title: Job stress management and ergonomic intervention for work-related upper extremity symptoms. Effect of keyboard keyswitch design on hand pain. Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice. The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up A randomised controlled trial evaluating an alternative mouse and forearm support on upper body discomfort and musculoskeletal disorders among engineers Workplace upper limb disorders: a prospective study with intervention. A randomized prospective study of vocational outcome in rehabilitation of patients with non-specific musculoskeletal pain: a multidisciplinary approach to patients identified after 90 days of sick-leave. Effect of Four Computer Keyboards in Computer Users with Upper Extremity Musculoskeletal Disorders The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders Effects of an active ergonomics training program on risk exposure, worker beliefs, and symptoms in computer users. Effects of ergonomic intervention in work with video display units. Predictors of Successful Work Role Functioning After Carpal Tunnel Release Surgery
abstract: In practice the secondary prevention of work-related upper extremity ( WRUE ) symptoms generally targets biomechanical risk factors . Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability . The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone . Seventy office workers with WRUE symptoms were r and omly assigned to an ergonomics intervention group ( assessment and modification of work station and stretching exercises ) or a combined ergonomic and job stress intervention group ( ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress ) . Baseline , 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks , job stress , pain , symptoms , functional limitation , and general physical and mental health were obtained from all participants . While both groups experienced significant decreases in pain , symptoms , and functional limitation from baseline to three months with improvements continuing to 12 months post baseline , no significant differences between groups were observed for any outcome measures . Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone This r and omized clinical trial evaluated the effects of keyboard keyswitch design on computer users with h and paresthesias . Twenty computer users were matched and r and omly assigned to keyboard A ( n = 10 ) or B ( n = 10 ) . The keyboards were of conventional layout and differed in keyswitch design . Various outcome measures were assessed during the 12 weeks of use . Subjects assigned keyboard A experienced a decrease in h and pain between weeks 6 and 12 when compared with keyboard B subjects ( P = 0.05 ) and demonstrated an improvement in the Phalen test time ( right h and , P = 0.006 ; left h and , P = 0.06 ) . Keyboard assignment had no significant effect on change in h and function or median nerve latency . We conclude that use of keyboard A for 12 weeks led to a reduction in h and pain and an improved physical examination finding when compared with keyboard B. There was no corresponding improvement in h and function or median nerve latency OBJECTIVES To determine whether minimal intervention by occupational specialists involving information about the disorder , encouragement to stay active and instruction in grade d self-performed exercises could enhance the prognosis of lateral epicondylitis compared with the treatment usually given in general practice , to quantify workplace factors associated with the prognosis , and to consider treatments given in general practice . METHODS A r and omized controlled trial was performed in a cohort of 266 consecutive new cases of lateral epicondylitis diagnosed in general practice . Workplace factors were assessed with question naires at the time of inclusion , and patients completed follow-ups at 3 , 6 and 12 months . Status at 1 yr was assessed as overall improvement and pain reduction compared with the time of diagnosis . General practitioners ( GPs ) registered the treatments given for both cases and controls during follow-up . Numbers of contacts with GPs and physiotherapists were obtained from the National Health Insurance registry . Prognostic factors were analysed by multiple logistic regression analysis . RESULTS After 1 yr , 83 % of cases showed improvement in the condition , but the intervention was found to have had no advantage . Poor overall improvement was associated with employment in manual jobs [ odds ratio ( OR ) 3.0 , 95 % confidence interval ( CI ) 1.0 - 8.7 ] , a high level of physical strain at work ( OR 8.5 , CI 1.0 - 74.7 ) and a high level of pain at baseline ( OR 2.3 , CI 1.0 - 5.3 ) . Pain reduction less than 50 % was associated with manual jobs ( OR 2.3 , CI 1.1 - 5.1 ) , high physical strain at work ( OR 3.6 , CI 1.0 - 12.9 ) , high baseline distress ( OR 1.9 , CI 1.0 - 4.0 ) and tennis elbow on the dominant side ( OR 3.1 , CI 1.4 - 6.8 ) . The intervention group received less treatment and fewer treatment modalities , but the intervention was not followed by a reduction in the number of visits to GPs and physiotherapist clinics during 12 months of follow-up . CONCLUSIONS Poor prognosis at 1 yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain , whilst no relation was found between the type of medical treatment given/chosen and prognosis . This may have implication s for the future management of lateral epicondylitis in terms of a greater focus on interaction with the workplace regarding job modification to reduce physical dem and s during recovery OBJECTIVES Following a consensus statement from a multidisciplinary UK workshop , a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb . The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting . METHOD 43 consecutive referrals to a soft tissue rheumatism clinic ( group 1 ) and 45 subjects with one of a list of specific upper limb disorders ( including shoulder capsulitis , rotator cuff tendinitis , lateral epicondylitis and tenosynovitis ) ( group 2 ) , were recruited from hospital rheumatology and orthopaedic outpatient clinics . All 88 subjects were examined by a research nurse ( blinded to diagnosis ) , and everyone from group 1 was independently examined by a rheumatologist . Between observer agreement was assessed among subjects from group 1 by calculating Cohen 's κ for dichotomous physical signs , and mean differences with limits of agreement for measured ranges of joint movement . To assess the validity of the examination , a pre-defined algorithm was applied to the nurse 's examination findings in patients from both groups , and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic 's independent diagnosis as the reference st and ard . RESULTS The between observer repeatability of physical signs varied from good to excellent , with κ coefficients of 0.66 to 1.00 for most categorical observations , and mean absolute differences of 1.4 ° –11.9 ° for measurements of shoulder movement . The sensitivity of the schedule in comparison with the reference st and ard varied between diagnoses from 58%–100 % , while the specificities ranged from 84%–100 % . The nurse and the clinic physician generally agreed in their diagnoses , but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis , whereas the clinic physician did not . CONCLUSION The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting . Examination can feasibly be delegated to a trained nurse , and the protocol has the benefit of face and construct validity as well as consensus backing . Its performance in the community , where disease is less clear cut , merits separate evaluation , and further refinement is needed to discriminate between discrete pathologies at the shoulder Abstract Objective : To determine the aetiology of forearm pain . In particular to determine the relative contribution of ( a ) psychological factors , features of somatisation , and health anxiety and behaviour , ( b ) work related mechanical factors , and ( c ) work related psychosocial factors in the onset of forearm pain . Design : 2 year prospect i ve population based cohort study , with retrospective assessment of exposures at work . Setting : Altrincham , Greater Manchester . Participants : 1953 individuals aged 18 - 65 years . Outcome measures : Forearm pain of new onset . Results : At follow up , 105 ( 8.3 % ) participants reported forearm pain of new onset lasting at least one day in the past month . Among these , 67 % also reported shoulder pain , 65 % back pain , and 45 % chronic widespread pain . Increased risks of onset were associated with high levels of psychological distress ( relative risk 2.4 , 95 % confidence interval 1.5 to 3.8 ) , reporting at least two other somatic symptoms ( 1.7 , 0.95 to 3.0 ) , and high scores on the illness behaviour subscale of the illness attitude scales . The two work related mechanical exposures associated with the highest risk of forearm pain in the future were repetitive movements of the arm ( 4.1 , 1.7 to 10 ) or wrists ( 3.4 , 1.3 to 8.7 ) , whereas the strongest work related psychosocial risk was dissatisfaction with support from colleagues or supervisors ( 4.7 , 2.2 to 10 ) . Conclusions : Psychological distress , aspects of illness behaviour , and other somatic symptoms are important predictors of onset of forearm pain in addition to work related psychosocial and mechanical factors . Misleading terms such as “ cumulative trauma disorder ” or “ repetitive strain injury , ” implying a single uniform aetiology , should be avoided OBJECTIVES This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care Objective : To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints . Methods : A r and omized controlled trial with a 1-year follow-up was carried out . Thirty-eight subjects were allocated to multidisciplinary treatment ( intervention , n=23 ) , or to usual care provided by occupational health services ( n=15 ) . The intervention consisted of psychological and physical sessions provided by a medical specialist , a psychologist , a physiotherapist and an occupational therapist . It aims at reconditioning , “ de-medicalizing ” , unrestrained moving and return-to-work . The intervention process was evaluated on compliance to the protocol and the effectiveness of its components . The individual outcome variable was the severity of complaints . The societal outcomes included return-to-work and costs . Measurements were performed at baseline and after 2 , 6 and 12 months . Mixed model analyses were used for analysis . Results : The intervention achieves its aims : physical disabilities ( P=0.039 ) , kinesiophobia ( P<0.001 ) and physical functioning ( P=0.016 ) improved significantly as compared to usual care . In addition , the intervention was significantly more effective in reducing the severity of complaints than usual care . The intervention was equally effective compared to usual care in terms of return-to-work ( 86 % in the intervention group vs. 73 % in the usual care group ) . The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months . Conclusion : Multidisciplinary treatment affects individuals positively , but shows no significant difference in ( cost- ) effectiveness on the societal level as compared to usual care Objectives : The aim of this intervention study was to determine the effects of an alternative mouse and /or a forearm support board on the change in upper body discomfort scores and the development of incident musculoskeletal disorders . Methods : This r and omised controlled intervention trial followed 206 engineers for one year . Participants were r and omised to receive ( 1 ) a conventional mouse only , ( 2 ) an alternative mouse only , ( 3 ) a forearm support board , or ( 4 ) an alternative mouse plus forearm support board . Outcome measures included weekly upper body discomfort scores and incident musculoskeletal disorders . Results : During the study , 42 participants were diagnosed with an incident musculoskeletal disorder . The group that received the forearm support board experienced a reduction in their right upper extremity discomfort ( beta-coefficient −0.35 , 95 % CI −0.67 to −0.03 ) in comparison to those who did not receive a forearm board . The group that received the alternative mouse had a protective , but non-significant ( p = 0.20 ) , effect on incident cases of right upper extremity musculoskeletal disorders ( HR 0.57 , 95 % CI 0.24 to 1.34 ) and a non-significant reduction in neck/shoulder discomfort ( beta-coefficient −0.23 , 95 % CI −0.056 to 0.10 ) in comparison to those who received a conventional mouse . Conclusions : In engineers who use a computer for more than 20 h per week , a forearm support board may reduce right upper extremity discomfort attributed to computer use A prospect i ve longitudinal study was carried out to investigate the occurrence of upper limb disorders in an electromechanical plant between 1980 and 1988 . It included clinical and epidemiological studies , measurement of  vibration produced by the power tools used , ergonomic assessment of the works and time and motion studies . Simultaneously during the same period remedial actions were taken through multidisciplinary interventions when the specific causal factors were known . The study shows the clinical entities of the disorder , identifies the risk factors and evaluates the results of the interventions . It assists in establishing a cause and effect relationship for the condition and demonstrates the way a preventive strategy could be developed This study was design ed to evaluate the effectiveness of a multidisciplinary rehabilitation programme offered to a general population with 90 days of sick-leave due to non-specific musculoskeletal pain . The results concerning return to work and re-sick-listing during a follow-up period of five years were evaluated for Swedes and immigrants separately . Compared to a control group , the rehabilitation offer result ed in improved work stability after work return among the Swedes . The immigrants , as a group , did not benefit from the programme compared to the controls in primary care Eighty computer users with musculoskeletal disorders participated in a six-month , r and omized , placebo-controlled trial evaluating the effects of four computer keyboards on clinical findings , pain severity , functional h and status , and comfort . The alternative geometry keyboards tested were : the Apple Adjustable Keyboard ™ [ kb1 ] , Comfort Keyboard System ™ [ kb2 ] , Microsoft Natural Keyboard ™ [ kb3 ] and placebo . Compared to placebo , kb3 and to a lesser extent kb1 groups demonstrated an improving trend in pain severity and h and function following six months of keyboard use . However , there was no corresponding consistent improvement in clinical findings in the alternative geometry keyboard groups compared to the placebo group . Overall , there was a significant correlation between improvement of pain severity and greater satisfaction with the keyboards . These results provide evidence that keyboard users may experience a reduction in h and pain after several months of use of some alternative geometry keyboards 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 OBJECTIVE The purpose of this study was to evaluate the effectiveness of an active ergonomics training ( AET ) program in computer users . Two constructs from the social-cognitive theory were adopted to provide a more comprehensive assessment of the proximal markers of behavior change . METHOD Eighty-seven symptomatic and asymptomatic employees who worked at a computer for a minimum of 10 hours per week took part in a prospect i ve r and omized controlled study . Subjects participated in a six-hour training intervention at their workplace . Key elements of the AET intervention were skill development in workstation analysis , active participation , and implementation of multiple prevention strategies . RESULTS After receiving AET , risk factor exposure was significantly reduced for participants at higher risk [ F(1,82 ) = 6.42 , p < 0.01 ] . Significant increases in knowledge [ F(1,74 ) = 8.39 , p < 0.01 ] , self-efficacy [ F(1,73 ) = 6.95 , p < 0.01 ] , and outcome expectations [ F(1,75 ) = 8.75 , p < 0.01 ] were found in the intervention group . When the participants were stratified according to the presence of symptoms at baseline , the group with pain that received the AET intervention had significantly less upper back pain intensity ( z = -2.03 , p < 0.05 ) , pain frequency ( z = -2.70 , p < 0.01 ) , and pain duration ( z = -3.25 , p < 0.01 ) post-intervention than the control group with pain . CONCLUSION Results from this study provide evidence that participative training in workstation ergonomics can improve work postures , work practice s , risk factor exposure , and pain OBJECTIVES This study evaluated the effect of an intensive ergonomic approach and education on workstation changes and  musculoskeletal disorders among workers who used a video display unit ( VDU ) . METHODS A r and omized controlled design was used . The subjects ( N=124 ) were allocated into three groups ( intensive ergonomics , ergonomic education , reference ) using stratified r and om sampling . The evaluation involved question naires , a diary of discomfort , measurements of workload , and an ergonomic rating of the workstations . The assessment s were made 2 weeks before the intervention and after 2 and 10 months of follow-up . RESULTS The intensive and training groups showed less musculoskeletal discomfort than the reference group after 2 months of follow-up . Positive effects on discomfort were seen primarily for the shoulder , neck , and upper back areas . No significant differences were found for the strain levels or prevalence of pain . After the intervention the ergonomic level was distinctly higher in the intensive ergonomic group than in the education or reference group . CONCLUSIONS Both the intensive ergonomics approach and education in ergonomics help reduce discomfort in VDU work . In attempts to improve the physical ergonomics of VDU workstations , the best result will be achieved with cooperative planning in which both workers and practitioners are actively involved This study identified the clinical , individual , and workplace predictors of  successful work role functioning ( WRF ) after carpal tunnel release surgery ( CTRS ) . A community-based cohort ( n = 197 ) was followed for 6 months post-CTRS . Predictors of successful WRF were analyzed prospect ively using ordinal logistic regression . Baseline WRF predicted successful WRF at 2 months , whereas being depressed and a workers ' compensation cl aim ant predicted being out of work . Baseline WRF , improved self-efficacy , and a supportive organization predicted 6-month successful WRF . Supportive organizations have an impact on the effectiveness of medical interventions for CTS . The significance of improved self-efficacy at 6 months and depression at 2 months postsurgery highlights the importance of psychosocial management of musculoskeletal disorders
target: There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms .
  There was limited , but high quality , evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks .
  In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms .
  There was a lack of high quality evidence to inform workplace management of lateral epicondylitis .
background: BACKGROUND Upper limb pain is common among working-aged adults and a frequent cause of absenteeism .
  AIMS To systematic ally review the evidence for workplace interventions in four common upper limb disorders .