title: Effect of workplace- versus home-based physical exercise on musculoskeletal pain among healthcare workers: a cluster randomized controlled trial. Comparison of two physical exercise programs for the early intervention of pain in the neck, shoulders and lower back in female hospital staff. Effects of a wearable type lumbosacral support for low back pain among hospital workers: A randomized controlled trial Back School programme for nurses has reduced low back pain levels: A randomised controlled trial Effects of a PRECEDE-PROCEED model based ergonomic risk management programme to reduce musculoskeletal symptoms of ICU nurses. Effects of a Participatory Ergonomics Intervention With Wearable Technical Measurements of Physical Workload in the Construction Industry: Cluster Randomized Controlled Trial Does an Exercise Intervention Improving Aerobic Capacity Among Construction Workers Also Improve Musculoskeletal Pain, Work Ability, Productivity, Perceived Physical Exertion, and Sick Leave?: A Randomized Controlled Trial Long-term effectiveness of an educational and physical intervention for preventing low-back pain recurrence: a randomized controlled trial. Effects on musculoskeletal pain, work ability and sickness absence in a 1-year randomised controlled trial among cleaners Diet, physical exercise and cognitive behavioral training as a combined workplace based intervention to reduce body weight and increase physical capacity in health care workers - a randomized controlled trial Integrated health programme: a workplace randomized controlled trial. Low back pain as a predictor of long-term work disability Effects of the Workplace Health Promotion Activities Soccer and Zumba on Muscle Pain, Work Ability and Perceived Physical Exertion among Female Hospital Employees No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial Effectiveness of intervention for low back pain in female caregivers in nursing homes: a pilot trial based on multicenter randomization The effect of a health promotion intervention for construction workers on work-related outcomes: results from a randomized controlled trial The effectiveness of a construction worksite prevention program on work ability, health, and sick leave: results from a cluster randomized controlled trial. A new bricklayers' method for use in the construction industry. The effect of insoles on the incidence and severity of low back pain among workers whose job involves long-distance walking Effect of two contrasting interventions on upper limb chronic pain and disability: a randomized controlled trial. Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study Kettlebell training for musculoskeletal and cardiovascular health: a randomized controlled trial. Effect of a multidisciplinary program for the prevention of low back pain in hospital employees: a randomized controlled trial. A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders Efficacy of 'Tailored Physical Activity' on reducing sickness absence among health care workers: A 3-months randomised controlled trial. Effect of Individually Tailored Biopsychosocial Workplace Interventions on Chronic Musculoskeletal Pain and Stress Among Laboratory Technicians: Randomized Controlled Trial. Effectiveness of a Back Pain Prevention Program: A Cluster Randomized Controlled Trial in an Occupational Setting Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers Decrease in musculoskeletal pain after 4 and 12 months of an aerobic exercise intervention: a worksite RCT among cleaners A Randomized Controlled Trial to Prevent Patient Lift and Transfer Injuries of Health Care Workers Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme. A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders: A Randomized Controlled Trial Effects of hamstring stretch with pelvic control on pain and work ability in standing workers. Prevention of Low Back Pain in Female Eldercare Workers: Randomized Controlled Work Site Trial Are Back Supports Plus Education More Effective Than Education Alone in Promoting Recovery From Low Back Pain?: Results From a Randomized Clinical Trial Rest break interventions in stoop labor tasks. Effects of a Worksite Supervised Adapted Physical Activity Program on Trunk Muscle Endurance, Flexibility, and Pain Sensitivity Among Vineyard Workers A Cluster Randomized Controlled Trial of a Total Worker Health® Intervention on Commercial Construction Sites Participatory organizational intervention for improved use of assistive devices in patient transfer: a single-blinded cluster randomized controlled trial. Effectiveness of Workplace-Based Muscle Resistance Training Exercise Program in Preventing Musculoskeletal Dysfunction of the Upper Limbs in Manufacturing Workers Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers
abstract: OBJECTIVE Numerous studies has shown that regular physical exercise can reduce musculoskeletal pain , but the optimal setting to achieve high adherence and effectiveness remains unknown . This study investigated the effect of workplace versus home-based physical exercise on musculoskeletal pain among healthcare workers . METHODS The r and omized controlled trial ( RCT ) comprised 200 female healthcare workers from 18 departments at 3 hospitals . Participants were r and omly allocated at the cluster level to ten weeks of : ( i ) workplace physical exercise ( WORK ) performed during working hours for 5 × 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise , or ( ii ) home-based physical exercise ( HOME ) performed during leisure time for 5 × 10 minutes per week . Both groups received ergonomic counseling on patient h and ling and use of lifting aides . Average pain intensity ( 0 - 10 scale ) in the low back and neck/shoulder was the primary outcome . RESULTS Per week , 2.2 ( SD 1.1 ) and 1.0 ( SD 1.2 ) training sessions were performed in WORK and HOME groups , respectively . Pain intensity , back muscle strength and use of analgesics improved more following WORK than HOME ( P<0.05 ) . Between-group differences at follow-up ( WORK versus HOME ) was -0.7 points for pain intensity [ 95 % confidence interval ( 95 % CI ) -1.0- -0.3 ] , 5.5 Nm for back muscle strength ( 95 % CI 2.0 - 9.0 ) , and -0.4 days per week for use of analgesics ( 95 % CI -0.7- -0.2 ) . The effect size for between-group differences in pain intensity was small ( Cohen 's d=0.31 ) . CONCLUSIONS Workplace physical exercise is more effective than home-based exercise in reducing musculoskeletal pain , increasing muscle strength and reducing the use of analgesics among healthcare workers The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain . Seventy-nine women agreed to participate in the intervention study . After a medical examination , 65 individuals were assigned to one of three balanced groups : Endurance training ( aerobic capacity promoting training : ET : n = 22 ) , strength promotion exercise ( SP : n = 24 ) or a control group ( CON : n = 19 ) . The active groups met twice a week for 60 minutes of exercise over 15 weeks . Aerobic capacity ( VO2max ) and musculoskeletal pain were measured immediately before ( T1 ) and after the intervention period ( T2 ) . Aerobic capacity significantly increased in the ET group , whereas no change was observed in the SP group , and a significant reduction was found in the CON group from T1 to T2 . Musculoskeletal pain was significantly reduced in both intervention groups , whereas minor changes were observed in the control group . Results from a 7-month follow-up ( T3 ) survey confirmed the beneficial effects of interventions on musculoskeletal pain . In conclusion , improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction Objective : To examine the effects of a new wearable type of lumbosacral support on low back pain . Methods : A total of 121 healthcare workers participated in this study . They were r and omly allocated into the experimental and control groups and the former wore the support with signals of compression on the back by poor posture for the first 3 months . The control group remained on a waiting list for the first 3 months . Medical history , musculoskeletal symptoms , feeling in good posture , sleep habits , psychological distress , Rol and -Morris Disability Question naire , and Somatosensory Amplification Scale ( SSAS ) were evaluated . The range of motion ( ROM ) in the shoulder and hip joints as well as spinal alignment were evaluated . Our primary concern was the difference in the change of low back pain measured by visual analog scale ( VAS ) between the two groups . Results : A total of 54 participants in the experimental and 53 participants in the control groups were analyzed . VAS and SSAS scores as well as lumbar spinal ROM in the experimental group significantly decreased . Low back pain ( OR=0.401 , 95 % CI=0.168 - 0.954 ) and neck pain in the experimental group ( OR=0.198 , 95 % CI=0.052 - 0.748 ) significantly decreased . Conclusions : The new lumbar support reduced VAS and SSAS scores , lumbar spinal ROM , low back pain , and neck pain . This new type of lumbar support reduced low back pain among healthcare workers AIMS AND OBJECTIVES ( i ) To examine patient lifting techniques used by nurses , and ( ii ) to evaluate an effectiveness of the Spine Care for Nurses programme in chronic nonspecific low back pain syndrome reduction and the execution of proper patient lifting techniques . BACKGROUND Millions of nurses around the world suffer from occupational-related chronic nonspecific low back pain ( chronic nonspecific low back pain syndrome ) . Generally , low back pain in nurses is a result of increased pressure on the spine and can be associated with improperly conducted patient lifting techniques . METHODS A r and omised controlled trial was conducted among 137 nurses with chronic nonspecific low back pain syndrome . Participants were r and omised into an experimental and control group ( experimental group n = 67 , control group n = 70 ) . Nurses in the experimental group attended the Spine Care for Nurses programme for 3 months . The programme consisted of didactic education , spine-strengthening exercises and education on safe patient h and ling techniques . The control group only received a brief written lifestyle guidance . The Zebris WinSpine Triple Lumbar examination was used to analyse nurses ' patient lifting techniques ( horizontal and vertical lifting ) . The lumbar pain intensity was measured with a 0 - 100 visual analogue scale . RESULTS The pre-intervention average chronic nonspecific low back pain syndrome intensity score on visual analogue scale decreased from 49.3 to the postintervention score of 7.5 . The correct execution of vertical lifting techniques in the experimental group increased from 8.91%-97.01 % ( control group : 8.57 % pre-intervention test and postintervention test 11.42 % ) . The  horizontal patient lifting technique pre-intervention increased from 10.44%-100 % correct execution in the experimental group ( control group : pre-intervention test 10.00 % and postintervention test 11.42 % ) . CONCLUSION The Spine Care for Nurses programme significantly reduced chronic nonspecific low back pain syndrome and increased the number of properly executed horizontal and vertical patient lifting techniques in nurses . RELEVANCE TO CLINICAL PRACTICE We recommend that healthcare organisations should consider the implementation of regular Spine Care for Nurses programmes as successful low back injury prevention programmes OBJECTIVES To evaluate effects of a PRECEDE-PROCEED Model based , nurse-delivered Ergonomic Risk Management Program ( ERMP ) in the aim of reducing musculoskeletal symptoms of intensive care unit ( ICU ) nurses . METHODS This pre-test post-test design for non-equivalent control groups study comprised 72 ICU nurses from two hospitals . A r and omised sampling was done through the study population . The ERMP was delivered as an intervention including 26weeks of follow-up . Data was collected by " Descriptives of Nurses and Ergonomic Risk Reporting Form " , " Rapid Upper Risk Assessment Form ( RULA ) " , " ICU Environment Assessment Form " and " Personal interviews form " . RESULTS There was no difference between sociodemographic characteristics , work and general health conditions within intervention and control group . One month after the intervention , nurses had significant decrease in their total RULA scores during bending down and patient repositioning movements as 1.40 and 0.82 , respectively . Six months after the ERMP , the mean total RULA scores of nurses during the patient repositioning was 4.39±1.49 which meant " immediate further analyses and modifications recommended " . After all , pain intensity scores , medication use due to pain , and RULA ergonomic risk scores were significantly decreased , while exercise frequency was increased . CONCLUSIONS The ERMP was effective to increase exercise frequency and to decrease musculoskeletal pain and ergonomic risk levels of ICU nurses Background Construction work frequently involves heavy physical work , and a reduction of the physical workload should have high priority . Technological development has made it possible to obtain field measurements with surface electromyography ( sEMG ) , kinematics measured with inertial measurement units ( IMUs ) , and video recordings . However , no studies have used these methods simultaneously to detect situations with excessive physical workload ( events ) during a working day . Thus , knowledge about these specific events may combat work-related risk factors . Participatory ergonomics ( PE ) has shown promising results , but whether it can be used as a tool to reduce the physical workload during construction work remains unknown . Objective This cluster r and omized controlled trial investigated whether a PE intervention with technical measurements consisting of IMUs , sEMG , heart rate monitoring , and video recordings of physical workload could reduce the number of events with excessive physical workload during a working day . Furthermore , other outcomes were obtained from question naires . Methods A total of 80 male full-time construction workers ( aged 19 to 67 years ) were r and omized at the cluster level ( gang ) to a PE intervention consisting of 3 workshops ( 7 gangs and 32 workers ) or to a control group ( 8 gangs and 48 workers ) . The physical workload was recorded by technical measurements , that is , IMUs ,  sEMG  , heart rate monitoring , and video recordings during a full working day at baseline and 3 and 6 months ’ follow-up . On the basis of the technical measurements , a custom-made computer program detected the situations ( events ) where the construction workers were exposed to excessive physical workload and used in the intervention . Differences in the number of events from baseline to follow-up between intervention and control were evaluated using linear mixed models ( intention-to-treat ) , with individual nested in cluster as a r and om factor . Furthermore , question naires were filled out on test days . Results The results of the primary outcome showed no change in the number of events with excessive physical workload . However , compared with the control group , the other outcomes showed decreased general fatigue after a typical working day ( P=.001 ) and increased influence on own work ( P=.04 ) . Conclusions This PE intervention with technical measurements did not reduce the number of events with excessive physical workload during construction work . However , the intervention led to decreased general fatigue and increased influence on own work . Trial Registration Clinical Trials.gov NCT02498197 ; https:// clinical trials.gov/ct2/show/NCT02498197 ( Archived by WebCite at http://www.webcitation.org/74SZ3DIWS Objective : To investigate whether an exercise intervention shown to increase aerobic capacity , would also lead to less musculoskeletal pain ; improved work ability , productivity , and perceived physical exertion ; and less sick leave . Methods : Sixty-seven construction workers were r and omized into an exercise group training 3 × 20 minutes per week and a control group . Question naires and text messages were completed before and after the 12-week intervention . Results : No significant changes were found in musculoskeletal pain , work ability , productivity , perceived physical exertion , and sick leave with the intervention . Question naires and text messages provided similar results of pain and work ability . Conclusions : Although the intervention improved aerobic capacity , it was not successful in improving musculoskeletal pain and other work-related factors . A detectable improvement presumably requires a more multifaceted intervention , larger sample size , or longer follow-up . Text messages may be a convenient data - collection method in future studies OBJECTIVE Low-back pain ( LBP ) is a common and recurrent condition , but the evidence is scarce about effective strategies to prevent recurrence and disability in the longer term . This study investigated the effect of a light exercise program , initiated in the workplace and continued at home , in reducing recurrence of  LBP  episodes  among healthcare workers . METHODS A total of 353 healthcare workers from ten hospitals were enrolled in a r and omized controlled trial ( RCT ) and were r and omized to the intervention or control groups , the latter of which received usual care . The intervention comprised three steps : ( i ) a 2-hour education session , ( ii ) five weekly 90-minutes exercise training sessions in the workplace , and ( iii ) a home-based self-managed exercise program . The main outcome was recurrence of LBP with sick-leave at 24-months follow-up . RESULTS At two-year follow-up , 35 workers ( 24 % ) in the intervention group and 31 workers ( 21 % ) in the control group had at least one LBP recurrence with sick leave . No effect was observed between groups [ odds ratio ( OR ) 1.22 , 95 % confidence interval ( 95 % CI ) 0.67 - 2.23 , P=0.516 ] . The intervention was effective in reducing fear avoidance with a mean reduction of -3.6 ( 95 % CI -4.8- -2.4 ) points on the fear-avoidance beliefs question naire score for physical activity ( FABQ-P ) in the intervention group compared with -1.3 ( 95 % CI -2.2- -0.3 ) points in the control group ( P<0.05 ) . It was also effective in improving muscle endurance with a mean increase of 13.9 ( 95 % CI 3.3 - 24.5 ) minutes on the Sorensen test in the intervention group compared with -8.3 ( 95 % CI-17.5 - 0.9 ) minutes in the control group ( P<0.05 ) . Healthcare utilization was reduced in the intervention group for painkillers , medical visits , imaging and outpatient physiotherapy . CONCLUSION It was not possible to conclude about the effectiveness of a light exercise program to reduce LBP recurrence episodes in the long-term in healthcare workers . However , it was effective to improve muscle endurance , and to reduce fear-avoidance beliefs and healthcare utilization . Further studies are necessary in order to identify effective interventions to reduce LBP recurrence and related sick-leaves Background Only a few workplace initiatives among cleaners have been reported , even though they constitute a job group in great need of health promotion . The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain , work ability and sickness absence among cleaners . Methods A cluster-r and omised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training ( PCT ) , cognitive behavioural training ( CBTr ) or a reference group ( REF ) .  Question naires about musculoskeletal pain and work ability were completed at baseline and after one year 's intervention . Sickness absence data were obtained from the managers ' records . Analyses were performed according to the intention-to-treat-principle ( ITT ) . Results No overall reduction in musculoskeletal pain , work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses . However , explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT . People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF ( p = 0.05 ) . Conclusions The PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners . It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence . Trial registration IS RCT N : IS RCT Background Health care workers comprise a high-risk workgroup with respect to deterioration and early retirement . There is high prevalence of obesity and many of the workers are overweight . Together , these factors play a significant role in the health-related problems within this sector . The present study evaluates the effects of the first 3-months of a cluster r and omized controlled lifestyle intervention among health care workers . The intervention addresses body weight , general health variables , physical capacity and musculoskeletal pain . Methods 98 female , overweight health care workers were cluster-r and omized to an intervention group or a reference group . The intervention consisted of an individually dietary plan with an energy deficit of 1200 kcal/day ( 15 min/hour ) , strengthening exercises ( 15 min/hour ) and cognitive behavioral training ( 30 min/hour ) during working hours 1 hour/week . Leisure time aerobic fitness was planned for 2 hour/week . The reference group was offered monthly oral presentations . Body weight , BMI , body fat percentage ( bioimpedance ) , waist circumference , blood pressure , musculoskeletal pain , maximal oxygen uptake ( maximal bicycle test ) , and isometric maximal muscle strength of 3 body regions were measured before and after the intervention period . Results In an intention-to-treat analysis from pre to post tests , the intervention group significantly reduced body weight with 3.6 kg ( p < 0.001 ) , BMI from 30.5 to 29.2 ( p < 0.001 ) , body fat percentage from 40.9 to 39.3 ( p < 0.001 ) , waist circumference from 99.7 to 95.5 cm ( p < 0.001 ) and blood pressure from 134/85 to 127/80 mmHg ( p < 0.001 ) , with significant difference between the intervention and control group ( p < 0.001 ) on all measures . No effect of intervention was found in musculoskeletal pain , maximal oxygen uptake and muscle strength , but on aerobic fitness . Conclusion The significantly reduced body weight , body fat , waist circumference and blood pressure as well as increased aerobic fitness in the intervention group show the great potential of workplace health promotion among this high-risk workgroup . Long-term effects of the intervention remain to be investigated . Trial registration Clinical Trials.gov : 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 Aim : To investigate low back pain ( LBP ) , with and without other musculoskeletal pains , as a predictor of long-term work disability . Method : A four-year prospect i ve study was conducted . All inhabitants in the municipality of Ullensaker , Norway , born in 1928 - 30 , 1938 - 40 , 1948 - 50 , 1958 - 60 and 1968 - 70 , received a  mailed question naire in 1990 and 1994 . The present study comprised the 1,788 responders who were working in 1990 . Of these , 1426 ( 80 % ) returned the question naire four years later . The main outcome measure was long-term work disability ( > eight weeks ) in 1994 . Results : LBP in 1990 predicted long-term work disability in 1994 ( odds ratio ( OR ) = 1.95 , 95 % confidence interval (CI)= 1.39- 2.74 ) . Localized LBP however , did not predict long-term work disability , while LBP accompanied by widespread pain did ( OR= 3.52 , 95 % CI = 1.09- 11.37 ) , also after adjustments for demographic , lifestyle , and work-related factors . Other predictors of long-term work disability were high age , sick leave last year , heavy lifting in the job , poor sleep quality and smoking . Conclusion : LBP in persons with widespread musculoskeletal pain predicted long-term work disability , while localized LBP did not Objectives This 40-week workplace physical training RCT investigated the effect of soccer and Zumba , respectively , on muscle pain intensity and duration , work ability , and rating of perceived exertion ( RPE ) during work among female hospital employees . Methods 107 hospital employees were cluster-r and omized into two training groups , and a control group . The training was conducted outside working hours as two-three 1-h sessions per week for the first 12 weeks , and continued as one-two 1-h sessions per week for the last 28 weeks . Muscle pain intensity and duration , work ability , and RPE during work were measured at baseline and after 12 and 40 weeks . Results After 12 weeks , both the soccer ( −1.9 , 95 % CI , −3.0 , −0.8 , P = 0.001 ) and the Zumba group ( −1.3 , 95 % CI , −2.3 , −0.3 , P = 0.01 ) reduced the pain intensity ( on a scale from 0 to 10 ) in the neck-shoulder region ( eta squared = 0.109 ) , whereas only the soccer group ( −1.9 , 95 % CI , −3.2 , −0.7 , P = 0.002 , eta squared = 0.092 ) showed a reduction after 40 weeks referencing the control group . After 40 weeks , both the soccer ( -16.4 days , 95 % CI , −29.6 , −3.2 , P<0.02 ) and the Zumba group ( -16.6 days , 95 % CI , −28.9 , −4.2 , P<0.01 ) reduced the pain duration during the past 3 months in the neck-shoulder region ( eta squared = 0.077 ) . No significant effects on intensity or duration of pain in the lower back , RPE during work or work ability were found . Conclusions The present study indicates that workplace initiated soccer and Zumba training improve neck-shoulder pain intensity as well as duration among female hospital employees . Trial Registration International St and ard R and omized Controlled Trial Number Register IS RCT N 61986892 The effects of two different prevention programmes on : ( 1 ) reported neck , shoulder and back pain , ( 2 ) perceived physical exertion at work and perceived work-related psychosocial factors , were evaluated by question naires after 12 and 18 months . Female nursing aides and assistant nurses ( n = 282 ) working in the home-care services , were r and omly assigned to one of three groups for : ( 1 ) individually design ed physical training programme , ( 2 ) work-place stress management , ( 3 ) control group . Results revealed no significant differences between the three groups . However , improvements in low back pain were registered within both intervention groups for up to 18 months . Perceived physical exertion at work was reduced in the physical training group . Improvements in neck and shoulder pain did not differ within the three groups . Dissatisfaction with work-related , psychosocial factors was generally increased in all groups . As the aetiology of neck , shoulder and back disorders is multifactorial , a combination of the two intervention programmes might be preferable and should be further studied Topical menthol gels are classified “ topical analgesics ” and are cl aim ed to relieve minor aches and pains of the musculoskeletal system . In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome ( CTS ) . We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/h and who were r and omly distributed into two groups to receive topical menthol ( Biofreeze ) or placebo ( gel with a menthol scent ) during the working day and 48 hours later the other treatment ( crossover design ) . Participants rated arm/h and pain intensity during the last hour of work ( scale 0–10 ) immediately before 1 , 2 , and 3 hours after application . Furthermore , global rating of change ( GROC ) in arm/h and pain was assessed 3 hours after application . Compared with placebo , pain intensity and GROC improved more following application of topical menthol ( P = 0.026 and P = 0.044 , resp . ) . Pain intensity of the arm/h and decreased by −1.2 ( CI 95 % : −1.7 to −0.6 ) following topical menthol compared with placebo , corresponding to a moderate effect size of 0.63 . In conclusion , topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain 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 Abstract This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics , physical training , and cognitive – behavioural training ( CBT ) for  low back pain ( LBP ) . Between November 2012 and May 2014 , we conducted a pragmatic stepped wedge cluster r and omised controlled trial with 594 workers from eldercare workplaces ( nursing homes and home care ) r and omised to 4 successive time periods , 3 months apart . The intervention lasted 12 weeks and consisted of 19 sessions in total ( physical training [ 12 sessions ] , CBT [ 2 sessions ] , and participatory ergonomics [ 5 sessions ] ) . Low back pain was the outcome and was measured as days , intensity ( worst pain on a 0 - 10 numeric rank scale ) , and bothersomeness ( days ) by monthly text messages . Linear mixed models were used to estimate the intervention effect . Analyses were performed according to intention to treat , including all eligible r and omised participants , and were adjusted for baseline values of the outcome . The linear mixed models yielded significant effects on LBP days of −0.8 ( 95 % confidence interval [ CI ] , −1.19 to −0.38 ) , LBP intensity of −0.4 ( 95 % CI , −0.60 to −0.26 ) , and bothersomeness days of −0.5 ( 95 % CI , −0.85 to −0.13 ) after the intervention compared with the control group . This study shows that a multifaceted intervention consisting of participatory ergonomics , physical training , and CBT can reduce LBP among workers in eldercare . Thus , multifaceted interventions may be relevant for improving LBP in a working population Objectives Although the importance of stretching exercise for pain-relieving and patient education is well documented for chronic lumbago patients , it is uncertain how effective on-the-job training ( OJT ) is for female caregivers in nursing homes . In the present pilot trial based on multicenter r and omization , we evaluated the intervention effect of a lecture and stretching exercise on caregivers in nursing homes . Methods Eighty-eight female caregivers ( four nursing homes ) volunteered to participate in this study , and they were separated into two groups r and omly . For the intervention group , guidance by an orthopedist and an exercise instructor were provided as one OJT , and stretching exercises for only 6 min every day were recommended for low back pain prevention to the caregivers . Low back pain visual analogue scale ( VAS ) , physical fitness , and mental and physical health were compared at baseline and immediately after the intervention . Results A total of 29 ( 33 % ) participants withdrew by 12 weeks . Regarding the reasons for withdrawal , 28 participants resigned , and one took a leave of absence due to exacerbation of lumbago . Adherence to the  stretching exercises was 2.3 ± 1.3 ( mean ± SD ) times per week . No significant differences were seen for any outcome measurements . The high adherence group ( ≧3 times per week ) did not show a change in the VAS , but the low adherence group ( <3 times per week ) and control group showed a tendency towards an increased score ( p = 0.068 ) . Conclusions Even with the conduct of one OJT , and exercises of only 6 min every day , the adherence of caregivers was low , and there appeared to be few effects of the OJT Purpose The objective of the present study is to investigate the effects of a worksite health promotion intervention on musculoskeletal symptoms , physical functioning , work ability , work-related vitality , work performance , and sickness absence . Methods In a r and omized controlled design , 314 construction workers were r and omized into an intervention group ( n = 162 ) receiving personal coaching , tailored information , and material s , and a control group ( n = 152 ) receiving usual care .  Sickness absence was recorded continuously in company records , and question naires were completed before , directly after the 6-month intervention period , and 12 months after baseline measurements . Linear and logistic regression analyses were performed to determine intervention effects . Results No significant changes at 6 or 12 months of follow-up were observed in musculoskeletal symptoms , physical functioning , work ability , work-related vitality , work performance , and sickness absence as a result of the intervention . Conclusions This study shows that the intervention was not statistically significantly effective on secondary outcomes . Although the intervention improved physical activity , dietary , and weight-related outcomes , it was not successful in decreasing musculoskeletal symptoms and improving other work-related measures . Presumably , more multifaceted interventions are required to establish significant change in these outcomes OBJECTIVE This study aim ed to investigate the effectiveness of a prevention program on work ability , health , and sick leave targeted at construction worksites . METHODS A total of 15 departments ( N = 297 workers ) from 6 construction companies participated in this cluster r and omized controlled trial and were r and omly allocated to the intervention ( 8 departments ; N = 171 workers ) or control ( 7 departments ; N = 122 workers ) group . The intervention consisted of two individual training sessions with a physical therapist aim ed at lowering the physical workload , a rest-break tool to improve the balance between work and recovery , and two empowerment training sessions to increase the worker 's influence at the worksite . Data on work ability , physical and mental health status , and musculoskeletal symptoms were collected at baseline , and at 3 , 6 , and 12 months follow-up . Sick leave data were obtained from the companies . RESULTS Overall , no differences in work ability [ β 0.02 , 95 % confidence interval ( 95 % CI ) -0.34 - 0.37 ] or physical and mental health status ( β -0.04 , 95 % CI -1.43 - 1.35 , and β 0.80 95 % CI -0.51 - 2.11 , respectively ) were found between the intervention and control group . The intervention showed an overall decline in musculoskeletal symptoms ( ranging from OR 0.68 , 95 % CI 0.34 - 1.33 , to OR 0.86 , 95 % CI 0.47 - 1.57 ) and long-term sick leave ( OR 0.44 , 95 % CI 0.13 - 1.26 ) among construction workers . Both reductions were not statistically significant . CONCLUSION The prevention program seemed to result in a beneficial but not statistically significant decline in the prevalence of musculoskeletal symptoms and long-term sick leave among construction workers , but showed no effects with regard to work ability , physical health , and mental health OBJECTIVES The aim of this study was to investigate the effect of raised bricklaying on physical workload , reported musculoskeletal disorders , sickness absence , and job satisfaction . METHODS A controlled intervention study with a follow-up period of 10 months was performed among 202 bricklayers from 25 construction companies . RESULTS The introduction of devices for raised bricklaying decreased the physical load on the lower back and , to a less extent , on the shoulders and upper extremities . Although raised bricklaying had no effect on the number of lifts , decreases in trunk bending lowered the biomechanical moment . The results showed no decrease in reported musculoskeletal symptoms as a result of the adoption of raised bricklaying . Irrespective of the reason(s ) , the percentage of bricklayers in the intervention group reporting sickness absence was significantly lower than the same percentage in the control group . The results also showed that , in general , the bricklayers in this study were very satisfied with the use of devices for raised bricklaying . CONCLUSIONS Controlled intervention studies on ergonomic improvements are rare . This study shows that the introduction of an ergonomic improvement in the construction industry may reduce physical load and the incidence of sickness absence The prevalence and incidence of low back pain in general society is high . Workers whose job involves walking long distances have an even higher tendency to suffer from low back pain . A positive effect of insoles in reducing low back pain was found in professional sports players . This was not examined on people whose job involves walking long distances . In this double blind prospect i ve study we examined the effectiveness of insoles constructed in a computerized method to placebo insoles in 58 employees whose work entailed extensive walking and who suffered from low back pain . The evaluation was performed by the MILLION question naire , which is considered as a valid question naire for evaluation of low back pain . We calculated the differences of the pain intensity before and after the intervention , in the employees using the insoles manufactured by computer  in comparison to the users of the  placebo insoles .  In each group , the analysis was performed in comparison to the baseline . A total of 81 % of the employees preferred the real insoles as effective and comfortable in comparison to 19 % of the users of the placebo insoles ( P<0.05 ) . The results of this study indicate a substantial improvement in the low back pain after the use of the true insoles . The average pain intensity according to the MILLION question naire before the use of the insoles was 5.46 . However , after the use of the real insoles and the placebo insoles , the average pain intensity decreased to 3.96 and 5.11 , respectively . The difference of the average pain intensity at the start of the study and after the use of the real insoles was significant : −1.49 ( P=0.0001 ) , whereas this difference after the use of the placebo insoles was not significant : −0.31 ( P=0.1189 ) . The reported severity of pain also decreased significantly : a level 5 pain and above was reported by 77 % of the subjects at the start of the study . After the use of the real insoles only 37.9 % of the subjects reported a similar degree of pain severity , and 50 % of the subjects did so after the use of the placebo insoles ( P < 0.05 ) . We did not find a link between low back pain and other variables such as gender , age , number of offspring , work seniority , smoking , previous use of insoles and previous medication . This study demonstrates that the low back pain decreased significantly after the use of real insoles compared to placebo ones BACKGROUND Chronic pain and disability of the arm , shoulder , and h and severely affect labor market participation . Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain . An alternative strategy could be to increase physical capacity of the worker by physical conditioning . OBJECTIVES To investigate the effect of 2 contrasting interventions , conventional ergonomic training ( usual care ) versus resistance training , on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual work . STUDY DESIGN Examiner-blinded , parallel-group r and omized controlled trial with allocation concealment . SETTING Slaughterhouses located in Denmark , Europe . METHODS Sixty-six adults with chronic pain in the shoulder , elbow/forearm , or h and /wrist and work disability were r and omly allocated to 10 weeks of specific resistance training for the shoulder , arm , and h and muscles for 3 x 10 minutes per week , or ergonomic training and education ( usual care control group ) .  Pain intensity ( average of shoulder , arm , and h and , scale 0 - 10 ) was the primary outcome , and disability ( Work module of DASH question naire ) as well as isometric shoulder and wrist muscle strength were secondary outcomes . RESULTS Pain intensity , disability , and muscle strength improved more following resistance training than usual care ( P < 0.001 , P = 0.05 , P < 0.0001 , respectively [ corrected ] ) . Pain intensity decreased by 1.5 points ( 95 % confidence interval -2.0 to -0.9 ) following resistance training compared with usual care , corresponding to an effect size of 0.91 ( Cohen 's d ) . LIMITATIONS Blinding of participants is not possible in behavioral interventions . However , at baseline outcome expectations of the 2 interventions were similar . CONCLUSION Resistance training at the workplace results in clinical relevant improvements in pain , disability , and muscle strength in adults with upper limb chronic pain exposed to highly repetitive and forceful manual work . TRIAL REGISTRATION NCT01671267 The aim of this study was to evaluate the effect of a transfer technique education programme ( TT ) alone or in combination with physical fitness training ( TTPT ) compared with a control group , who followed their usual routine . Eleven clinical hospital wards were cluster r and omised to either intervention ( six wards ) or to control ( five wards ) . The intervention cluster was  individually r and omised to TT ( 55 nurses ) and TTPT ( 50 nurses ) , control ( 76 nurses ) . The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues . The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks . Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not , when compared to a control group , show any statistical differences according to self-reported low back pain ( LBP ) , pain level , disability and sick leave at a 12-month follow-up . However , the individual r and omised intervention subgroup ( transfer technique/physical training ) significantly improved the LBP-disability ( p = 0.001 ) . Although weakened by a high withdrawal rate , teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered . Other priorities such as physical training may be taken into consideration . The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP . However , physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel OBJECTIVE The aim of this trial was to investigate the effectiveness of a worksite intervention using kettlebell training to improve musculoskeletal and cardiovascular health . METHODS This single-blind r and omized controlled trial involved 40 adults from occupations with a high prevalence of reported musculoskeletal pain symptoms ( mean age 44 years , body mass index 23 kg/m² , 85 % women , with pain intensity of the neck/shoulders 3.5 and of the low back 2.8 on a scale of 0 - 10 ) . A blinded assessor took measures at baseline and follow-up . Participants were r and omly assigned to training -- consisting of ballistic full-body kettlebell exercise 3 times per week for 8 weeks -- or a control group . The main outcome measures were pain intensity of the neck/shoulders and low back , isometric muscle strength , and aerobic fitness . RESULTS Compared with the control group , pain intensity of the neck/shoulders decreased 2.1 points [ 95 % confidence interval ( 95 % CI ) -3.7- -0.4 ] and pain intensity of the low back decreased 1.4 points ( 95 % CI -2.7- -0.02 ) in the training group . Compared with the control group , the training group increased muscle strength of the trunk extensors ( P<0.001 ) , but not of the trunk flexors and shoulders . Aerobic fitness remained unchanged . CONCLUSIONS Worksite intervention using kettlebell training  reduces pain in the neck/shoulders and low back and improves muscle strength of the low back among adults from occupations with a high prevalence of reported musculoskeletal pain symptoms . This type of training does not appear to improve aerobic fitness BACKGROUND Hospital workers with physically dem and ing jobs are at risk for developing recurrent LBP . There is a lack of studies evaluating multidisciplinary prevention of  low back pain ( LBP ) in hospital workers . OBJECTIVE This r and omized controlled trial evaluates the effect of a multidisciplinary prevention program , focusing on a client-centred approach , on hospital workers at risk for developing LBP . METHODS Caregiving hospital workers were allocated to an experimental ( 12-week lasting multidisciplinary prevention program ) or control group ( no intervention ) . They were evaluated prior to the intervention and after a 6 months follow-up period . Primary outcome measures included incidence of LBP , work absenteeism and general health . Secondary outcomes included daily physical activity , job satisfaction and coping strategies . RESULTS A significant improvement was seen for passive coping after 6 months follow-up , but no significant differences were observed between groups in primary or other secondary outcome measures ( p > 0.05 ) . CONCLUSIONS A multidisciplinary prevention program fitting into a bio-psychosocial context may not have been intensive enough to promote a change in daily habitudes , and had no effect on work absenteeism , incidence of LBP or general health . Further research should determine whether prevention of LBP is possible in caregiving personnel Objectives : To examine the efficacy of a participatory ergonomics intervention in preventing musculoskeletal disorders among kitchen workers .  Participatory ergonomics is commonly recommended to reduce musculoskeletal disorders , but evidence for its effectiveness is sparse . Methods : A cluster r and omised controlled trial among the 504 workers of 119 kitchens in Finl and was conducted during 2002–2005 . Kitchens were r and omised to an intervention ( n = 59 ) and control ( n = 60 ) group . The duration of the intervention that guided the workers to identify strenuous work tasks and to seek solutions for decreasing physical and mental workload , was 11 to 14 months . In total , 402 ergonomic changes were implemented . The main outcome measures were the occurrence of and trouble caused by musculoskeletal pain in seven anatomical sites , local fatigue after work , and sick leave due to musculoskeletal disorders . Individual level data were collected by a question naire at baseline and every 3 months during the intervention and 1-year follow-up period . All response rates exceeded 92 % . Results : No systematic differences in any outcome variable were found between the intervention and control groups during the intervention or during the 1-year follow-up . Conclusions : The intervention did not reduce perceived physical work load and no evidence was found for the efficacy of the intervention in preventing musculoskeletal disorders among kitchen workers . It may be that a more comprehensive re design of work organisation and processes is needed , taking more account of workers ’ physical and mental re sources AIM The aim was to evaluate efficacy of " Tailored Physical Activity " ( TPA ) versus a reference group ( REF ) in reducing the number of self-reported days of sickness absence for health care workers in the Sonderborg Municipality . METHODS In this r and omised controlled trial , all participants ( n = 54 ) received health guidance for 1.5 h  and were r and omised to TPA or REF . The primary aim was to make a comparison of participants ' self-reported sickness absence due to musculoskeletal troubles measured three months after baseline . Secondary outcomes included anthropometric , health-related and physical capacity measures . RESULTS A TPA intervention was not significantly more effective than REF in reducing sickness absence caused by musculoskeletal troubles . However , there were significant improvements for TPA participants compared to REF in reducing pain intensity from 47.9 mm to 21.8 mm ( p < .01 ) , increasing work ability from 7.3 to 8.1 ( p = .04 ) and decreasing kinesiophobia from 26.7 to 22.5 ( p < .01 ) . A trend towards a significant improvement was seen for aerobic capacity while no effect of the intervention was found on productivity , BMI or grip strength . CONCLUSION This physical activity intervention is a promising initiative for health care workers since participants achieved a substantial effect on their experience of pain , on their work ability and on their fear of physical movement relating to pain . Moreover , a difference in aerobic capacity was apparent between the sample groups . TPA however , had no significant effect in reducing sickness absence days BACKGROUND Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem . OBJECTIVES This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements . STUDY DESIGN This trial uses a single-blind r and omized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians . The trial " Implementation of physical exercise at the Workplace (IRMA09)--Laboratory technicians " was registered at Clinical Trials.gov prior to participant enrolment . SETTING The study was conducted at the head division of a large private pharmaceutical company 's research and development department in Denmark . The study duration was March 2014 ( baseline ) to July 2014 ( follow-up ) . METHODS Participants ( n = 112 ) were allocated to receive either physical , cognitive , and mindfulness group-based training ( PCMT group ) or a reference group ( REF ) for 10 weeks at the worksite . PCMT consisted of 4 major elements : 1 ) resistance training individually tailored to the pain affected area , 2 ) motor control training , 3 ) mindfulness , and 4 ) cognitive and behavioral therapy/education . Participants of the REF group were encouraged to follow ongoing company health initiatives . The predefined primary outcome measure was pain intensity ( VAS scale 0 - 10 ) in average of the regions : neck , shoulder , lower and upper back , elbow , and h and at 10 week follow-up . The secondary outcome measure was stress assessed by Cohen´s perceived stress question naire . In addition , an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress , respectively , as outcome measures . RESULTS A significant ( P < 0.0001 ) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 ( 95%CI : -1.4 to -0.6 ) . No significant effect on stress was observed ( treatment by time P = 0.16 ) . Exploratory analyses for each body region separately showed significant pain reductions of the neck , shoulders , upper back and lower back , as well as a tendency for h and pain . Within the PCMT group , general linear models adjusted for age , baseline pain , and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week ( -0.60 [ 95%CI -0.95 to -0.25 ] ) and the number of mindfulness sessions ( 0.15 [ 95%CI 0.02 to 0.18 ] ) . No such associations were found with the change in stress as outcome . LIMITATIONS Limitations of behavioral interventions include the inability to blind participants to which intervention they receive . Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations . CONCLUSIONS We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives . A higher dose of physical-cognitive training appears to facilitate pain reduction , whereas a higher dose of mindfulness appears to increase pain . Hence , combining physical training with mindfulness may not be an optimal strategy for pain reduction . TRIAL REGISTRATION NCT02047669 Study Design . A cluster r and omized controlled trial and economic evaluation with a 12-month follow-up and with work department as the unit of r and omization . Objective . To evaluate the effectiveness of a prevention program for  low back pain ( LBP ) in an occupational setting with an economic evaluation . Summary of Background Data . LBP accounts for high economic costs in Western societies . Little is known on the effectiveness and related costs and savings of prevention programs for LBP . Methods . The study population consisted of workers in physically dem and ing jobs from 9 large companies located throughout The Netherl and s. In each company , 2 comparable work units were r and omly allocated , result ing in 18 clusters with 258 workers assigned to the intervention group and 231 workers to the control group . Results . Results in our study did not show significant differences in effects or costs savings of the program . Indirect costs related to work absence and productivity losses accounted for the majority ( 84 % ) of total costs due to LBP . Conclusions . This study provides no evidence for the adoption of this worksite prevention program for LBP Context Lumbar supports are commonly used to prevent low back pain , but evidence on their effectiveness is lacking . Contribution This trial assigned 360 home care workers with a history of low back pain to a short course on healthy work habits , with or without worker-directed use of a lumbar support . Over 12 months , participants assigned to lumbar support had a similar number of sick days but fewer days with low back pain than did those assigned to the course only . Implication Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence , but not absenteeism , among workers with previous low back pain . The Editors Low back pain is a common problem that results in high medical expenses , work absenteeism , and disability ( 1 ) . The reported 1-year prevalence ranges from 15 % to 40 % in a general population ( 2 ) and from 44 % to 72 % among home care workers ( 3 , 4 ) . Various ergonomic aids are marketed for the prevention of low back pain . Workers frequently use lumbar supports to prevent back pain ( 5 ) , but the effectiveness of such supports remains unclear . Recent systematic review s of the sparse evidence on lumbar supports ( 6 , 7 ) concluded that no evidence exists for the effectiveness of  lumbar supports  in the primary prevention of low back pain in the workplace , but 2 of the 4 included r and omized , controlled trials ( 8 , 9 ) reported that lumbar supports might be effective in workers with a history of low back pain ( secondary prevention ) . However , these findings were derived from subgroup analyses , and evidence from direct research on secondary prevention was not available . In cohort studies , a history of low back pain proved to be a strong predictor for the incidence of new episodes of low back pain ( 1012 ) . Home care workers with a history of low back pain may therefore be well suited to secondary preventive measures . In a previous uncontrolled feasibility study , we found that home care workers who had frequent episodes of low back pain reported adherence rates of 61 % to 81 % with lumbar supports and a 45 % decrease in pain intensity when using lumbar supports ( 13 ) . We design ed the current trial to evaluate the effectiveness of adding worker-directed use of lumbar supports to a short course on healthy working methods to reduce low back pain and work absenteeism among home care workers with a history of low back pain . Methods Design Our r and omized , controlled trial included 2 groups . The control group received a short refresher course on healthy working methods provided by their employer at the start of their employment ( Appendix ) ; primary and secondary care for the management of low back pain was available as usual ( 14 ) . The intervention group received a lumbar support in addition to usual care . The intervention and data collection continued for 12 months after enrollment . The Medical Ethical Committee of the Erasmus University Medical Center , Rotterdam , the Netherl and s , approved the study . Participants All participants were recruited from employees of a large home care organization in Rotterdam . During staff meetings , all present team members completed a brief survey about study inclusion criteria that was distributed and collected by the team managers . We included persons who performed medical care or domestic tasks as a home care worker , were experiencing low back pain symptoms at the time of inquiry or had experienced 2 or more episodes ( on 2 consecutive days ) of low back pain symptoms in the 12 months before the inquiry , did not have specific low back pain ( for example , due to rheumatoid arthritis or vertebral fractures ) , and were not pregnant at the start of the study . Because of a possible association between lumbar supports and increased blood pressure and heart rate , we excluded workers receiving medical treatment for high blood pressure ( 15 ) . Employees who met the inclusion criteria received detailed information about the trial , and those who agreed to participate provided written consent . R and omization In the Netherl and s , home care workers provide 1 of 8 functions , each of which requires different skills and tasks . To ensure a balance in workload and working conditions between the 2 study groups , we stratified r and omization by these 8 functions . We also stratified r and omization by low back pain experience at baseline ( current pain vs. past pain ) . The r and omization process used a computer-generated r and om-number table with 16 strata ( 2 low back pain by 8 workplace functions ) , arranged in blocks of 8 within each stratum . After baseline measurements were completed , colleagues who were not otherwise involved in the study and who were blinded to participants ' baseline characteristics used the r and om-number table to allocate each participant to 1 of the study groups . Intervention All participants in the intervention group were instructed to wear the lumbar supports on working days on which they had or expected they might develop low back pain . Participants could select 1 of 4 types of lumbar supports , supplied by Bauerfeind B.V. , Haarlem , the Netherl and s. LumboTrain and LumboTrain Lady are individually adjustable , hook- and -loop fastening , fully elastic supports that are available in 5 sizes for men or women . LumboLoc and LordoLoc are more structured supports , with integrated stays in the back , that have individually adjustable hook- and -loop fastenings and are available in 6 sizes . Participants chose the lumbar support on the basis of fit and wearing comfort , and they were not given advice to direct their choice from among the 4 available supports . When measured by the research er for the lumbar support , the participants were advised to wear the support for a few days in a row , regardless of low back pain , in order to become accustomed to it . The expected duration of wearability of the lumbar supports was 1 year . The costs of the lumbar supports were 75 for LumboTrain and LumboTrain Lady , 56 for LumboLoc , and 50 for LordoLoc . Outcome Measures Our primary outcome measures were the number of days that participants reported low back pain per month and the number of calendar days of sick leave that participants took during the 12-month intervention . Secondary outcome measures were the average severity of low back pain in the previous week , rated on a scale of 0 to 10 ( 16 ) , and functional status in the previous week , measured by using a Dutch translation of the Quebec Back Pain Disability Scale ( on which 0 corresponds to no disablement and 100 corresponds to fully disabled ) ( 17 , 18 ) . Participants used a calendar to record the days per month on which they experienced low back pain . The intervention group was also asked to record on the calendar whether they had worn the lumbar support ;  thus , the calendars also served as a monitor for adherence to therapy . The calendars were collected for review after 1 , 3 , 6 , 9 , and 12 months . The number of calendar days of sick leave was derived from the staff register and was provided by the home care organization at the end of the study ; this information covered 15 months , from 3 months before the start of the study until the end of the intervention . We could gather only general data on sick leave because employees are not obliged to specify their illness for the employer when they report themselves ill , and registration by a company doctor starts from 6 consecutive weeks of sick leave . We collected information on self-reported , low back painrelated sick leave ; however , this was not a predetermined outcome , and the results should be interpreted cautiously . We administered a question naire at baseline to obtain information on the secondary outcome measures and demographic characteristics ; history of low back pain ; job characteristics ( among others , the Job Content Question naire , Dutch translation [ 19 ] ) ; and other possible confounders , such as additional work ( hours per week and type ) , preference for study group assignment , confidence in pain reduction with use of the lumbar support ( scale of 0 to 10 ) , and confidence in improved functioning ( scale of 0 to 10 ) . Follow-up question naires were administered at 3 , 6 , 9 , and 12 months to measure the secondary outcomes . In the intervention group , these question naires also measured the general satisfaction with the lumbar support ( scale of 0 to 10 ) , several items on comfort of wearing ( 5-point Likert scale ) , and adherence to use of the lumbar support ( 7-point Likert scale ) . We recorded spontaneously reported side events and asked participants about side effects in the question naires . Statistical Analysis We estimated that with a power of 80 % , a significance level of 0.05 , and an SD of 20 days , we would need 140 participants in each study group to demonstrate a difference of 7 days of low back pain per year or sick leave per year between the 2 groups . To prevent inadequate power because of participant withdrawal or low adherence to therapy , we sought to enroll 400 home health care workers . We used a longitudinal marginal model with generalized estimating equation estimates to analyze the data , according to intention-to-treat principles . For the primary outcomes ( number of days of low back pain and number of days of sick leave ) , we used a negative-binomial count data model with a log-link and an exchangeable correlation structure . Covariates ( history of low back pain , body mass index , additional work , and pregnancy during follow-up ) were added to the model separately and were used in the final model if they statistically significantly contributed to the model ( P < 0.05 ) . The scale scores of the secondary outcomes were analyzed by using a normal distributed model and an exchangeable correlation structure . To investigate model misspecification and the effect of missing data , we performed sensitivity analyses in which we used various structures for the working correlation to estimate the models and used multiple imputation techniques to analyze 5 imputed data sets for missing data ( 20 ) . For all analyses , we used SAS , Background : Prevalence of musculoskeletal pain is high in jobs with high physical work dem and s. An aerobic exercise intervention targeting cardiovascular health was evaluated for its long term side effects on musculoskeletal pain . Objective : The objective was to investigate if aerobic exercise affects level of musculoskeletal pain from baseline to 4- and 12-months follow-up . Methods : One-hundred- and -sixteen cleaners aged 18–65 years were cluster-r and omized . The aerobic exercise group ( n = 57 ) received worksite aerobic exercise ( 30 min twice a week ) and the reference group ( n = 59 ) lectures in health promotion . Strata were formed according to closest manager ( total 11 strata ) ; clusters were set within strata ( total 40 clusters , 20 in each group ) . Musculoskeletal pain data from eight body regions was collected at baseline and after 4- and 12-months follow-up . The participants stated highest pain in the last month on a scale from 0 , stating no pain , up to 10 , stating worst possible pain . A repeated-measure 2 × 2 multi-adjusted mixed-models design was applied to compare the between-groups differences in an intention to treat analysis . Participants were entered as a r and om effect nested in clusters to account for the cluster-based r and omization . Results : Clinical ly significant reductions ( > 30 % , f 2 > 0.25 ) in the aerobic exercise group , compared to the reference group , in pain intensity in neck , shoulders , arms/wrists were found at 12-months follow-up , and a tendency ( p = 0.07 , f 2 = 0.18 ) to an increase for the knees . At 4-months follow-up the only significant between-group change was an increase in hip pain . Conclusions : This study indicates that aerobic exercise  reduces musculoskeletal pain in the upper extremities , but as an unintended side effect may increase pain in the lower extremities . Aerobic exercise interventions among workers st and ing or walking in the majority of the working hours should tailor exercise to only maintain the positive effect on musculoskeletal pain Study Design . R and omized controlled trial ( RCT ) . Objectives . To compare the effectiveness of training and equipment to reduce musculoskeletal injuries , increase comfort , and reduce physical dem and s on staff performing patient lifts and transfers at a large acute care hospital . Summary of Background Data . Back injury to nursing staff during patient h and ling tasks is a major issue in health care . The value of mechanical assistive devices in reducing injuries to these workers is unclear . Methods . This three-armed RCT consisted of a “ control arm , ” a “ safe lifting ” arm , and a “ no strenuous lifting ” arm .  A medical , surgical , and rehabilitation ward were each r and omly assigned to each arm . Both intervention arms received intensive training in back care , patient assessment , and h and ling techniques . Hence , the “ safe lifting ” arm used improved patient h and ling techniques using manual equipment , whereas the “ no strenuous lifting ” arm aim ed to eliminate manual patient h and ling through use of additional mechanical and other assistive equipment . Results . Frequency of manual patient h and ling tasks was significantly decreased on the “ no strenuous lifting ” arm . Self-perceived work fatigue , back and shoulder pain , safety , and frequency and intensity of physical discomfort associated with patient h and ling tasks were improved on both intervention arms , but staff on the mechanical equipment arm showed greater improvements . Musculoskeletal injury rates were not significantly altered . Conclusions . The “ no strenuous lifting ” program , which combined training with assured availability of mechanical and other assistive patient h and ling equipment , most effectively improved comfort with patient h and ling , decreased staff fatigue , and decreased physical dem and s. The fact that injury rates were not statistically significantly reduced may reflect the less sensitive nature of this indicator compared with the subjective indicators Our objective was to evaluate the effect of 12 weeks of stress management training ( SMT ) , physical exercise ( PE ) and an integrated health programme ( IHP ) in a worksite setting on subjective health complaints . To do this , we r and omly split 860 employees into the following groups : control ( n = 344 ) , PE ( n = 189 ) , IHP ( comprising physical exercise and health information ) ( n = 165 ) and SMT ( n = 162 ) . There were no significant effects on subjective health complaints , sick leave or job stress . However , strong and specific positive effects were experienced for the particular goal areas defined for each intervention . The PE group showed improved general health , physical fitness and muscle pain , while the SMT group showed improved stress management . The IHP group showed the strongest effects , affecting most goals set for treatment Objective : The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain . Methods : Sixty female subjects were r and omly assigned to an intervention group or a control group . The IG was administered of a 6-month , twice-a-week , tailored exercise program , whereas the CG received no intervention . Results : The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures . In addition , reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength . Conclusions : This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders , showing clinical ly meaningful reductions of pain symptoms and disability on upper limb and neck regions BACKGROUND Hamstring tightness induces posterior pelvic tilt and decreased lumbar lordosis , which can result in low back pain OBJECTIVE : We investigated effects of hamstring stretch with pelvic control on pain and work ability in st and ing workers . METHODS One hundred adult volunteers from a st and ing workers were r and omly assigned to pelvic control hamstring stretching ( PCHS ) ( n = 34 ) , general hamstring stretching ( GHS ) ( n = 34 ) , control ( n = 32 ) groups . The control group was performed self-home exercise . All interventions were conducted 3 days per week for 6 weeks , and included in the hamstring stretching and lumbopelvic muscle strengthening . Outcomes were evaluated through the visual analog scale ( VAS ) , straight leg raise test ( SLR ) , sit and reach test ( SRT ) , Oswestry disability index ( ODI ) , and work ability index ( WAI ) . RESULTS Significant difference in VAS , SLR , SRT , ODI , and WAI were found in the PCHS and GHS groups . The control group was a significant difference only in ODI . The PCHS group showed a greater difference than the GHS group and control group in VAS , SLR , SRT , and ODI . CONCLUSIONS The pelvic control hamstring stretch exercise would be more helpful in back pain reduction and improvement of work ability in an industrial setting Study Design . R and omized controlled trial . Objective . To evaluate the effectiveness of an ergonomic and psychosocial intervention in reducing  low back pain ( LBP ) among health care workers . Summary of Background Data . LBP and injuries are reported frequently among health care workers worldwide . Improvement of person-transfer techniques is the preferred tool in the prevention of both . Although popular , to our knowledge , any effect has not been documented in controlled trials . Methods . Study participants were eldercare workers from 19 eldercare groups r and omly assigned to the transfer technique , stress management , or reference arm . A total of 163 individuals ( 79 % of the source population ) participated in both baseline and follow-up after 2 years . Outcome was intra-individual change in rating of LBP during the past 3 and 12 months . Results . We found no difference in LBP in any of the intervention arms over the study period . Conclusion . The study showed no effect of a transfer technique or stress management program targeting LBP . Thus , there is a need for discussing other priorities in the prevention of LBP among health care workers Study Design . R and omized clinical trial . Objectives . To evaluate the effectiveness of a back support plus education versus education alone in promoting recovery from a work-related low back disorder ( WR-LBD ) while simultaneously considering personal , health , and occupational factors and the impact of occupational factors on recovery . Summary of Background Data . No r and omized studies of active industrial workers with low back disorders exist regarding the effectiveness of back supports plus education . Methods . A total of 433 actively employed hourly union workers who had a recent diagnosis of a WR-LBD : 1 ) those who wore a specially design ed back support plus received education on back health ; and 2 ) those who received education on back health only .  Demographic , health , medical , and occupational factors were obtained through interview or abstract ion of computer files ; individual ergonomic exposures were measured with a lumbar motion monitor . Outcomes evaluated over a 12-month period included : self-reported measures of back pain , back pain disability level , physical health , mental health , and administrative measures of recurrence , lost work time , and medical care utilization . Results . There was no difference between the study groups with respect to mental or physical health , low back pain , back pain disability , neurogenic symptoms , lost work time , likelihood of recurrence of an episode of a back disorder , or other administrative measures of healthcare utilization or lost work time . However , significant decreases in low back pain , low back pain disability , neurogenic symptoms , and an increase in physical health were observed over the 12 months of observation in both study groups . The only occupational variable found to influence was plant group whereby service parts operations workers in the back support plus education group experienced a lower likelihood of WR-LBD recurrence . Conclusion . Although there was no overall effect on self-reported recovery or administrative measures or lost work time between the study groups , a back support plus health education may have some value in preventing recurrent WR-LBD in industrial workers who work in psychosocial environments and perform manual material h and ling tasks similar to those found in parts distribution centers H and cultivation and harvest of agricultural products constitute strenuous physical tasks . Working with labor-management ergonomics committees in agricultural setting s , the UC Agricultural Ergonomics Research Center ( AERC ) tested an experimental rest and recovery protocol for its impact on symptoms and productivity during two types of work tasks . The experimental condition consisted of adding a 5 min rest break to every working hour in which there was no other scheduled break ( e.g. , lunchtime ) . This result ed in an additional 20 min of rest per workday . We tested the intervention in two trials : Trial one compared workers ( n=66 ) r and omly assigned to an experimental or a control group during the harvest of commercial strawberries . Trial two utilized a cross-over design ( n=16 pairs of workers ) to compare experimental and control conditions while workers inserted bud grafts into young 18 ' ' high citrus trees . For both trials , workers under the experimental condition reported significantly less severe symptoms than workers under control conditions . The order in which the intervention was given , however , appeared to result in variations in productivity . We conclude that the introduction of frequent , brief rest breaks may improve symptoms for workers engaged in strenuous work tasks ABSTRACT Objectives : In viticulture , the prevalence of low back pain is particularly high among vineyard workers exposed to sustained and awkward postures . One promising setting for low back pain prevention resides in the implementation of workplace physical activity . Methods : This nonr and omized pilot study aims at evaluating the effects of a worksite supervised adapted physical activity program among 17 vineyard workers volunteered to enter either an intervention group ( n = 10 ) or a control group ( n = 7).The intervention group followed a physical activity program for 8 weeks involving ( 1 ) 15 minutes of warm-up every working day and ( 2 ) two weekly 1-hour adapted physical activity sessions targeting trunk muscle endurance and flexibility . The control group was advised to continue normal physical activity . Evaluations were carried out at weeks 0 , 4 , 8 , and 12 . Physical capacity was assessed using flexibility tests for the trunk , along with trunk muscle flexor and extensor endurance tests . Finally , pain sensitivity was evaluated by assessing pressure pain thresholds over 14 anatomical locations in the low back region . Results : For the intervention group , the endurance of the trunk extensor and flexor significantly increased from baseline to week 8 as well as the pressure pain thresholds . No change was observed for the control group over the same period . Conclusions : These encouraging results in combination with the high adherence rate set interesting foundations for the promotion of worksite supervised adapted physical activity and , most likely , offer a new promising approach to prevent low back pain among vineyard workers This study evaluated the efficacy of an integrated Total Worker Health ® program , “ All the Right Moves ” , design ed to target the conditions of work and workers ’ health behaviors through an ergonomics program combined with a worksite-based health promotion Health Week intervention . A matched-pair cluster r and omized controlled trial was conducted on ten worksites ( five intervention ( n = 324 ) ; five control sites ( n = 283 ) ) .  Worker surveys were collected at all sites pre- and post- exposure at one- and six-months . Linear and logistic regression models evaluated the effect of the intervention on pain and injury , dietary and physical activity behaviors , smoking , ergonomic practice s , and work limitations . Worker focus groups and manager interviews supplemented the evaluation . After controlling for matched intervention and control pairs as well as covariates , at one-month following the ergonomics program we observed a significant improvement in ergonomic practice s ( B = 0.20 , p = 0.002 ) , and a reduction in incidences of pain and injury ( OR = 0.58 , p = 0.012 ) in the intervention group . At six months , we observed differences in favor of the intervention group for a reduction in physically dem and ing work ( B = −0.25 , p = 0.008 ) , increased recreational physical activity ( B = 35.2 , p = 0.026 ) and higher consumption of fruits and vegetables ( B = 0.87 , p = 0.008 ) . Process evaluation revealed barriers to intervention implementation fidelity and uptake , including a fissured multiemployer worksite , the itinerant nature of workers , competing production pressures , management support , and inclement weather . The All the Right Moves program had a positive impact at the individual level on the worksites with the program . For the longer term , the multi-organizational structure in the construction work environment needs to be considered to facilitate more upstream , long-term changes Objectives This r and omized controlled trial ( RCT ) evaluated the effect of a participatory organizational intervention for improved use of assistive devices ( AD ) in patient transfer . Methods We r and omly allocated 27 departments from five hospitals in Denmark to a participatory intervention ( 14 clusters , 316 healthcare workers ) or a control group ( 13 clusters , 309 healthcare workers ) . The intervention consisted of 2 × 2 hour workshops with managers , the hospital 's health and safety staff , and 2 - 5 healthcare workers from each department . Based on an assessment of barriers and solutions conducted prior to r and omization , participants developed an action plan for implementing department-specific solutions for improving the use of AD . Use of necessary AD ( using digital counters as primary outcome ) , and general use of AD ( using accelerometers as secondary outcome ) , pain intensity in the low-back , work-related back injuries during patient transfer , and communication and guidance in the use of AD were measured at baseline , 6 and 12 months . Results Use of necessary AD ( primary outcome ) , low-back pain , and back injuries did not change in the intervention compared with control group at 12-month follow-up . However , general use of AD measured with accelerometers as well as communication and guidance improved significantly in the intervention versus control group . Conclusion The intervention did not result in more frequent use of the necessary AD but led to more general use of AD , as well as increased communication and guidance Aims Given the high levels of absenteeism due to musculoskeletal disorders of the upper limbs , there is a need for preventive strategies to protect workers exposed to high risk levels . The purpose of this study was to determine the effect of a workplace-based muscle resistance training exercise program in the presence of pain and musculoskeletal dysfunction of the upper extremities in manufacturing workers exposed to repetitive movements and excessive effort in the workplace . Method R and omized controlled trial in manufacturing workers . A sample of 120 healthy workers was allocated at r and om to an experimental group , which received a resistance-based exercise program , and a control group , which performed stretching exercises . Results The muscle resistance training exercise had a protective effect on the intensity of pain perceived by workers in their upper limbs ( RR : 0.62 95 % CI 0.44–0.87 ) compared with the group of workers who performed stretching exercises . Conclusion A workplace-based muscle resistance training exercise program is an effective preventive strategy in factory workers exposed to risk ; however , it is necessary for companies initially to adopt mechanisms to minimize exposure as a prevention strategy Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Objective To estimate the impact of pain in different body regions on future long-term sickness absence ( LTSA ) among blue- and white-collar workers . Method Prospect i ve cohort study in a representative sample of 5603 employees ( the Danish Work Environment Cohort Study ) interviewed in 2000 , and followed in 2001–2002 in a national sickness absence register . Cox regression analysis was performed to assess the risk estimates of mutually adjusted severe pain in the neck/shoulder , low back , h and /wrist and knees for onset of LTSA , defined as receiving sickness absence compensation for at least 3 consecutive weeks . Age , gender , body mass index , smoking and diagnosed disease were controlled for . Results In 2000 the prevalence among blue- and white-collar workers , respectively , of severe pain was 33 % and 29 % ( neck/shoulder ) , 33 % and 25 % ( low back ) , 16 % and 11 % ( h and /wrists ) , and 16 % and 12 % ( knees ) . During 2001–2002 , the prevalence of LTSA among blue- and white-collar workers was 18 % and 12 % , respectively . H and /wrist pain ( HR 1.49 , 95 % CI 1.23 to 1.81 ) and low back pain ( HR 1.30 , 95 % CI 1.11 to 1.53 ) were significant risk factors among the total cohort . Neck/shoulder pain was a significant risk factor among white-collar workers only ( HR 1.35 , 95 % CI 1.21 to 1.85 ) . Knee pain was not a significant risk factor . Conclusion While h and /wrist pain and low back pain are general risk factors for LTSA , neck/shoulder pain is a specific risk factor among white-collar workers . This study suggests the potential for preventing future LTSA through interventions to manage or reduce musculoskeletal pain
target: Results Level of evidence from 54 high and medium quality studies showed moderate evidence of a positive effect of physical exercise .
  Within this domain , there was strong evidence of a positive effect of workplace strength training .
  There was limited evidence for ergonomics and strong evidence for no benefit of participatory ergonomics , multifaceted interventions , and stress management .
  No intervention domains were associated with “ negative effects ” .
  Conclusions The evidence synthesis recommends that implementing strength training at the workplace can reduce MSD  among workers with physically dem and ing work .
  In regard to workplace ergonomics , there was not enough evidence from the scientific literature to guide current practice s. Based on the scientific literature , participatory ergonomics and multifaceted workplace interventions seem to have no beneficial effect on reducing MSD among this group of workers .
background: Purpose This systematic review investigates the effectiveness of workplace interventions to rehabilitate musculoskeletal disorders ( MSDs ) among employees with physically dem and ing work .