the primary care physician until the worker 1 ) recovers and receives an ending form , 2 ) reaches a maximum of 18 months of temporary work disability , or 3 ) receives a proposal for evaluation for permanent work disability . Proposals for permanent work disability are evaluated by the INSS , which determines the need for and type of long-term compensation . Inspection services in each health district oversee all administrative aspects of these processes . Design We did a r and omized , controlled study , unblinded for both patients and physicians , to test whether a clinical intervention could improve the outcome of patients with recent-onset MSD-related temporary work disability . The study began in March 1998 in health district 7 and in March 1999 in health districts 4 and 9 . Selection and r and omization of patients was done during the first year of the study in each district . Follow-up lasted for another year . Patients and Selection Criteria Health districts 4 , 7 , and 9 were chosen . Health district 4 had a total population of 508249 persons and an active working population of 192939 persons ; health district 7 had a total population of 522742 persons and an active working population of 179155 persons ; and health district 9 had a total population of 371294 persons and an active working population of 135475 persons ( 14 ) . The inclusion criterion was the issue of a common diseases temporary work disability initiation form , with an MSD-related cause reported by the primary care physician , within the inclusion period . The MSD-related causes included all arthropathies , connective tissue disorders , back disorders , soft-tissue rheumatisms , bone and cartilage disorders , musculoskeletal pain not caused by cancer , and nerve entrapment syndromes . Patients were excluded if they had a common diseases temporary work disability form with an MSD-related cause result ing from trauma or surgery . They were also excluded if they had work accidents or professional diseases noted on the temporary work disability initiation form . Work accidents are primarily sudden , external , violent causes of disease occurring at work or during travel to work , and they represent less than 27 % of cases of temporary work disability . Professional diseases include silicosis , asbestos-related mesothelioma , and noise-induced hearing loss , and they represent less than 1 % of cases of temporary work disability . R and omization All temporary work disability initiation forms meeting the selection criteria were collected daily by a study rheumatologist and coded . The patients associated with the forms were r and omly assigned to either the intervention group , which received a specific care program , or the  control group  , which received st and ard care ( Figure 1 ) . Computer-generated lists of pseudor and om numbers were produced for each district . Group assignments were r and omly done in blocks of 50 patients with intervention : control ratios of 1:1 in district 7 and 2:3 in districts 4 and 9 . This was done so that similar numbers of patients would be seen by the rheumatologists in all areas . The ratios were based on the number of episodes of MSD-related temporary work disability registered in previous years . Patients maintained their group assignments in successive episodes of MSD-related temporary work disability during follow-up . Figure 1 . Flow diagram of the study . Care in the Intervention Group A secretary contacted all patients assigned to the intervention group by telephone or mail as soon as possible after the initiation form was issued , offering them an appointment in the program . Patients who voluntarily decided to enter the program were attended by 2 rheumatologists in each district who worked full-time for the study . Patients were seen as often as necessary until the episode of temporary work disability was resolved or recovery was deemed unrealistic . Patients who were assigned to the intervention group but were unable or unwilling to participate , were already working , or could not be located were considered to be assigned to the intervention group throughout the study for statistical purpose s. Within the intervention program , care was delivered in regular visits and included education , clinical management , and administrative duties . Education At the first 45-minute visit , patients received a specific diagnosis , reassurance that no serious disease was present , instructions on self-management , instructions on taking medications on a fixed schedule , and information on indications for return to work before complete symptom remission . Return to work was negotiated with patients and was never forced on them . Instructions on self-management included instructions to avoid bed rest , instructions to promote early mobilization of the painful regions , restrictions on the use of splint and neck collars , training in stretching and strengthening exercises ( 15 - 18 ) , teaching of ergonomic care ( 19 ) , delivery of booklets in instances of back or neck pain ( 19 ) , and information on optimal levels of physical activity ( 20 ) . Patients with higher degrees of disability or abnormal pain behavior received immediate extra reassurance , information on pain-relieving positions , and a telephone call or second visit within 72 hours . Specific protocol s were created for low-back ( 21 ) , neck , shoulder , arm and h and , knee , and foot pain ( 19 , 22 - 25 ) and included the 3-level clinical -management system described later . Moving a patient from the lower to the upper levels of the system implied the need for further diagnostic or therapeutic procedures and was indicated 1 ) after a patient spent a predefined period at the lower level without return to work or substantial clinical improvement or 2 ) by the clinical judgment of the rheumatologist . At the first level of the system , patients received the clinical management started at the first visit , including a diagnosis based on clinical criteria , pharmacologic treatment of pain and inflammation , pharmacologic treatment of anxiety and depression , peripheral intra- and periarticular injections ( 26 ) , and education . Time spent at the first level averaged 2 to 6 weeks . At the second level , patients received maintenance of therapy plus referral for formal rehabilitation and laboratory tests , radiography , computerized tomography , magnetic resonance imaging , and electromyography . After 4 to 8 weeks with no improvement at the second level , patients were moved to the third level and received further diagnostic procedures or referral for surgical or other specialized care . Red flags were defined , including age older than 50 years for patients with axial pain , previous trauma , cancer , serious medical illness , inflammatory pain , night pain , drug abuse , corticosteroid use , fever , weight loss , progressively deteriorating function , and progressive neurologic deficit . The presence of a red flag precluded the use of the level system , and the patient in question was managed according to clinical criteria , with a focus on excluding serious illness . Treatment Failures Patients who did not respond to interventions at the second level of the system were examined for the presence of yellow flags , which included psychiatric illness , family problems , sociolabor conflicts , unemployment , and occupational causes of disability . The presence of a CONTEXT Active physical training is commonly recommended for patients with chronic neck pain ; however , its efficacy has not been demonstrated in r and omized studies . OBJECTIVE To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic , nonspecific neck pain . DESIGN Examiner-blinded r and omized controlled trial conducted between February 2000 and March 2002 . SETTING Participants were recruited from occupational health care systems in southern and eastern Finl and . PATIENTS A total of 180 female office workers between the ages of 25 and 53 years with chronic , nonspecific neck pain . INTERVENTIONS Patients were r and omly assigned to either 2 training groups or to a control group , with 60 patients in each group . The endurance training group performed dynamic neck exercises , which included lifting the head up from the supine and prone positions . The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic b and . Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells . All groups were advised to do aerobic and stretching exercises regularly 3 times a week . MAIN OUTCOME MEASURES Neck pain and disability were assessed by a visual analog scale , the neck and shoulder pain and disability index , and the Vernon neck disability index . Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures . RESULTS At the 12-month follow-up visit , both neck pain and disability had decreased in both training groups compared with the control group ( P<.001 ) . Maximal isometric neck strength had improved flexion by 110 % , rotation by 76 % , and extension by 69 % in the strength training group . The respective improvements in the endurance training group were 28 % , 29 % , and 16 % and in the control group were 10 % , 10 % , and 7 % . Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation , but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension . CONCLUSIONS Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic , nonspecific neck pain . Stretching and fitness training are commonly advised for patients with chronic neck pain , but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training OBJECTIVE Previously we reported that early part-time sick leave enhances return to work ( RTW ) among employees with musculoskeletal disorders ( MSD ) . This paper assesses the health-related effects of this intervention . METHODS Patients aged 18 - 60 years who were unable to perform their regular work due to MSD were r and omized to part- or full-time sick leave groups . In the former , workload was reduced by halving working time . Using vali date d question naires , we assessed pain intensity and interference with work and sleep , region-specific disability due to MSD , self-rated general health , health-related quality of life ( measured via EuroQol ) , productivity loss , depression , and sleep disturbance at baseline , 1 , 3 , 8 , 12 , and 52 weeks . We analyzed the repeated measures data ( 171 - 356 observations ) with the generalized estimating equation approach . RESULTS The intervention ( part-time sick leave ) and control ( full-time sick leave ) groups did not differ with regard to pain intensity , pain interference with work and sleep , region-specific disability , productivity loss , depression , or sleep disturbance . The intervention group reported better self-rated general health ( adjusted P=0.07 ) and health-related quality of life ( adjusted P=0.02 ) than the control group . In subgroup analyses , the intervention was more effective among the patients whose current problem began occurring < 6 weeks before baseline and those with ≤30 % productivity loss at baseline . CONCLUSIONS Our findings showed that part-time sick leave did not exacerbate pain-related symptoms and functional disability , but improved self-rated general health and health-related quality of life in the early stage of work disability due to MSD OBJECTIVE The objective of this study was to evaluate the effects of regular stretching exercises on  pain associated with working at a computer workstation , and to ascertain whether the type of media used for exercise instruction had an effect on outcomes . PARTICIPANTS Sixty-eight volunteers were divided into three equivalent groups . All of the subjects worked at computers for prolonged periods of time and reported that their pain had been a source of distress for at least three weeks prior to the intake evaluation . METHODS A pretest-posttest-control group design with cluster r and omization was used to evaluate the effect of a stretching program on pain . Thirty-six different stretches were performed by the subjects for 15 - 17 work days . Two intervention groups were directed to stretch once every six minutes . One group ( n=22 ) was reminded to stretch via a computer program , the second group ( n=23 ) by using a hard copy version of the stretches with pictures and written instructions , and a third group received no intervention . RESULTS ANOVA analysis found a significant reduction in pain of 72 % ( p < 0.001 ) for the computer-generated stretching program , and of 64 % ( p < 0.001 ) using the hardcopy version of the intervention . The control group had an increase in pain of 1 % . CONCLUSIONS Both software and hard copy stretching interventions contributed to a decrease in pain without making any changes to workstation ergonomics and there was no significant statistical difference in the outcomes of either intervention . The subjective evaluation of pain using both visual analog scales and a newly created " pain spot " assessment technique yielded similar results 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 BACKGROUND The aim of the present study is to explore factors affecting or modifying self-reported neck/shoulder pain in sewing machine operators . METHODS We investigated self-report neck/shoulder pain in 247 workers who participated in a 4-month prospect i ve intervention study for musculoskeletal disorders . All participants were immigrants . We examine the influence of individual and work-related factors on changes in neck/shoulder pain during follow-up employing linear mixed models with time-spline functions . RESULTS We observed a dramatic decline ( 72 % ) in self-reported pain intensity in the first month of follow-up , followed by a small increase from the first to fourth month ( 4 % per month ) . Workers who perceived and reported their physical workload as high or worked overtime experienced less overall pain reduction . Higher baseline pain intensity , being of Hispanic ethnicity ( vs. Asian ) , and taking cumulative daily rest time during work of 35 min or more allowing for muscles to rest were associated with a larger pain reduction in the first month , but not thereafter . CONCLUSION Our findings indicate that some work-related factors may be of clinical relevance for reducing neck/shoulder pain . Having lower physical workloads and less overtime work should be considered when treating patients or planning workplace interventions for managing work-related musculoskeletal disorders in this underserved immigrant population Nineteen Ss who experienced chronic , occupational pain of the upper limbs and who had previously completed a programme of either individual or group cognitive-behaviour therapy  were followed up 2 yr later . Significant improvements on measures of depression , anxiety , coping strategies and interference in daily living were found following treatment . Such improvements were not evident for the waiting list control Ss and no difference was found between group vs individual applications of therapy . A 2 yr follow-up , significant improvements from pre-treatment levels were evident for depression , coping strategies , significant other report of disability , self monitored pain and distress caused by pain . While there was generally little evidence of relapse , a significant decline from post-treatment levels was found for the individual therapy condition compared to the group therapy condition on measures of self monitored pain and interference caused by pain . Since post-treatment levels tended to be somewhat superior for the individual therapy condition , the overall finding at 2 yr follow-up was of minimal difference in outcome for group vs individual forms of cognitive-behaviour therapy . Despite improvements from pre-treatment levels , the vast majority of Ss still reported significant and distressing levels of pain at 2 yr follow-up 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 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 The cluster r and omized trial  with a concurrent economic evaluation is considered the gold st and ard evaluative design for the conduct of implementation research evaluating different strategies to promote the transfer of research findings into clinical practice . This has implication s for the planning of such studies , as information is needed on the effects of clustering on both effectiveness and efficiency outcomes . This paper describes the design considerations specific to implementation research studies , focusing particularly on the estimation of sample size requirements and on the need for reliable information on intracluster correlation coefficients for both effectiveness and efficiency outcomes OBJECTIVES To determine whether nocturnal splinting of workers identified through active surveillance with symptoms consistent with carpal tunnel syndrome ( CTS ) would improve symptoms and median nerve function as well as impact medical care . DESIGN R and omized controlled trial . SETTING A Midwestern auto assembly plant . PARTICIPANTS Active workers with symptoms suggestive of CTS based on a h and diagram . INTERVENTION The treatment group received customized wrist splints , which were worn at night for 6 weeks ; the control group received ergonomic education alone . MAIN OUTCOME MEASURES Change in wrist , h and , and /or finger discomfort , carpal tunnel symptom severity index , median sensory nerve function , and the percentage of subjects who had carpal tunnel release surgery . RESULTS The splinted group , unlike the controls , had a significant reduction in wrist , h and , and /or finger discomfort and a similar trend in the Levine carpal tunnel symptom severity index , which was maintained at 12 months . A secondary analysis showed that more median nerve impairment at baseline was associated with less clinical improvement among controls but not among the splinted group . CONCLUSIONS Workers identified with CTS symptoms in an active symptom surveillance tended to benefit from a 6-week nocturnal splinting trial , and the benefits were still evident at the 1-year follow-up . The splinted group improved in terms of h and discomfort regardless of the degree of median nerve impairment , whereas the controls showed improvement only among subjects with normal median nerve function . Results suggest that a short course of nocturnal splinting may reduce wrist , h and , and /or finger discomfort among active workers with symptoms consistent with CTS OBJECTIVES This study evaluated the effect of an intensive ergonomic approach and education on workstation changes and  musculoskeletal disorders among workers who used a video display unit ( VDU ) . METHODS A r and omized controlled design was used . The subjects ( N=124 ) were allocated into three groups ( intensive ergonomics , ergonomic education , reference ) using stratified r and om sampling . The evaluation involved question naires , a diary of discomfort , measurements of workload , and an ergonomic rating of the workstations . The assessment s were made 2 weeks before the intervention and after 2 and 10 months of follow-up . RESULTS The intensive and training groups showed less musculoskeletal discomfort than the reference group after 2 months of follow-up . Positive effects on discomfort were seen primarily for the shoulder , neck , and upper back areas . No significant differences were found for the strain levels or prevalence of pain . After the intervention the ergonomic level was distinctly higher in the intensive ergonomic group than in the education or reference group . CONCLUSIONS Both the intensive ergonomics approach and education in ergonomics help reduce discomfort in VDU work . In attempts to improve the physical ergonomics of VDU workstations , the best result will be achieved with cooperative planning in which both workers and practitioners are actively involved PURPOSE The objective of this study is to investigate the effect of three different workplace interventions on long-term compliance , muscle strength gains , and neck/shoulder pain in office workers . METHODS A 1-yr r and omized controlled intervention trial was done with three groups :  specific resistance training ( SRT , n = 180 ) , all-round physical exercise ( APE , n = 187 ) , and reference intervention ( REF , n = 182 ) with general health counseling . Physical tests were performed and question naires answered at pre- , mid- , and postintervention . The main outcome measures were compliance , changes in maximal muscle strength , and changes in intensity of neck/shoulder pain ( scale 0 - 9 ) in those with and without pain at baseline . RESULTS Regular participation was achieved by 54 % , 31 % , and 16 % of those of the participants who answered the question naire in SRT ( 78 % ) , APE ( 81 % ) , and REF ( 80 % ) , respectively , during the first half of the intervention period , and decreased to 35 % , 28 % and 9 % , respectively , during the second half . Shoulder elevation strength increased 9 - 11 % in SRT and APE ( P < 0.0001 ) . Participants with neck pain at baseline decreased the intensity of neck pain through SRT , from 5.0 + /- 0.2 to 3.4 + /- 0.2 ( P < 0.0001 ) , and through APE , from 5.0 + /- 0.2 to 3.6 + /- 0.2 ( P < 0.001 ) , whereas REF caused no change . For participants without shoulder pain at baseline , there was a significantly greater increase in pain over the 1-yr period in REF compared with SRT and APE ( P < 0.01 ) . CONCLUSION Compliance was highest in SRT but generally decreased over time . SRT and APE caused increased shoulder elevation strength , were more effective than REF to decrease neck pain among those with symptoms at baseline , and prevent development of shoulder pain in those without symptoms at baseline Study Design . This is a 4-month r and omized controlled trial to evaluate the effect of chair design on neck/shoulder pain  among sewing machine operators . Objective . Determine whether a chair with a curved seat pan leads to improved changes in monthly neck/shoulder pain scores compared with a control intervention . Summary of Background Data . Sewing machine operators experience a high prevalence and severity of neck and shoulder pain in comparison to other working population s probably due to the sustained shoulder abduction and neck and upper back flexion required of the task . An adjustable height task chair that supports a forward sitting posture may reduce these posture-related risk factors and reduce neck/shoulder pain . Material s and Methods . A total of 277 sewing machine operators with neck/shoulder pain were assigned to receive 1 ) miscellaneous items ( control group ) , 2 ) a chair with a flat seat pan plus miscellaneous items , or 3 ) a chair with a curved seat pan plus miscellaneous items . Participants completed a monthly question naire assessing neck/shoulder pain severity . Results . Based on estimates of pain score changes from a repeat- measures linear regression , participants who received the flat seat chair experienced a decline in pain of 0.14 ( 95 % confidence interval , 0.07–0.22 ) points per month compared with those in the control group , while those who received the curved seat experienced a decline of 0.34 ( 95 % confidence interval , 0.28–0.41 ) points per month compared with those in the control group . These estimates did not change after adjustment for potential covariates . Conclusions . These findings demonstrate that an adjustable height task chair with a curved seat pan can reduce neck and shoulder pain severity among sewing machine operators OBJECTIVE To investigate the clinical course and prognostic factors of complaints of arm , neck , and shoulder . STUDY DESIGN AND SETTING A prospect i ve cohort study in physical therapy practice . Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and /or upper extremities . Participants filled in question naires at baseline , 3 months , and 6 months . The main outcome measure was the persistence of complaints over 6-month follow-up . Possible predictors like social and psychological factors , physical factors , and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements . RESULTS Of the 624 participants at baseline 543 ( 87 % ) returned at least one follow-up question naire . At 6-month follow-up , 40 % had persisting pain and discomfort . Somatization , kinesiophobia , catastrophizing , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population . In those with paid work ( 77 % ) , catastrophizing , low decision authority at work , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months . CONCLUSION 40 % of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course Abstract The effect of exercise on neck – shoulder pain was studied in 103 women with work‐related trapezius myalgia r and omized into three exercise groups and a control group . One group trained strength , the second muscular endurance and the third co‐ordination . The exercise groups met three times weekly for 10 weeks . Pain assessment was made on three visual analogue scales , indicating pain at present , pain in general and pain at worst . Pain thresholds were measured in the trapezius muscle with a pressure algometer . A pain drawing was completed . The rated pain decreased significantly ( P<0.05 ) on the VAS describing pain at worst in the strength and endurance groups . Pressure sensitivity decreased significantly ( P<0.05 ) in four triggerpoints in the exercise groups . No changes were seen in the extent of painful body area in any group . Comparison of exercisers ( n=82 ) and controls ( n=21 ) showed significantly larger pain reductions on VAS pain at present and VAS pain at worst among exercisers . All three exercise programs showed similar decreases of pain which indicates that the type of exercise is of less importance to achieve pain reduction OBJECTIVES To study whether isometric shoulder endurance was more advantageous than isometric shoulder strength training in reducing pain and perceived exertion and to increase shoulder function through improved muscle endurance and strength . DESIGN R and omized trial . SETTING Three occupational health care centers . PARTICIPANTS Women industrial workers with nonspecific neck-shoulder pain . The International Classification of Diseases , 10th Revision ( ICD-10 ) diagnosis was " cervicobrachial syndrome " ( M53.1 ) . Thirty-eight patients completed the isometric shoulder endurance training  and 31 patients completed the isometric shoulder strength training . INTERVENTION Twelve weeks of training . MAIN OUTCOME MEASURES Self-reported pain and rating of perceived exertion ( RPE ) , arm motion performance test , shoulder muscle strength , shoulder muscle endurance , and shoulder functional tests , as well as follow-up after supervised training had ended . RESULTS The isometric shoulder strength training result ed in an almost one-scale step decrease in RPE at work and a 5 % to 15 % improvement of arm motion performance compared with the endurance training . The isometric shoulder strength training more effectively improved left side shoulder abduction strength ( p < .026 ) , but no major differences were found for the other strength measurements . The isometric shoulder endurance training was not more successful than the strength training in the endurance test ( p .51 to .81 ) . CONCLUSIONS Physical training programs for neck-shoulder pain may include isometric shoulder muscular strength exercise in addition to isometric shoulder endurance training , rather than endurance training only Forty five subjects who experienced chronic , occupational pain of the upper limbs were r and omly assigned to one of three conditions ; individual cognitive-behaviour therapy ( ICBT ) , group cognitive-behaviour therapy ( GCBT ) and WLC . Significant benefits were found for both ICBT and GCBT on measures of anxiety , depression , coping strategies , impact on daily living , pain and distress caused by pain . These gains were not evident in the WLC and were maintained at the 6 month follow-up Minimal difference was found between ICBT and GCBT on measures of pain and psychopathology , although client evaluation ratings at the end of treatment favoured ICBT OBJECTIVES This study examined the health-related effects of two worksite interventions , physical exercise and reduced workhours , on women employed in dentistry . METHODS Six workplaces were r and omized to one of the following three conditions : ( i ) 2.5 hours of weekly , m and atory physical exercise of middle-to-high intensity to be performed during workhours ( N=62 ) , ( ii ) a reduction of full-time weekly workhours from 40 to 37.5 hours ( N=50 ) , and ( iii ) reference . In all , 177 women participated . Biomarkers and self-ratings in question naires were obtained before the intervention ( T ( 1 ) ) , and six ( T ( 2 ) ) and 12 months ( T ( 3 ) ) after the intervention . RESULTS The results showed increased levels of physical activity and exercise in all of the groups , the level of physical exercise being significantly greater in the physical exercise group . Repeated- measures analyses of variance using data from T ( 1 ) and T (3)for biological measures and all three time points for self-ratings produced significant interaction effects for glucose , waist-to-hip ratio , and work ability and clear trends for general symptoms and upper-extremity disorders . Posthoc analyses showed that the results of the health-related measures differed between the interventions , decreased glucose and upper-extremity disorders in the exercise group , and increased high-density lipoprotein and waist-to-hip ratio among those working reduced hours . CONCLUSIONS These results show that the two interventions had small and varied effects on biomarkers and self-reports of different aspects of health among women . It is suggested that interventions involving a modest reduction in workhours seem to be more effective if these hours are used for physical exercise OBJECTIVES This study evaluates the effect of two different worksite physical-activity interventions on neck-shoulder symptoms , together with perceived work ability and sick leave  among office workers . METHODS An examiner-blinded r and omized controlled trial was conducted with 549 office workers allocated to one of three intervention groups : one with specific resistance training ( SRT ) of the neck-shoulder region ( N=180 ) , one with all-round physical exercise ( APE ) ( N=187 )  , and one which acted as a reference group , which was informed about general health-promoting activities but did not include a physical activity program ( N=182 ) . Question naires were filled out at baseline and after 1 year of training . RESULTS The duration and intensity of neck and shoulder symptoms was lower after the specified worksite physical-activity interventions than in the reference group . On an intervention group level , SRT was not more effective than APE in reducing the duration and intensity of neck and shoulder symptoms . However , those asymptomatic at baseline had a significant lower prevalence of neck-shoulder symptoms at follow-up when allocated to the SRT group than placed in the APE group or reference group . At baseline the work ability index ( WAI ) was close to 90 % of the maximum score , and the mean sick leave was 5 days per year , both being unaffected by the interventions . CONCLUSIONS Different physical-activity interventions were successful in reducing neck-shoulder symptoms , and SRT was superior to APE in the primary prevention of such symptoms . The initially relatively high WAI was the most probable reason for no further increase in WAI . Likewise the mean sick leave the year before the intervention was very low , and it was probably not possible to reduce it further The effect of " neck school " on neck and shoulder disorders was studied in medical secretaries . A  neck school reinforced with compliance enhancing measures ( group B ) was compared with a traditional neck school ( group A ) and a control group ( group C ) . The results show that ergonomical knowledge was good even before the secretaries attended the neck schools and that compliance was significantly higher for group B. When comparisons were made within groups some improvements on neck and shoulder fatigue and pain were noted , particularly for group B. When workload was controlled no significant group differences were found . No differences were noted for range of neck motion , or sick leave in any group . Our conclusion is that neck schools , despite good compliance , appear to be of limited clinical value for prevention of neck and shoulder disorders OBJECTIVE To explore the effectiveness of naturopathic care ( NC ) on rotator cuff tendinitis using a prospect i ve r and omized clinical trial design . METHODS Canadian postal workers with rotator cuff tendinitis for a duration of > 6 weeks were r and omized to receive NC ( n = 43 ) or st and ardized physical exercises ( PEs ; n = 42 ) over 12 weeks . Participants in the NC group received dietary counseling , acupuncture , and Phlogenzym ( 2 tablets 3 times/day ) . The PE intervention group received passive , active-assisted , and active range of motion exercises and matched placebo . The primary outcome measure was the Shoulder Pain and Disability Index ( SPADI ) , and secondary outcomes were the pain visual analog scale ( VAS ) , Short Form 36 ( SF-36 ) , Measure Yourself Medical Outcomes Profile ( MYMOP ) , and shoulder maximal range of motion . Participants and assessors were blinded to group and placebo allocation . RESULTS Seventy-seven participants ( 87 % ) completed > or=8 weeks of the trial .  Final total SPADI scores decreased by 54.5 % ( P < 0.0001 ) in the NC group and by 18 % ( P = 0.0241 ) in the PE group . Between-group differences in changes to SPADI scores showed statistically significant decreases in shoulder pain and disability in the NC group compared with the PE group ( P < 0.0001 ) . Significant differences between groups were also observed in the pain VAS , MYMOP , SF-36 , and shoulder extension , flexion , and abduction , with the NC group showing superiority in each outcome . No serious adverse reactions were observed . CONCLUSION NC and PE provided significant improvements , with greater improvement in shoulder function in the NC  group compared with the PE group . Statistically significant improvements in quality of life measures were observed in the NC group as compared with the PE group 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: None of the ergonomic interventions was more beneficial for any outcome measures when compared with another treatment or with no treatment or with placebo .
  Behavioural interventions had inconsistent effects on pain and disability , with some subgroups showing benefit and others showing no significant improvement when compared with no treatment , minor intervention controls or other behavioural interventions .In the eight studies that evaluated various other interventions , there was no evidence of a clear beneficial effect of any of the interventions provided .
  We found very low- quality evidence indicating that pain , recovery , disability and sick leave are similar after exercises when compared with no treatment , with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm , neck or shoulder .
  Low- quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up .
  There was no evidence of an effect on other outcomes .
  For behavioural and other interventions , there was no evidence of a consistent effect on any of the outcomes .
background: BACKGROUND Work-related upper limb disorder ( WRULD ) , repetitive strain injury ( RSI ) , occupational overuse syndrome ( OOS ) and work-related complaints of the arm , neck or shoulder ( CANS ) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements , awkward postures and impact of external forces such as those associated with operating vibrating tools .
  Work-related CANS , which is the term we use in this review , severely hampers the working population .
  OBJECTIVES To assess the effects of conservative interventions for work-related complaints of the arm , neck or shoulder ( CANS ) in adults on pain , function and work-related outcomes .