Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis

Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

A year-long case study of multicomponent interventions to promote physical activity in office workers: A randomized control trial

The purpose of this study was to identify if workplace interventions, (i.e., mindfulness classes and monetary incentives for gym attendance), influenced workers' physical activity. Office-based participants were randomized into one of four intervention assignments: 1) CONTROL (no interventions) (n = 40), 2) MINDFULNESS (n = 33), 3) GYM INCENTIVE (n = 41), or 4) BOTH mindfulness and gym incentive (n = 31). Activity-tracker and self-reported metabolic expenditure and step counts were gathered between January 2020 and December 2020 whereas the eight-week long interventions were provided between January and March 2020, when the impact of COVID-19 pandemic started. While physical activity decreased during the follow-up months, percent changes of physical activity at 1-, 2-, and 9-month follow-ups compared to baseline show no significant differences between or across the four intervention assignments (p > 0.05). These results suggest that the intervention assignments had no effect on physical activity from baseline. The lack of effectiveness of these interventions on participant physical activity could be attributed to the influence of the COVID-19 pandemic, and any effects of the interventions could not outweigh the effects of the pandemic.

Relationship between occupational stress and presenteeism status among workers in small and medium-sized enterprises

This study aimed to identify characteristics of workers experiencing health problems without a decline in labor productivity to address presenteeism. A cross-sectional analysis was conducted on 554 workers in Japan, with a median age of 43 years. Participants reported any health problems in the past month, along with job stressors, stress responses, social support, and job and life satisfaction using the Brief Job Stress Questionnaire. They were categorized into three groups: "no symptoms," "pre-presenteeism" (health problems without work impact), and "presenteeism" (health problems with work impact). Results showed that 30.1% were in "prepresenteeism" and 52.0% in "presenteeism." Stress responses and social support were linked to both "pre-presenteeism" and "presenteeism," while job stressors and job and life satisfaction were only associated with "presenteeism." These findings offer insights for preventing presenteeism.

Mediators and moderators of a walking intervention to prevent neck pain among high-risk office workers: a secondary analysis of a randomized controlled trial

OBJECTIVES

To test hypothesized mediators and moderators of the benefits of an app-provided walking intervention for preventing neck pain in high-risk office workers.

METHODS

Ninety-one office workers at risk for developing neck pain participated in the primary clinical trial. Two hypothesized mediators (the total number of steps taken and the number of days that participants exceed the number of recommended steps) were tested using a smartphone application every month during a 6-month period. Four hypothesized moderators (number of working hours, level of work psychological demands, chair height adjustability, and body mass index) were assessed at baseline. Parallel mediation and moderation analyses were conducted using the Hayes PROCESS macro, model 4 and 1, respectively, with post-hoc Johnson-Neyman techniques.

RESULTS

The number of days that participants exceeded the recommended steps ‒ the specific number was tailored to each participant, but averaged 7735 steps/day ‒ mediated the benefits of the walking intervention for reducing the risk for neck pain at each of six assessment points (B's range -0.63 to -0.89, all p's < 0.05) over 6-month period. None of the hypothesized moderators evidenced statistically significant moderator effects of the walking intervention.

CONCLUSION

Workers should walk at rates greater than recommended levels on as many days as possible, rather than attempt to maximize walking within a limited number of days. Given that the walking program studied appeared to be similarly effective across multiple groups of workers, the findings suggest that regular walking can reduce the risk for developing neck pain among high-risk office workers.

Impact of neck posture and insulating stick use on neck disability in Korean line workers: a cross-sectional study

Background

Occupational neck disability is a prevalent issue, especially among line workers, who are often exposed to elevated levels of cervical ergonomic stress. The aim of this study was to investigate the impact of neck posture and insulating stick use on neck disability in a specific occupational group in Korea.

Methods

This cross-sectional study was conducted among 483 line workers in Gwangju and Jeonnam, Korea. Data were collected using the Neck Disability Index, Cervical Degenerative Index, and a structured questionnaire focusing on demographic and occupational factors. Logistic regression analysis was applied to determine the adjusted odds ratio (OR) and 95% confidence interval (CI) for neck posture and factors related to neck disability.

Results

Neck disability prevalence was 17.2% among the participants. Multivariate logistic regression analysis showed that factors related to neck disability included age over 60 years (adjusted OR: 3.08; 95% CI: 1.63-5.83), depression (adjusted OR: 8.33; 95% CI: 3.85-18.00), a history of cervical trauma (adjusted OR: 2.13; 95% CI: 1.04-4.40), and radiological degenerative changes in the cervical spine (adjusted OR: 2.33; 95% CI: 1.26-4.33). In particular, the adjusted OR of neck disability among live-line workers was 2.10 (95% CI: 1.12-3.92) when compared with support workers (model 1). Other analysis models showed that use of insulating sticks for more than 10 hours per week (adjusted OR: 2.46; 95% CI: 1.32-4.61) and higher neck extension (adjusted OR: 2.98; 95% CI: 1.14-3.46) were significant work-related risk factors (model 2,3).

Conclusions

Neck posture, age, depression, cervical trauma history, degenerative changes in the cervical spine, and use of insulating sticks are significant risk factors for neck disability among line workers in Korea. These findings highlight the need to improve the working environment and reduce the burden of cervical ergonomic stress among line workers.

The Potential Relationship Between a Cognitive Dissonance State and Musculoskeletal Injury: A Systematic Review

OBJECTIVE

The objective of this systematic review was to investigate the potential link between cognitive dissonance or its related constructs (emotional dissonance, emotional labor) and musculoskeletal disorders.

BACKGROUND

The etiology of musculoskeletal disorders is complex, as pain arises from complex interactions among physical, social, and psychological stressors. It is possible that the psychological factor of cognitive dissonance may contribute to the etiology and/or maintenance of musculoskeletal disorders.

METHOD

MEDLINE, APA PsycInfo, and CINAHL Plus databases were searched for studies investigating cognitive dissonance or its related constructs as exposure(s) of interest and outcomes related to physical health (including, but not limited to, musculoskeletal pain). Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool.

RESULTS

The literature search yielded 7 studies eligible for inclusion. None of the included studies investigated cognitive dissonance directly but instead investigated dissonance-related constructs of emotional dissonance and emotional labor, in which a mismatch between required and felt emotions might elicit a psychological response consistent with the cognitive dissonance state. Moderate effect sizes between dissonance-related constructs and musculoskeletal disorders were noted (OR 1.25-2.22).

CONCLUSION

There is likely a relationship between the two factors studied. However, as the included studies were cross-sectional in nature, a causal relationship between cognitive dissonance-related constructs and musculoskeletal disorders cannot be inferred. Therefore, future study proposing and validating a causal pathway between these variables is warranted.

APPLICATION

Cognitive dissonance and its related constructs may serve as risk factors for musculoskeletal disorders that have not been considered previously.

Study protocol and rationale of "the UP project": evaluating the effectiveness of active breaks on health indicators in desk-based workers

Background

Excessive sedentary time has been negatively associated with several health outcomes, and physical activity alone does not seem to fully counteract these consequences. This panorama emphasizes the essential of sedentary time interruption programs. "The Up Project" seeks to assess the effectiveness of two interventions, one incorporating active breaks led by a professional and the other utilizing a computer application (self-led), of both equivalent duration and intensity. These interventions will be compared with a control group to evaluate their impact on physical activity levels, sedentary time, stress perception, occupational pain, and cardiometabolic risk factors among office workers.

Methods

This quasi-experimental study includes 60 desk-based workers from universities and educational institutes in Valparaiso, Chile, assigned to three groups: (a) booster breaks led by professionals, (b) computer prompts that are unled, and (c) a control group. The intervention protocol for both experimental groups will last 12 weeks (only weekdays). The following measurements will be performed at baseline and post-intervention: cardiometabolic risk based on body composition (fat mass, fat-free mass, and bone mass evaluated by DXA), waist circumference, blood pressure, resting heart rate, and handgrip strength. Physical activity and sedentary time will be self-reported and device-based assessed using accelerometry. Questionnaires will be used to determine the perception of stress and occupational pain.

Discussion

Governments worldwide are addressing health issues associated with sedentary behavior, particularly concerning individuals highly exposed to it, such as desk-based workers. Despite implementing certain strategies, there remains a noticeable gap in comprehensive research comparing diverse protocols. For instance, studies that contrast the outcomes of interventions led by professionals with those prompted by computers are scarce. This ongoing project is expected to contribute to evidence-based interventions targeting reduced perceived stress levels and enhancing desk-based employees' mental and physical well-being. The implications of these findings could have the capacity to lay the groundwork for future public health initiatives and government-funded programs.

Usability of a visual feedback system to assess and improve movement disorders related to neck pain: Perceptions of physical therapists and patients

A prototype visual feedback system has been developed to assess and improve movement disorders related to neck pain. The aim of this study was to assess the usability of the prototype in a rehabilitation setting. Twelve physical therapists integrated the device into their regular therapy programs for 24 neck pain patients with movement disorders. Each patient performed three individual therapy sessions with the device under physical therapist supervision. Usability was assessed by the physical therapists and patients using therapy diaries, the System Usability Scale, and focus group or personal interviews. Based on an overall usability rating of marginally acceptable, the visual feedback system was generally found to be a device with the potential to assess and train neck pain patients but needs improvement. To become a useful adjunct to regular physical therapy, improvements in the hardware and software, and further system developments are required.

Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. We present the most current estimates of neck pain prevalence and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) by age, sex, and location, with forecasted prevalence to 2050.

METHODS

Systematic reviews identified population-representative surveys used to estimate the prevalence of and YLDs from neck pain in 204 countries and territories, spanning from 1990 to 2020, with additional data from opportunistic review. Medical claims data from Taiwan (province of China) were also included. Input data were pooled using DisMod-MR 2.1, a Bayesian meta-regression tool. Prevalence was forecast to 2050 using a mixed-effects model using Socio-demographic Index as a predictor and multiplying by projected population estimates. We present 95% UIs for every metric based on the 2·5th and 97·5th percentiles of 100 draws of the posterior distribution.

FINDINGS

Globally, in 2020, neck pain affected 203 million (95% uncertainty interval [UI] 163-253) people. The global age-standardised prevalence rate of neck pain was estimated to be 2450 (1960-3040) per 100 000 population and global age-standardised YLD rate was estimated to be 244 (165-346) per 100 000. The age-standardised prevalence rate remained stable between 1990 and 2020 (percentage change 0·2% [-1·3 to 1·7]). Globally, females had a higher age-standardised prevalence rate (2890 [2330-3620] per 100 000) than males (2000 [1600-2480] per 100 000), with the prevalence peaking between 45 years and 74 years in male and female sexes. By 2050, the estimated global number of neck pain cases is projected to be 269 million (219-322), with an increase of 32·5% (23·9-42·3) from 2020 to 2050. Decomposition analysis of the projections showed population growth was the primary contributing factor, followed by population ageing.

INTERPRETATION

Although age-standardised rates of neck pain have remained stable over the past three decades, by 2050 the projected case numbers are expected to rise. With the highest prevalence in older adults (higher in females than males), a larger effect expected in low-income and middle-income countries, and a rapidly ageing global population, neck pain continues to pose a challenge in terms of disability burden worldwide. For future planning, it is essential we improve our mechanistic understanding of the different causes and risk factors for neck pain and prioritise the consistent collection of global neck pain data and increase the number of countries with data on neck pain.

FUNDING

Bill & Melinda Gates Foundation and Global Alliance for Musculoskeletal Health.

Prevention of neck pain in adults with a Back School-Based intervention: a randomized controlled trial

BACKGROUND

Neck pain is a health problem worldwide. To prevent it, experts recommend exercise and education.

OBJECTIVE

To evaluate the effects of a Back School-based intervention for the prevention of nonspecific neck pain in a healthy adult population.

METHODS

A randomized controlled trial with 58 participants with no history of neck pain within the past six months. The experimental group performed an 8-week Back School-based program. The control group maintained their usual lifestyle. Primary outcomes, which include the number of episodes, days and intensity of neck pain, and the number of medical visits, were recorded in a 1-year follow-up diary and analyzed using the Mann-Whitney test. Secondary outcomes, such as neck flexor, neck extensor, and scapular muscles endurance, were analyzed using the ANOVA test.

RESULTS

In the analysis of the primary outcomes, no significant differences were found in the number of episodes (p = 0.068,d = -0.49), number of days (p = 0.059,d = -0.54), or the average intensity of neck pain (p = 0.061,d = -0.53). There were significant changes in the number of medical visits (p = 0.033,d = -0.57). Moving to secondary outcomes, significant interactions were observed in neck flexor (p = 0.045, ηp2 = 0.036) and neck extensor endurance (p = 0.049, ηp2 = 0.035), but not in scapular muscle endurance (p = 0.536, ηp2 = 0.003).

CONCLUSIONS

The Back School-based program reduced the number of medical visits and increased the endurance of the cervical musculature. Trial registration in ClinicalTrials.gov: NCT05260645.

Clinical effectiveness of trigger point acupuncture on chronic neck and shoulder pain (katakori) with work productivity loss in office workers: a randomized clinical trial

OBJECTIVES

To evaluate whether trigger point acupuncture (TrPA) is beneficial for office workers who have reduced job performance (presenteeism) due to chronic neck and shoulder pain (katakori).

METHODS

A 4-week single-center randomized controlled trial was conducted on 20 eligible female office workers with chronic neck and shoulder pain of at least 3-month duration. The control group implemented only workplace-recommended presenteeism measures, whereas the intervention group received TrPA up to 4 times per month in addition to the presenteeism measures recommended by each workplace. The major outcome measure was the relative presenteeism score on the World Health Organization Health and Work Performance (WHO-HPQ). The secondary outcome measures were pain intensity (numerical rating scale), absolute presenteeism (WHO-HPQ), anxiety and depression (Hospital Anxiety and Depression Scale; HADS), catastrophic thoughts related to pain (Pain Catastrophizing Scale; PCS), and sleep (Athens Insomnia Scale; AIS).

RESULTS

All 9 cases in the intervention group and 11 cases in the control group were analyzed. TrPA up to 4 times per month reduced the intensity of neck and shoulder pain by 20% (P < .01, d = 1.65) and improved labor productivity (relative presenteeism value) by 0.25 (P < .01, d = 1.33) compared with the control group over 1 month. No significant differences were observed between the 2 groups in terms of absolute presenteeism score, HADS, PCS, or AIS.

CONCLUSIONS

These results suggest that regular intervention with TrPA may be effective in the relative presenteeism score before and after the intervention and the degree of neck and shoulder pain over 28 days compared with the control group.

Cognitive dissonance increases spine loading in the neck and low back

Cognitive dissonance refers to a state where two psychologically inconsistent thoughts, behaviours, or attitudes are held at the same time. The objective of this study was to explore the potential role of cognitive dissonance in biomechanical loading in the low back and neck. Seventeen participants underwent a laboratory experiment involving a precision lowering task. To establish a cognitive dissonance state (CDS), study participants were provided negative feedback on their performance running counter to a pre-established expectation that their performance was excellent. Dependent measures of interest were spinal loads in the cervical and lumbar spines, calculated via two electromyography-driven models. The CDS was associated with increases to peak spinal loads in the neck (11.1%, p < .05) and low back (2.2%, p < .05). A greater CDS magnitude was also associated with a greater spinal loading increase. Therefore, cognitive dissonance may represent a risk factor for low back/neck pain that has not been previously identified.Practitioner summary: Upon establishing a cognitive dissonance state in a group of participants, spinal loading in the cervical and lumbar spines were increased proportional to the magnitude of the cognitive dissonance reported. Therefore, cognitive dissonance may represent a risk factor for low back and neck pain that has not been previously identified.

Central Sensitisation Inventory-Thai version: translation, cross-cultural adaptation, and psychometric evaluation in chronic non-specific neck pain

PURPOSE

To translate and cross-culturally adapt the English version of the Central Sensitisation Inventory (CSI) into Thai (CSI-Thai) and to evaluate its psychometric properties in individuals with chronic non-specific neck pain.

MATERIALS AND METHODS

Cross-cultural translation and adaptation of the CSI were performed according to standard guidelines. A total of 340 participants were invited to complete the CSI-Thai, Visual Analogue Scale (pain intensity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophising Scale (PCS), and Short Form-36. Psychometric evaluation included confirmatory factor analysis, internal consistency, test-retest reliability, agreement, and construct validity.

RESULTS

Dimensionality analyses indicated that a bifactor model, comprising one general factor plus four orthogonal factors, fit the CSI structure better than unidimensional and the four-factor models. The general factor showed substantial reliability (Cronbach α = 0.91, Omega ω = 0.94, and omega hierarchical ω-h = 0.91). The intraclass correlation coefficient was 0.90, representing excellent stability over a 48 h interval. Moderate-to-strong correlations and acceptable-to-excellent discriminations were found between the CSI-Thai and all questionnaires. The exception was the PCS (no correlation and discrimination). The standard error of measurement and minimal detectable change of the CSI-Thai were 2.33 and 6.47, respectively.

CONCLUSIONS

The translation and cross-cultural adaptation of the CSI-Thai were successful, with satisfactory reliability and construct validity.Implications for rehabilitationCentral Sensitisation Inventory-Thai version (CSI-Thai) is successfully adapted and demonstrated satisfactory reliability and construct validity.The CSI-Thai can be applicable to assess central sensitisation-related signs and symptoms in Thai-speaking patients with chronic non-specific neck pain (CNSNP) both clinical and research purposes.The CSI-Thai correlated to pain, disability and quality of life among patients with CNSNP.

Muscle energy technique to reduce pain and disability in cases of non-specific neck pain: A systematic review and meta-analysis of randomized controlled trials

Background

To investigate the effectiveness of muscle energy technique (MET) for treatment of non-specific neck pain (NSNP).

Methods

A literature search was performed using electronic databases from their inception until October 2023 for randomized controlled trials (RCTs) that investigated the effects of MET on NSNP. A change in pain intensity and reduced disability were the primary and secondary outcomes, respectively, standardized using Hedges' g. A random effects model was used for data pooling.

Results

This study included 26 RCTs comprising 1170 participants. The results showed that MET significantly reduced pain intensity (Hedges' g = -0.967 95 % CI = -1.417 to -0.517, p < 0.001). However, subgroup analysis revealed that this significant benefit was observed only when MET was combined with other treatments and not with MET monotherapy. MET also reduced disability (Hedges' g = -0.545, 95 % CI = -1.015 to - 0.076, p = 0.023). Meta-regression analysis showed that an increase in treatment duration/session per week contributed to greater pain reduction. No adverse events were reported following the MET.

Conclusions

In conclusion, our meta-analysis suggests MET's potential effectiveness within a combined treatment for NSNP. However, the evidence's low certainty is likely influenced by bias and study variations. To strengthen these findings, future research should focus on higher-quality clinical trials, longer follow-up periods, and prediction interval presentations.

Risk factors for neck pain in college students: a systematic review and meta-analysis

BACKGROUND

During the COVID-19 epidemic, the prevalence of neck pain among college students has increased due to the shift from offline to online learning and increasing academic and employment pressures. Therefore, this systematic review aimed to identify the personal, occupational, and psychological factors associated with the development of neck pain to promote the development of preventive strategies and early intervention treatment.

METHODS

Seven electronic databases were searched from inception to December 2022 for cross-sectional studies, cohort studies, case----control studies, and randomized controlled trials (RCTs) on neck pain. The quality of the selected studies were assessed by American Agency for Healthcare Research and Quality (AHRQ) or the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the effects of the included risk factors on neck pain.

RESULTS

Thirty studies were included, including 18,395 participants. And a total of 33 potentially associated risk factors were identified. Ultimately, 11 risk factors were included in the meta-analysis after assessing, and all results were statistically significant (P < 0.05). The factors supported by strong evidence mainly include the improper use of the pillow (OR = 2.20, 95% CI: 1.39 to 3.48), lack of exercise (OR = 1.88, 95% CI: 1.53 to 2.30), improper sitting posture (OR = 1.97, 95% CI: 1.39 to 2.78), history of neck and shoulder trauma (OR = 2.32, 95% CI: 1.79 to 3.01), senior grade (OR = 2.86, 95% CI: 2.07 to 3.95), staying up late (OR = 1.80, 95% CI: 1.35 to 2.41), long-time electronic product usage daily (OR = 1.53, 95% CI: 1.33 to 1.76), long-time to bow head (OR = 2.04, 95% CI: 1.58 to 2.64), and emotional problems (OR = 2.09; 95% CI: 1.66  to 2.63). Risk factors supported by moderate evidence were high stress (OR = 1.61, 95% CI: 1.02 to 2.52) and female gender (OR = 1.69, 95% CI: 1.52 to 1.87).

CONCLUSION

This study obtained 11 main risk factors affecting college students neck pain, including improper use of the pillow, lack of exercise, improper sitting posture, history of neck and shoulder trauma, senior grade, staying up late, long-term electronic product usage daily, long time to bow head, high stress, emotional problems and female gender.

Effects of back school-based intervention on non-specific neck pain in adults: a randomized controlled trial

BACKGROUND

Neck pain has a high prevalence and socioeconomic impact worldwide. The Back School consists of programs that include exercises and educational interventions to treat back pain. Accordingly, the main objective was to evaluate the effects of an intervention based on Back School on non-specific neck pain in an adult population. The secondary objectives were to analyze the effects on disability, quality of life and kinesiophobia.

METHODS

A randomized controlled trial was conducted with 58 participants with non-specific neck pain divided into two groups. The experimental group (EG) carried out the 8-week programme based on the Back School, (two sessions per week, for a total of 16 sessions, lasting 45 min). Of all the classes, 14 had a practical focus (strengthening and flexibility exercises) and the other two had a theoretical focus (concepts of anatomy and healthy lifestyle). The control group (CG) stated that they did not vary their lifestyle. The assessment instruments were: Visual Analogue Scale, Neck Disability Index, Short-Form Health Survey-36 and Tampa Scale of Kinesiophobia.

RESULTS

The EG reduced pain (-40 points, CI95% [-42 to -37], g = -1.03, p < 0.001), EG had less disability (-9.3 points, CI95% [-10.8 to -7.8], g = -1.22, p < 0.001), EG improved the physical dimension of the survey Short-Form Health Survey-36 (4.8 points, CI95% [4.1 to 5.5], g = 0.55, p = 0.01) but had not significant change in psychosocial dimension of the survey Short-Form Health Survey-36 and EG reduced Kinesiophobia (-10.8 points, CI95% [-12.3 to -9.3], g = -1.84, p < 0.001). The CG did not obtain significant results in any variable of the study. Significant differences in change between both groups were found on pain (-11 points, CI95% [5.6 to 16.6], p < 0.001, g = 1.04), disability (-4 points, CI95% [2.5 to 6.2], p < 0.001, g = 1.23), physical dimension of the survey Short-Form Health Survey-36 (3 points, CI95% [-4-4 to -2-5], p = 0.01, g = -1.88), and kinesiophobia ( 7 points, CI95%[-8.3 to -5.4], p < 0.001, g = 2.04), while no significant differences were found on psychosocial dimension of the survey Short-Form Health Survey-36 (-0.02, CI95% [-1.7 to 1.8], g = 0.01, p = 0.98).

CONCLUSIONS

The back school-based programme has beneficial effects on pain, neck disability, the physical dimension of quality of life and kinesiophobia in an adult population with non-specific neck pain. However, it did not lead to improvements in the psychosocial dimension of the participants' quality of life. This programme could be applied by health care providers with the aim of reducing the severe socio-economic impact of non-specific neck pain worldwide. TRIAL REGISTRATION IN CLINICALTRIALS.GOV: NCT05244876 (registered prospectively, date of registration: 17/02/2022).

Working from home during lockdown: the association between rest breaks and well-being

One of the challenges with working from home (WFH) is the question of its effect on health and well-being. The impact of home working on health has so far not been studied extensively. We address this gap by investigating the association between internal recovery, operationalised as rest break frequency (low, medium, and high) during the working day, on self-reported musculoskeletal pain, and post-work recovery symptoms in WFH knowledge workers (n = 382). The analysis showed that failing to take frequent breaks was associated with a dose-response increased risk of reporting headaches. For post-work recovery symptoms, failing to take rest breaks throughout the day was associated with an increased risk of reporting psychological fatigue, physical fatigue, and sleep problems, and a decreased risk of psychologically detaching from work and experiencing adequate rest. Our findings emphasise the importance of remote workers taking recovery breaks from work demands in the maintenance of health and well-being.Practitioner Summary: For the foreseeable future, many knowledge workers will be obliged to work from home for at least, some days of the week. It is therefore important for workers to learn to regulate their behaviour, and workers need to be educated about the value of taking regular rest breaks throughout the working day.Abbreviations: ICT: Information and communications technology; MSDs: musculoskeletal disorders; MSPs: Musculoskeletal pain symptoms; OR: Odds ratio; WFH: Working from home; WRRQ: Work-Related Rumination Questionnaire Questionnaire.

Investigation of the predictors of temporomandibular disorders in engineers across different variables: sociodemographic characteristics, neck pain and neck awareness

PURPOSE/AIM

This study aimed to investigate the predictors of temporomandibular disorders (TMD) in desk-bound engineers.

MATERIALS AND METHODS

The Fonseca Anamnestic Index (FAI), The Visual Analogue Scale (VAS), The Neck Pain and Disability Scale (NPDS), Neck Bournemouth Questionnaire (NBQ) and The Fremantle Neck Awareness Questionnaire-Turkish (FreNAQ-T) were used for TMD severity, pain, disability, neck awareness.

RESULTS

The study was conducted with 208 desk-bound engineers. Mild-to-severe TMD was detected in 78.9% of the subjects. Intensity of pain at rest and during activity was higher in female engineers compared to male engineers (p = 0.002 and <0.01, respectively) and mean FAI, NBQ, NPDS and FreNAQ-T scores were also higher than that of male engineers (p = 0.005, 0.005, 0.006 and 0.016, respectively). FAI, VAS, NPDS, NBQ and FreNAQ-T were found to be correlated with each other (p < 0.05). A statistically significant contribution to the regression model was observed for the variables gender, daily duration of computer use, neck pain at rest, and NBQ (p = 0.043, p = 0.043, p = 0.031 and p = 0.003, respectively). NBQ was identified as the most influential variable in this model, followed by neck pain at rest.

CONCLUSIONS

Temporomandibular disorders are common among desk-bound engineers and are associated with neck pain, disability, and neck awareness. For this reason, it is important to take preventive and protective ergonomic approaches at the personal and institutional levels in desk-bound engineers.

Risk factors of neck disability in computer-using office workers: a cross-sectional study

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04821024.

Baduanjin improves neck pain and functional movement in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials

Background

Neck pain (NP), one of the most common musculoskeletal diseases, exercises a great influence on the daily life of individuals, especially the elderly. Baduanjin is a traditional Qigong therapy from China, but there is no evidence for its use in the treatment of neck pain in middle-aged and elderly people.

Objective

We hope to summarize the efficacy evidence of Baduanjin in the treatment of middle-aged and elderly patients with neck pain (NP) for the first time, conduct a systematic review and meta-analysis, and provide basic evidence-based evidence for clinical practice.

Methods

Two researchers collectively searched PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk (Sino-Med), China National Knowledge Infrastructure (CNKI), Wanfang database, and China Science and Technology Journal Database (VIP). The search time is set from initial to 27 September 2022, to find out RCT articles that may meet the criteria. The risk bias assessment tool Cochrane was applied to assess the methodological quality of involved studies. RevMan 5.3 was used for the meta-analysis with a mean difference (MD) and 95% confidence interval (CI), and the model type was a random effects model. The VAS scores of the intervention and control groups were extracted and the results of the meta-analysis were presented using a forest plot.

Results

In total, 13 randomized controlled trials were meta-analyzed, including 840 patients. The results turned out that the VAS score in the intervention group was below the control group, which was statistically significant [MD = -1.15, 95% CI (-1.39, -0.92) and P < 0. 001]. The result of general efficiency suggests that the Baduanjin group was better than the control group [RR = 1.19, 95% CI (1.10, 1.29), P < 0.001].

Conclusion

The existing results seem to show that Baduanjin is safe and has a trend of positive benefits in the treatment of neck pain in middle-aged and elderly people. However, considering the limitations of this study, we need to be cautious in our conclusions, and more studies are needed to verify it in future.

Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes-The Maastricht Study

BACKGROUND

Detrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes (T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS).

METHODS

Cross-sectional data from 2827 participants aged 40-75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships.

RESULTS

The fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01-1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00-1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91-1.18) or NGM (OR = 1.05, 95%CI: 0.98-1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant.

CONCLUSION

Among middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.

Evaluation of a Workplace Active Rest Program in Office Workers With Comparison of a Prospective and Retrospective Survey

Physical activity-related workplace interventions can be counterstrategies for physical inactivity due to office work. Newly introduced programs should be evaluated for success. This study aimed to evaluate the intervention of a workplace active rest program and to compare a prospective and retrospective design of evaluation. A Germany-wide multicenter evaluation of a 3-month workplace active rest program (30 min, once a week) was carried out at 14 locations with a longitudinal pre/post design by means of an anonymous questionnaire (npre = 405, npost = 369). The participants' program-related changes in targeted characteristics regarding posture, function, complaints and physical awareness were collected with a questionnaire in a prospective design and afterward retrospectively. The prospective evaluation showed a significant improvement in the target characteristic "postural muscles in the neck area". In the retrospective survey, all target characteristics improved significantly. There were no differences between locations. The workplace active rest program in this study had positive effects on the perception of postural neck muscle status regardless of prospective or retrospective approach. Selection of survey mode should depend on desired outcome and consecutive influencing factors. In this specific case, retrospective survey could give more indirect information about overall satisfaction with the program and job although being influenced by response bias. Recall bias should be relatively small for shorter time periods assessed. Future studies should account for corresponding bias and specifics of target characteristics regardless of the chosen approach to survey.

Evaluation of an exercise and ergonomics intervention for the prevention of neck pain in office workers: exploratory analysis of a cluster randomised trial

OBJECTIVES

To determine the impact of a 12-week ergonomic/exercise programme compared with an ergonomic/health education programme on the development of neck pain in office workers over 12 months.

METHODS

This cluster-randomised trial prospectively recruited office workers from public and private organisations. Only non-neck pain cases at baseline were included (n=484). All participants received an ergonomic workstation review then randomly allocated to receive a neck/shoulder progressive exercise programme (20 min, 3 ×/week; intervention group) or health education sessions (60 min, 1 ×/week; active control) for 12 weeks. Generalised estimating equations evaluated group differences in the point prevalence of neck pain cases (defined as those with a neck pain score of ≥3 on a 0 (no pain) to 9 (worst pain) scale) over time (3, 6, 9 and 12 months) with cumulative incidence of neck pain cases evaluated descriptively.

RESULTS

While no significant group × time interaction was evident, the 12-month point prevalence of neck pain cases in the intervention group (10%) was half that of the active control group (20%) (adjusted OR 0.46, 95% CI 0.21 to 1.01, p=0.05). Lower cumulative incidence of neck pain cases was observed in the intervention (17%) compared with active control group (30%) over the 12 months.

CONCLUSIONS

A combined ergonomics and exercise intervention may have more benefits in preventing neck pain cases in office workers than an ergonomic and health education intervention. Group differences were modest and should be interpreted with caution when considering strategies for primary prevention of neck pain in the office worker population.

TRIAL REGISTRATION

ACTRN12612001154897.

Global, regional, and national neck pain burden in the general population, 1990–2019: An analysis of the global burden of disease study 2019

Background

This study describes the global epidemiology and trends associated with neck pain. Global Burden of Disease data collected between 1990 and 2019 were used to determine the global burden of neck pain in the general populations of 204 countries.

Methods

Global, regional, and national burdens of neck pain determined by prevalence, incidence, and years lived with a disability (YLD) from 1990 to 2019 were comprehensively analyzed according to age, gender, and socio-demographic index using the Global Burden of Disease Study 1990 and 2019 data provided by the Institute for Health Metrics and Evaluation.

Results

Globally, in 2019, the age-standardized rates for prevalence, incidence, and YLD of neck pain per 100,000 population was 2,696.5 (95% uncertainty interval [UI], 2,177.0 to 3,375.2), 579.1 (95% UI, 457.9 to 729.6), and 267.4 (95% UI, 175.5 to 383.5) per 100,000 population, respectively. Overall, there was no significant difference in prevalence, incidence, or YLD of neck pain between 1990 and 2019. The highest age-standardized YLD of neck pain per 100,000 population in 2019 was observed in high-income North America (479.1, 95% UI 323.0 to 677.6), Southeast Asia (416.1, 95% UI 273.7 to 596.5), and East Asia (356.4, 95% UI 233.2 to 513.2). High-income North America (17.0, 95% UI 9.0 to 25.4%) had the largest increases in YLD of neck pain per 100,000 population from 1990 to 2019. At the national level, the highest age-standardized YLD of neck pain was found in the Philippines (530.1, 95% UI 350.6 to 764.8) and the highest change age-standardized YLD between 1990 and 2019 was found in the United States (18.4, 95% UI 9.9 to 27.6%). Overall, the global burden of neck pain increased with age until the age of 70–74 years, and was higher in women than men. In general, positive associations between socio-demographic index and burden of neck pain were found.

Conclusions

Because neck pain is a major public health burden with a high prevalence, incidence, and YLD worldwide, it is important to update its epidemiological data and trends to cope with the future burden of neck pain.

Chiropractic Care and Quality of Life Among Office Workers With Nonspecific Pain: A Cross-Sectional Study

Objective

The aim of this study was to evaluate the quality of life by a self-administered World Health Organization Quality of Life short version survey (WHOQoL-BREF) among office workers with nonspecific pain receiving chiropractic care in Istanbul, Turkey.

Methods

This cross-sectional study included 77 office workers (age interval, 18-65) with nonspecific neck, thoracic, back and/or extremity pain who underwent chiropractic care. Two weeks later, the quality of life was evaluated by a self-administered WHOQoL-BREF. The Numeric Pain Scale to evaluate the perceived pain was administered to all of the participants in the beginning and at the end of the study. Group-level changes on WHOQoL-BREF total score and subdimensions were compared according to descriptive data of office workers. The significance level was set at P ≤ .05.

Results

WHOQoL-BREF scale scores after chiropractic care (mean ± standard deviation) were 71.21% ± 7.91% (total score), 81.49% ± 14.43% (general health), 80.38% ± 10.49% (physical health), 73.16% ± 11.68% (psychological), 70.41% ± 12.43% (social), and 65.58% ± 10.91% (environment). Numeric Pain Scale scores decreased in a statistically significant way when compared with baseline (P ≤ .05). The descriptive statistical analysis of WHOQoL-BREF dimensions revealed that women had significantly higher scores than men, the 18-to-35 age group had higher scores compared with the 50-to-65 age group, and those married had significantly higher scores than those who were not married (P ≤ .05).

Conclusion

The findings of our study suggest that chiropractic care had positive effects on the quality of life of office workers.

Predictors of Workplace Substance Reuse among Patients with Alcohol or Illegal Substance Use Disorder in the Workplace

Substance and alcohol use in the workplace have become a global health burden; however, the etiologies have seldom been explored. The aims of this study were to develop a Workplace Substance Reuse Questionnaire (WSRQ) to measure the multidimensional factors associated with the reuse of alcohol or illegal substances in the workplace. The predictors of reuse were also investigated. The WSRQs for alcohol (WSRQ-Alc) and illegal substances (WSRQ-Sub) were composed of 15 and 13 items, respectively. Factors associated with workplace substance reuse included workplace environment, workload, social interaction in the workplace and other cues. Construct validity and reliability were performed to verify the questionnaires. Multivariate linear regression was conducted to estimate the associations between the factors and WSRQ score. A total of 90 patients with substance or alcohol use disorder were recruited. The results demonstrated that the WSRQ-Alc and WSRQ-Sub had acceptable reliability, with variance of 76.4% and 75.4%, respectively. The confirmatory factor analysis fit indices also indicated the adequacy of the model. A longer duration of alcohol use (β = 0.44; p = 0.002) and higher frequencies of changing job (β = 0.32; p = 0.027) and working part time (β = 0.32; p = 0.028) were significantly associated with higher WSRQ-Alc score. Our results highlight the importance of abstinence treatment and job referral for individuals with alcohol or substance use. Further studies are warranted to help extend the applicability and generalizability of the WSRQ.

Factors associated with reduced risk of musculoskeletal disorders among office workers: a cross-sectional study 2017 to 2020

Background

Prolonged sitting at work should be avoided to reduce the risks of either noncommunicable diseases (NCDs) or musculoskeletal disorders (MSDs) among office workers. A short duration of breaks in sitting every hour can reduce cardiometabolic risk factors contributing to NCDs. However, the recommendation for a break from sitting at work to reduce the risks of MSDs has not been identified. Therefore, this study aimed to determine whether breaking by changing position at work, physical activity, physical fitness, stress and sleep were associated with MSDs among office workers.

Methods

A cross-sectional study was conducted from 2017 to 2020. Participants aged 20–59 years and using a computer at work ≥ 4 days/week were recruited. Data were collected using an online self-reporting questionnaire for computer users and 5 domains of physical fitness tests. Odds ratio (OR) with 95% confidence interval (CI) and multivariate logistic regression were used for statistical analysis.

Results

Prevalence of MSDs was 37.9% (n = 207/545) and the most area of complaint were the neck, shoulders and back. A nonsignificant association between physical fitness and MSDs among office workers was obtained. After adjusting for age, sex, body mass index, and comorbidity, moderate-to-vigorous intensity physical activity (MVPA) ≥ 150 min/week and sitting at work ≥ 4 h/day were MSDs risk factors (OR = 1.57, 95%CI = 1.04–2.37). Frequently changing positions from sitting to standing or walking at work every hour could reduce the risks of MSDs by more than 30%. The risks of MSDs increased among office workers who commuted by staff shuttle bus and personal car and had high to severe stress and slept < 6 h/day (1.6 to 2.4 times).

Conclusion

Our findings indicated MVPA and prolonged sitting were MSD risk factors. We recommend office workers change position from sitting to standing or walking during work every hour and sleep ≥ 6 h/day to reduce risks of MSDs.

Investigating The Impacts of Working at Home Among Offıce Workers With Neck Pain on Health Status, Depression and Sleep Quality During COVID-19 Pandemic

OBJECTIVE

This study aimed to assess the effect of workplace and ergonomic features on neck pain intensity, sleep problems, depression and health status at office workers during COVID-19 pandemic.

METHODS

One-hundred and thirty-nine office workers with neck pain who are 18-55 years of age were enrolled in the study. Sociodemographic features including ergonomic features of workplace were evaluated. The Beck Depression Inventory (BDI), the Nottingham Health Profile (NHP), the Pittsburgh Sleep Quality Index (PSQI), the Neck Pain and Disability Scale (NPDS) were administered to all patients.

RESULTS

All participants was grouped based on workplace into Group 1 (working in office n = 84) and Group 2(working at home n = 55). There was a statistically significant difference between the groups according to rate of absence of back support, flexible back (respectively p = 0.020 and p = 0.029). The scores of the Neck Pain and Disability Index scores of the participants who work with a computer more than 3 hours without break was higher in Group 2 than ın Group 1, and the differences between groups were found statistically significant (p = 0.001).

CONCLUSIONS

The health related quality of life was worse and neck pain intensity was severe in working at home group than working in office group.Trial registration:ClinicalTrials.gov identifier: NCT05074407..

Ergonomic and psychosocial risks related to musculoskeletal problems among Brazilian labor judges in telework during the COVID-19 pandemic

AbstractObjectives. The aim of this study was to evaluate the ergonomic and psychosocial risks in telework and their relationship with musculoskeletal problems in Brazilian labor judges during the COVID-19 pandemic. Methods. A cross-sectional study was conducted with 119 participants. The data were collected through a sociodemographic and occupational questionnaire, from the Brazilian versions of the Maastricht Upper Extremity Questionnaire (MUEQ-Br revised), the Rapid Office Strain Assessment (ROSA-Br) and the Nordic Musculoskeletal Questionnaire (NMQ), added to a numerical pain scale. Results. According to ROSA-Br, 47.06% of the participants showed an outcome where it is considered that there is a need for immediate intervention in the workplace. The results of ROSA-Br and MUEQ-Br revised presented a significant correlation with the intensity of complaints in the neck and shoulders in the last 12 months and in the last seven days. The total score of MUEQ-Br revised presented more important correlations with problems in these body regions and with the intensity of complaints in the upper back, wrists/hands and lower back in both periods. Conclusions. Companies should propose ways to assess the ergonomic and psychosocial risks among their employees in telework as a way to prevent the occurrence of musculoskeletal problems.

Effectiveness of multimodal exercises integrated with cognitive-behavioral therapy in working patients with chronic neck pain: protocol of a randomized controlled trial with 1-year follow-up

Background

The etiology of neck pain is multifactorial and includes personal and work-related factors such as age, sex, wrong postures, and repeated strains. Studies based on bio-psychosocial model also link chronic neck pain to psychological factors. Over time, the use of multidisciplinary interventions for chronic neck pain has grown in order to improve disability, pain, and adaptive cognitions and behaviors towards patients’ problems. The objective is to evaluate the effectiveness of an individual-based multidisciplinary rehabilitation program that integrates cognitive-behavioral therapy focused on kinesiophobia with specific exercises in the treatment of patients with chronic neck pain, employed in different working activities.

Methods

A randomized, parallel-group superiority-controlled trial will be conducted with 1-year follow-up. One hundred seventy patients engaged in several working activities (blue collar and white collar workers) will be randomly allocated to either the experimental (receiving a multidisciplinary rehabilitation program combining multimodal exercises with psychologist-lead cognitive-behavioral therapy sessions) or the control group (receiving general care physiotherapy). Both groups will follow individual-based programs once a week for 10 weeks. The main outcome measures will be the Neck Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, the Short-Form Health Survey, and the Work Ability Index. Participants will be evaluated before, after training, and after 12 months.

Discussion

Findings may provide empirical evidence on the effectiveness of an individual-based multidisciplinary rehabilitation program on inducing clinically significant and long-term improvements in the disability, pain, psychological factors, and quality of life of workers with chronic neck pain and that these would be maintained in the long term. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities’ recommendations.

Trial registration

ClinicalTrials.gov NCT04768790. Registered on 24 February 2021

Predictors of failure to achieve minimal clinical important difference for pain and disability after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain: a retrospective analysis of 4998 patients

PURPOSE

To determine predictors of failure to achieve minimal clinical important difference (MCID) for pain and disability at discharge after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain (NP).

METHODS

Pre- and post-treatment numerical pain rating scale (NPRS) and neck disability index (NDI) in patients with mechanical NP were analysed in this retrospective study. Multivariate analysis was performed to investigate the effect of covariates such as age, gender, lifestyle, body mass index, presentation, diabetes, osteoporosis, response to repeated movement testing, treatment sessions, compliance rate, and pre-treatment NPRS and NDI scores on failure to achieve MCID of ≥ 30% for NPRS and NDI scores post-treatment.

RESULTS

In the 4998 patients analysed for this study, 7% and 14.5% of patients failed to achieve MCID for NPRS and NDI scores, respectively, at the end of treatment. Age > 70 years, diabetes, osteoporosis, partial or non-response to repeated movements, lesser treatment sessions, and lower compliance rate were associated with increased risk for failure to achieve MCID for NPRS and NDI scores. A higher pre-treatment NDI score was associated with failure to achieve MCID for NPRS score, whereas lower pre-treatment NPRS and NDI scores were associated with failure to achieve MCID for NDI score.

CONCLUSION

Although MDT-based multimodal rehabilitation helped to achieve significant reduction in pain and disability in mechanical NP, several baseline risk factors were associated with failure to achieve MCID for pain and disability after treatment. Identifying and modifying these factors as part of rehabilitation treatment may help to achieve better outcomes in mechanical NP.

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

BACKGROUND

Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease.

METHODS

Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews.

FINDINGS

799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence.

CONCLUSIONS

MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue ("fascial armoring"). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A "global percutaneous needle fasciotomy" that respects tensegrity principles may treat MPS/fibromyalgia more effectively. "Functional-somatic syndromes" can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.

Telework during the COVID-19 pandemic: Ergonomic and psychosocial risks among Brazilian labor justice workers

BACKGROUND

The imposition of telework by the COVID-19 pandemic represented a challenge for companies and workers with regard to the management and organization of the workplace at home.

OBJECTIVES

To evaluate the ergonomic risks, psychosocial factors and musculoskeletal symptoms as well as the relationships between these variables in employees of a Brazilian labor judiciary unit.

METHODS

A cross-sectional study was carried out with 55 employees who had their workstations evaluated by means of the Rapid Office Strain Assessment (ROSA-Br) and answered a questionnaire of sociodemographic and occupational characterization, the dimensions of workstation and posture of the Maastricht Upper Extremity Questionnaire (MUEQ-Br-revised), the short version of the Job Stress Scale and the Nordic Musculoskeletal Questionnaire (NMQ).

RESULTS

The workstations evaluations by ROSA-Br and MUEQ-Br-revised showed a strong correlation between themselves and to body posture, but they were not related to the occurrence of musculoskeletal symptoms. Body posture and demands were correlated to each other and with to occurrence of musculoskeletal symptoms. Shoulders, neck and wrists / hands were the most affected body regions.

CONCLUSIONS

Companies that adopt teleworking for their employees must be aware of working conditions at home, including the workload, and offer adequate support in order to prevent the occurrence of musculoskeletal problems.

Evaluation of Shoulder Microcirculation Abnormality Using Laser Doppler Flowmetry

Severe neck-shoulder pain induces functional limitations in both life and work. The purpose of this study was to determine the characteristics of shoulder microcirculation abnormality in workers. This study recruited 32 workers and patients, both n = 16. Questionnaires were administered, and Laser Doppler Flowmetry (LDF) was used to measure microcirculatory blood flow (MBF) at the myofascial trigger points (MTrPs) on the shoulders. The absolute-deviation_MMBF represented the mean MBF (MMBF) variability among subjects. The differences in the life characteristics, shoulder pain level, and microcirculatory characteristics at MTrPs between the two groups were compared. It was found that shoulder pain level was significantly higher in the patient than in the control group (p < 0.001). Deviation of the MMBF value beyond the postulated “normal range” of 60–80 was significantly higher in the patient than in the control group (p < 0.001). The MMBF deviation was significantly correlated with shoulder pain level, pain duration, and the symptom effect (p < 0.01, n = 32). A normal range for the MMBF of 60–80 on the shoulder near MTrPs is hypothesized for the first time based on this study. Noninvasive LDF can be used to assess abnormality in the MBF on shoulder MTrPs at an early stage.

Neck pain: global epidemiology, trends and risk factors

Background

Neck pain is one of the most common musculoskeletal disorders, having an age-standardised prevalence rate of 27.0 per 1000 population in 2019. This literature review describes the global epidemiology and trends associated with neck pain, before exploring the psychological and biological risk factors associated with the initiation and progression of neck pain.

Methods

The PubMed database and Google Scholar search engine were searched up to May 21, 2021. Studies were included that used human subjects and evaluated the effects of biological or psychological factors on the occurrence or progression of neck pain, or reported its epidemiology.

Results

Psychological risk factors, such as long-term stress, lack of social support, anxiety, and depression are important risk factors for neck pain. In terms of the biological risks, neck pain might occur as a consequence of certain diseases, such as neuromusculoskeletal disorders or autoimmune diseases. There is also evidence that demographic characteristics, such as age and sex, can influence the prevalence and development of neck pain, although further research is needed.

Conclusions

The findings of the present study provide a comprehensive and informative overview that should be useful for the prevention, diagnosis, and management of neck pain.

Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis

BACKGROUND

Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions.

METHODS

Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies' risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review.

RESULTS

Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP - OR = 1.19(1.03 - 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 - 1.92)] and neck/shoulder pain [OR = 1.73(1.46 - 2.03)], but not with extremities pain [OR = 1.17(0.65 - 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting.

CONCLUSIONS

We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases.

PROTOCOL REGISTRATION

PROSPERO ID # CRD42020166412 (Amended to limit the scope).

Developing a practice and evidence-based guideline for occupational health and safety professionals to prevent and handle musculoskeletal pain in workplaces

Practice guidelines can facilitate the translation of evidence-based knowledge into better occupational health and safety (OHS) prevention. This paper describes the development process, findings and content of a practice and evidence-based guideline for musculoskeletal pain (MSP) to OHS professionals in Denmark. We used a participatory process with involvement of more than 100 OHS professionals in the development of the guideline. The guideline contains three sections: 1) Rapid review of risk factors for MSP (Push/pull, Screen work, Lifting, Awkward postures and Psychosocial factors related to MSP) and single- and multi-stranded interventions targeting MSP. 2) Process recommendations for use of the guideline by a three-phase participatory process 3) Practical recommendations that contain advice and methods for the three-phase participatory process. This paper can promote future guideline development, as it provides specific insight into how OHS professionals can be included in the development of practice and evidence-based guideline through a participatory process.

Factors associated with neck and shoulder pain: a cross-sectional study among 16,000 adults in five county councils in Sweden

Background

Neck and shoulder pain is common in the general population, but studies on factors related to the risk of neck and shoulder pain have produced inconclusive results. Known factors related to pain include general physical activity, exercise, sleep disorders, and lifestyle, but further research is needed to improve our ability to prevent neck and shoulder pain. The aim was to investigate whether neck and shoulder pain are associated with physical domains (i.e., aerobic physical activities, general physical activities, and sitting time), sleep disturbances, general health, job satisfaction, and/or working time.

Methods

This population-based, cross-sectional study was conducted in Sweden in 2017 and included 16,167 individuals, aged 18 to 63 years. We administered a questionnaire to determine neck and shoulder pain, the time spent in general physical activity or aerobic physical activity, the time spent sitting, sleep disturbances, general health, job satisfaction, and the time spent working. Factors associated with neck and shoulder pain were explored using logistic regression.

Results

Significant factors associated with neck and shoulder pain were: overall health, sleep quality, and aerobic exercise. The odds of sustaining neck and shoulder pain increased with moderate or poor health (odds ratios [ORs]: 2.3 and 2.8, respectively) and sleep disorders (OR: 1.7). Conversely, aerobic physical activity performed more than 60 min/week at a level that enhanced respiratory and heart rate was associated with a reduced risk of experiencing neck and shoulder pain (OR: 0.8).

Conclusions

Although no causal relationships could be determined in the present study, the results highlight important associations between aerobic exercise, undisturbed sleep, good health, and the absence of upper body pain. Exercises that enhance breathing and heart rate were associated with a reduced risk of experiencing neck or shoulder pain, but there was no association between general physical activity and upper body pain. Therefore, clinicians may not recommend low-intensity activities, such as walking, for preventing or improving neck and shoulder pain.

Traditional Chinese Mind and Body Exercises for Neck Pain: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Neck pain is common and can have a significant impact on patients' physical functionality, mobility, and quality of life (QOL). In clinical practice, traditional Chinese mind and body exercise (TCMBE) is a combination of different types of exercise based on traditional Chinese medicine, including qigong, tai chi, the 12-words-for-life-nurturing exercise, and so on, and many studies have found that it is safe and effective at helping patients with neck pain.

OBJECTIVE

The aim of this study was to investigate the effectiveness of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain.

METHODS

The PubMed, MEDLINE, PEDro, and Embase databases were systematically searched for relevant studies. Randomized controlled trials reporting the effects of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain were included. Screening, data extraction, and literature quality assessments were performed independently by two reviewers. RevMan5.4 software was used for data analysis.

RESULTS

Six studies with 716 participants met the inclusion criteria. Compared with the control groups, TCMBE had no therapeutic advantage in improving pain intensity (visual analogue scale: mean difference (MD) = 1.8, 95% confidence interval (CI): -7.70 to 11.46, and P = 0.70); functional mobility (neck disability index: MD = 0.15, 95% CI: -6.37 to 6.66, and P = 0.96; neck pain and disability scale: MD = 1.31, 95% CI: -4.10 to 6.71, and P = 0.64); or 36-item short-form health survey (SF-36) scores for physical function (MD = 5.58, 95% CI: -8.03 to 19.18, and P = 0.42), general health (MD = 1.87, 95% CI: -4.99 to 8.72, and P = 0.59), body pain (MD = 2.26, 95% CI: -3.80 to 8.32, and P = 0.46), vitality (MD = 6.24, 95% CI: -1.49 to 13.98, and P = 0.11), social function (MD = 8.06, 95% CI: -4.85 to 20.98, and P = 0.22), role physical (MD = -1.46, 95% CI: -8.54 to 5.62, and P = 0.69), or role emotional (MD = 6.5, 95% CI: -3.45 to 16.45, and P = 0.2). However, TCMBE was less effective at improving mental health results based on the SF-36 survey (MD = 3.37, 95% CI: 0.5 to 6.24, and P = 0.02).

CONCLUSIONS

Based on the meta-analysis, there is insufficient evidence to support the clinical use of TCMBE in improving pain intensity and enhancing functional mobility and QOL in individuals with neck pain.

Non-Preferred Work and the Incidence of Spinal Pain and Psychological Distress-A Prospective Cohort Study

Mental illness and psychological distress are global concerns. This study aimed to investigate the association between having non-preferred work and the incidence of spinal pain, psychological distress, and spinal pain with concurrent psychological distress, and if associations are modified by sleep disturbance. A prospective study of 4285 participants 23-62 years old was conducted, from years 2007 to 2010. Participants reported their work situation as preferred/non-preferred regarding profession/workplace with a high/low possibility to change. Psychological distress was measured with the General Health Questionnaire 12 and spinal pain with questions about neck/back pain. Binominal regression analyses calculated relative risk (RR) with 95% confidence interval (CI). Non-preferred work with a low possibility to change was associated with a higher incidence of spinal pain (RR 1.8; 95% CI 1.2-2.6) and psychological distress (RR 1.8; 95% CI 1.4-2.4) compared to preferred work. The RR was 1.4 (95% CI 0.9-2.1) for spinal pain and 1.3 (95% CI 1.0-1.7) for psychological distress among those with a high possibility to change. Non-preferred work yielded a higher incidence of spinal pain with concurrent psychological distress (RR 1.9; 95% CI 1.0-3.7). Sleep disturbance did not modify associations. A replication based on newer data is needed to confirm the results. In conclusion, non-preferred work is associated with a higher incidence of spinal pain and psychological distress, especially if the possibility to change job is low.

Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis

Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies. PERSPECTIVE: Despite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher prevalence of chronic low back pain in this population. Given the aging population, high-quality prospective studies are warranted to address this gap.

Health-related quality of life in Chinese workers: a systematic review and meta-analysis

BACKGROUND

Studies of health-related quality of life among workers have generated varying results. The purpose of this study was to conduct a systematic review to synthesize the scores of health-related quality of life measured by the World Health Organization Quality of Life questionnaire among Chinese workers and compare the results across gender, age, occupation and region.

METHODS

Six databases including China National Knowledge Infrastructure, WanFang Data, China Science and Technology Journal Database, PubMed, Web of science and Scopus were searched for relevant publications in both English and Chinese from their inception to February 2021. Inclusion and exclusion criteria were established, and study and participant characters as well as health-related quality of life scores were extracted from included publications. Study quality was assessed by using the Crombie tool. The meta-analysis including individual publications used random-effects models. Subgroups analyses by gender, age, occupation and region were also conducted to explore the source of heterogeneity.

RESULTS

One hundred thirty-nine out of 1437 potential publications were included. The pooled mean scores of health-related quality of life were 14.1 for the physical domain (95%CI: 13.9-14.3), 13.7 for the psychological domain (95%CI: 13.5-13.8), 14.0 for the social relationship domain (95%CI: 13.8-14.2), 12.3 for the environment domain (95%CI: 12.1-12.5). No significant statistical difference was found between the different subgroups. Publication bias was present in the independence domain and the pooled scores were corrected to 15.0 (95%CI: 14.6-15.5) using the trim and fill method. Sensitivity analysis suggested that the results of the meta-analysis were stable. Region might be a source of heterogeneity. Workers in northeast China reported higher scores in the social relationship domain, and those in the central region reported lower scores in the environmental domain.

CONCLUSIONS

Chinese workers reported lower scores in four health-related quality of life domains than the general population. Region might be a potential influencing factor for workers' scores different, which needs further study. The pooled scores can served as benchmarks for workplace health promotion programes in Chinese workers and global occupational health studies.

Sensitization in office workers with chronic neck pain in different pain conditions and intensities

OBJECTIVES

Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers.

METHODS

One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as 'mild-pain' (Visual Analog Scale [VAS]≤3) and 'moderate-pain' (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers.

RESULTS

PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors for prediction of pain intensity in chronic trapezius myalgia (R²=0.319) and chronic non-specific neck pain (R²=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R²=0.525), and stress in moderate pain group (R²=0.494) for the prediction of disability.

CONCLUSIONS

Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.

Is Shear-Wave Elastography a Clinical Severity Indicator of Myofascial Pain Syndrome? An Observational Study

Since manual palpation is a subjective procedure for identifying and differentiate Myofascial Trigger Points -MTrPs-, the use of Shear Wave Elastography -SWE- as an objective alternative is increasing. This study aimed to analyze pain pressure thresholds -PPTs- and SWE differences between active MTrPs, latent MTrPs and control points located in the upper trapezius to analyze the association of SWE features with clinical severity indicators (e.g., pain extension area, PPTs, neck pain and neck disability). An observational study was conducted to calculate the correlation and to analyze the differences of sociodemographic, clinical and SWE features on 34 asymptomatic subjects with latent MTrPs and 19 patients with neck pain and active MTrPs. Significant PPT differences between active with latent MTrPs (p < 0.001) and control points (p < 0.001) were found, but no differences between latent MTrPs and control points (p > 0.05). No stiffness differences were found between active MTrPs with latent MTrPs or control points (p > 0.05). However, significant control point stiffness differences between-samples were found (p < 0.05). SWE showed no significant correlation with clinical severity indicators (p > 0.05). No stiffness differences between active and latent MTrPs were found. Neck pain patients showed increased control point stiffness compared with asymptomatic subjects. SWE showed no association with clinical severity indicators.

Additive effect of "Brahma Mudra" on pain, proprioception and functional abilities in non-specific mechanical neck pain

OBJECTIVE

Being the second highest musculoskeletal problem irrespective of age, gender and occupation, the etiology of neck pain is predominantly mechanical in nature. This can lead to dysfunction with time and recurrence. Altered joint position sense (JPS) from soft tissues can alter the cervical biomechanics by compromising the cephalo spatial orientation, which depends on the visual, vestibular and proprioceptive cues. This study was done to observe the additive effect of "Brahma mudra" (BM) a yogic tool on non-specific mechanical neck pain and its clinical implication on pain, proprioception and functional abilities.

METHODS

It was a quasi-experimental pre -post study design involving 30 individuals from a software firm between the age group of 18-45 years. The conventional treatment group received standard physiotherapy regime and in the BM group BM was incorporated in addition to standard physiotherapy regime. Independent sample student t-test/Mann Whitney test were used to compare continuous variables between two groups. Paired sample test/Wilcoxon signed rank test were used for within groups.

RESULTS

There was a significant reduction in pain, improved functional abilities and proprioception in BM group when compared to conventional treatment group with 0.01 level of statistical significance.

CONCLUSION

It may be concluded that practice of BM had an added effect to conventional standard physiotherapy regime in reduction of pain, improvement of proprioception and functional abilities among individuals with chronic non-specific mechanical neck pain.

A Longitudinal Evaluation of Risk Factors and Interactions for the Development of Nonspecific Neck Pain in Office Workers in Two Cultures

OBJECTIVE

To identify risk factors for the development of interfering neck pain in office workers including an examination of the interaction effects between potential risk factors.

BACKGROUND

The 1-year incidence of neck pain in office workers is reported as the highest of all occupations. Identifying risk factors for the development of neck pain in office workers is therefore a priority to direct prevention strategies.

METHODS

Participants included 214 office workers without neck pain from two cultures. A battery of measures evaluating potential individual and workplace risk factors were administered at baseline, and the incidence of interfering neck pain assessed monthly for 12 months. Survival analysis was used to identify relationships between risk factors and the development of interfering neck pain.

RESULTS

One-year incidence was 1.93 (95% CI [1.41, 2.64]) per 100 person months. Factors increasing the risk of developing interfering neck pain were older age, female gender, increased sitting hours, higher job strain, and stress. A neutral thorax sitting posture, greater cervical range of motion and muscle endurance, and higher physical activity were associated with a decreased risk of neck pain. The effects of some risk factors on the development of neck pain were moderated by the workers' coping resources.

CONCLUSION

Multiple risk factors and interactions may explain the development of neck pain in office workers. Therefore, plans for preventing the development of interfering neck pain in office workers should consider multiple individual and work-related factors with some factors being potentially more modifiable than others.

Translation, cross-cultural adaptation and psychometric validation of the Thai version of the STarT Back Screening Tool in patients with non-specific low back pain

BACKGROUND

Low back pain (LBP) is a top musculoskeletal problem and a substantial cause of socioeconomic burden internationally. The STarT Back Screening Tool (SBST) is a useful screening tool to manage patients with LBP but it is unavailable in Thai. Therefore, the aims of this study were to translate and cross-culturally adapt the SBST into a Thai version (SBST-TH) and validate its psychometric properties (e.g., factor analysis, internal consistency, test-retest reliability, agreement, convergent validity and discriminative validity).

METHODS

Translation and cross-cultural adaptation of the SBST into Thai version were conducted according to standard guidelines. A total of 200 participants with non-specific LBP were invited to complete the SBST, visual analogue scale for pain intensity, Roland-Morris disability questionnaire (RMDQ), fear-avoidance beliefs questionnaire, pain catastrophising scale, hospital anxiety and depression scale and the EuroQol five-dimensional questionnaire. Thirty participants completed the SBST-TH twice with an interval of 48 h to evaluate test-retest reliability.

RESULTS

Factor analysis demonstrated two (physical and psychological) components for the SBST-TH (39.38% of the total variance). The Cronbach's alpha (0.86 for total score and 0.76 for psychosocial subscore) represent satisfactory internal consistency. The acceptability of intraclass correlation coefficient was found in the total (0.73) and subscore (0.79). The areas under the curve (AUC) for the total score ranged 0.67-0.85 and 0.66-0.75 for subscore. The excellent discriminative validity was observed (AUC = 0.85, 95% confidence interval = 0.72, 0.97) between the total score of the SBST-TH and disability (RMDQ). Spearman's correlation coefficients represented moderate to strong correlation (0.32-0.56) between the SBST-TH and all questionnaires. The findings suggest a good relationship between the SBST-TH and disability and quality of life. Owing to the results from the convergent and discriminative validity, construct validity of the SBST-TH can be supported. The minimal detectable changes of the total score and subscore were 2.04 and 1.60, respectively. Significant floor and ceiling effects were not found in the SBST-TH.

CONCLUSION

The SBST-TH was successfully translated and adapted. It is a valid and reliable tool to classify Thai patients with non-specific LBP into low, moderate and high risks for chronicity.

TRIAL REGISTRATION

TCTR20191009005 #.

A Two Joint Neck Model to Identify Malposition of the Head Relative to the Thorax

Neck pain is a frequent health complaint. Prolonged protracted malpositions of the head are associated with neck pain and headaches and could be prevented using biofeedback systems. A practical biofeedback system to detect malpositions should be realized with a simple measurement setup. To achieve this, a simple biomechanical model representing head orientation and translation relative to the thorax is introduced. To identify the parameters of this model, anthropometric data were acquired from eight healthy volunteers. In this work we determine (i) the accuracy of the proposed model when the neck length is known, (ii) the dependency of the neck length on the body height, and (iii) the impact of a wrong neck length on the models accuracy. The resulting model is able to describe the motion of the head with a maximum uncertainty of 5 mm only. To achieve this high accuracy the effective neck length must be known a priory. If however, this parameter is assumed to be a linear function of the palpable neck length, the measurement error increases. Still, the resulting accuracy can be sufficient to identify and monitor a protracted malposition of the head relative to the thorax.