Evaluation of two preventive interventions for reducing musculoskeletal complaints in operators of video display terminals

Effectiveness of Physical Exercise on Pain, Disability, Job Stress, and Quality of Life in Office Workers with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial

Neck pain is a widespread medical condition among office workers worldwide. This study aimed to compare physical exercises, including basic body awareness, neck-specific training exercises and ergonomic modifications, and ergonomic modifications alone in the management of chronic non-specific neck pain (NSNP) among office workers. Sixty participants were randomly allocated to an experimental group (physical exercises and ergonomic modifications) or a control group (ergonomic modifications) and received the intervention two times a week for eight weeks. The Numerical Pain Rating Scale, Neck Disability Index, Health and Safety Stress Tool, and Short Form Health Survey-36 were used to measure pain, disability, job stress, and quality of life at baseline, and at weeks 4 and 8 of the study period. A repeated measure ANOVA was used to determine the within-group significant differences and an independent t-test was utilized to compare group differences. The baseline data of the experimental and control groups showed no significant difference (p ≥ 0.05). The 2 × 3 mixed models ANOVA showed a significant difference in pain intensity (p = 0.001, ηp2 = 0.042), functional disability (p = 0.001, ηp2 = 0.052), work-related stress (p = 0.001, ηp2 = 0.036), and QoL (p = 0.012, ηp2 = 0.025). Four weeks post-intervention, the experimental group showed significant changes in primary (pain intensity and disability) (1.9; 95% confidence interval 1.65-2.14) and secondary (quality of life and work-related stress) outcomes (p < 0.001). The same gradual improvement in these variables was observed in the 8-week follow-up (p < 0.001). There was a significant improvement in clinical outcomes following the application of physical exercises with ergonomic modifications for chronic NSNP among office workers. This is significant for office workers because it suggests the importance of incorporating physical exercises into their daily routine and making ergonomic changes to their workspaces.

Young people's low back pain and awareness of postural habits: A cross-sectional study

BACKGROUND

Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders.

OBJECTIVE

To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits.

METHODS

Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied.

RESULTS

The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing.

CONCLUSIONS

Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.

Riscos ergonômicos e sintomas musculoesqueléticos em técnicos administrativos do Instituto Federal Catarinense durante o teletrabalho na pandemia da COVID-19

RESUMO O objetivo deste estudo foi avaliar os sintomas osteomusculares e os riscos ergonômicos nos ambientes de teletrabalho dos técnicos administrativos do Instituto Federal Catarinense (IFC). Participaram 142 técnicos administrativos, que responderam um questionário online sobre informações sociodemográficas, realização de tarefas, ambiente de trabalho e dor musculoesquelética. Os dados foram analisados por meio de uma regressão logística binária separadamente para cada desfecho, utilizando como variáveis dependentes as dores no pescoço, no ombro direito e na coluna lombar. A prevalência de dor entre os técnicos administrativos foi de 92,7% e as regiões mais afetadas foram o pescoço, a coluna lombar e o ombro direito. Os principais riscos ergonômicos foram: sobrecarga mental (estresse), mesa, monitor e cadeira de trabalho inadequados, ausência de orientação acerca dos riscos ergonômicos e das adaptações no ambiente de trabalho. Foi observada associação entre dor no pescoço e os técnicos administrativos que apresentaram maior sobrecarga mental (estresse), não fazem atividade física, não trabalhavam com mesa ao nível do cotovelo, não tinham espaço para apoiar os antebraços e utilizavam o touchpad; e entre dor no ombro direito e os técnicos administrativos que não tinham espaço para apoiar os antebraços e utilizavam o touchpad. Ainda, a dor na coluna lombar foi associada às mulheres que não possuíam apoio para os pés, mesa ao nível do cotovelo e cadeira com apoio lombar e estofamento, assim como àquelas que apresentaram maior sobrecarga mental (estresse). Conclui-se que é importante a instituição fornecer equipamentos e mobiliários adequados e oferecer treinamentos sobre os riscos ergonômicos presentes no trabalho.

Ergonomic risks and musculoskeletal symptoms in Instituto Federal Catarinense administrative technicians during telework in the COVID-19 pandemic

ABSTRACT This study aimed to evaluate musculoskeletal symptoms and ergonomic risks in telework environments of administrative technicians at the Instituto Federal Catarinense. In total, 142 administrative technicians who answered an online questionnaire about sociodemographic information, task performance, work environment, and musculoskeletal pain participated in the study. Data were analyzed by binary logistic regression separately for each outcome, using pain in the neck, right shoulder and low back pain as dependent variables. The prevalence of pain among administrative technicians was 92.7% and the most frequent regions were the neck, lumbar spine, and right shoulder. Mental overload (stress), inadequate worktable, monitor and work chair, lack of guidance on ergonomic risks and adaptations in the work environment were the main ergonomic risks. An association was observed between neck pain and administrative technicians who were mentally overloaded, did not practice any physical activity, did not have the table at elbow level, had neither forearms support nor used a mouse (but a touchpad instead); and right shoulder pain in administrative technicians who had no forearm support and used a touchpad. Also, low back pain was associated with mentally overloaded women who did not have footrest, table at the elbow level, or a chair with lumbar support and upholstery. The institution should provide adequate equipment and furniture and training the employees on the ergonomic risks at work.

[Comprehensive ergonomics program for the reduction of musculoskeletal discomfort in computer user workers]

INTRODUCTION

Musculoskeletal complaints represent one of the main problems that affect the well-being and work performance of computer users demanding interventions with a comprehensive approach where workers actively participate.

OBJECTIVE

To evaluate the effect of a comprehensive ergonomics program to reduce musculoskeletal discomfort and postural overload in computer user workers.

METHODS

A quantitative study with an analytical approach and quasi-experimental design with independent groups was carried out during 3-month. 242 people participated, divided into 2 groups of 121 people each, who used a computer for more than 4h a day. The experimental group participated in the ergonomics program that included training, delivery of an informative leaflet on ergonomics in offices, adaptation of the workstation and a stretching exercise program. The control group received training and only once the information leaflet. A baseline measurement of musculoskeletal discomfort and postural overload was performed in both groups. At the end of 3months, a second data collection was carried out and compared with the baseline data.

RESULTS

The ergonomics program significantly reduced the intensity of musculoskeletal discomfort in the different neck, shoulder and back segments (P<.05), but did not reduce the frequency of discomfort (P>.05). Furthermore, the program significantly reduced the level of postural overload (P<.05).

CONCLUSION

The comprehensive ergonomics program was effective in reducing the intensity of musculoskeletal complaints and postural overload, but did not significantly reduce the frequency of musculoskeletal complaints.

Effect of an ergonomic intervention involving workstation adjustments on musculoskeletal pain in office workers-a randomized controlled clinical trial

Office workers remain in a awkward position for long periods, which can lead to musculoskeletal symptoms. Ergonomic guidelines are recommended to avoid such problems. Evidence of the long-term effectiveness of ergonomic interventions is scarce. The aim of this randomised controlled trial was to compare pain intensity among office workers who received an ergonomic intervention and a control group before as well as 12, 24, and 36 wk after the intervention. Workers were randomly allocated to a control group (CG) and experimental group (EG). The EG received an ergonomic workstation intervention. Furniture measurements were related to individual anthropometric measurements to identify mismatches. The outcome was pain intensity, which was determined using a numerical pain scale and the Nordic Musculoskeletal Questionnaire. A linear mixed model was created with pain intensity as the dependent variable. Group and time were the independent variables. No significant interactions were found between group and time. Significant differences between groups were found for the pain intensity in the neck, shoulder, upper back, and wrist/hand (p<0.05), with lower intensity in the EG. The intervention reduced pain intensity in the neck, shoulder, upper back, and wrist/hand. However, no reduction in pain intensity was found for the lower back or elbow.

A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain - a secondary outcome analysis

Background

Neck pain is prevalent among office workers. This study evaluated the impact of an ergonomic and exercise training (EET) intervention and an ergonomic and health promotion (EHP) intervention on neck pain intensity among the All Workers and a subgroup of Neck Pain cases at baseline.

Methods

A 12-month cluster-randomized trial was conducted in 14 public and private organisations. Office workers aged ≥18 years working ≥30 h per week (n = 740) received an individualised workstation ergonomic intervention, followed by 1:1 allocation to the EET group (neck-specific exercise training), or the EHP group (health promotion) for 12 weeks. Neck pain intensity (scale: 0–9) was recorded at baseline, 12 weeks, and 12 months. Participants with data at these three time points were included for analysis (n = 367). Intervention group differences were analysed using generalized estimating equation models on an intention-to-treat basis and adjusted for potential confounders. Subgroup analysis was performed on neck cases reporting pain ≥3 at baseline (n = 96).

Results

The EET group demonstrated significantly greater reductions in neck pain intensity at 12 weeks compared to the EHP group for All Workers (EET: β = − 0.53 points 95% CI: − 0.84– − 0.22 [36%] and EHP: β = − 0.17 points 95% CI: − 0.47–0.13 [10.5%], p-value = 0.02) and the Neck Cases (EET: β = − 2.32 points 95% CI: − 3.09– − 1.56 [53%] and EHP: β = − 1.75 points 95% CI: − 2.35– − 1.16 [36%], p = 0.04). Reductions in pain intensity were not maintained at 12 months with no between-group differences observed in All Workers (EET: β = − 0.18, 95% CI: − 0.53–0.16 and EHP: β = − 0.14 points 95% CI: − 0.49–0.21, p = 0.53) or Neck Cases, although in both groups an overall reduction was found (EET: β = − 1.61 points 95% CI: − 2.36– − 0.89 and EHP: β = − 1.9 points 95% CI: − 2.59– − 1.20, p = 0.26).

Conclusion

EET was more effective than EHP in reducing neck pain intensity in All Workers and Neck Cases immediately following the intervention period (12 weeks) but not at 12 months, with changes at 12 weeks reaching clinically meaningful thresholds for the Neck Cases. Findings suggest the need for continuation of exercise to maintain benefits in the longer term.

Clinical trial registration

hACTRN12612001154897 Date of Registration: 31/10/2012.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-03945-y.

Effectiveness of workplace intervention strategies in lower back pain prevention: a review

The aim of this study was to identify effective work place intervention strategies for the prevention of low back pain (LBP). The study focused on interventions to two major groups: personal interventions and technical interventions. Data basis were searched for with inclusion criteria: study design based on randomised controlled trial; outcome measures including non-specific LBP occurrence expressed by prevalence or intensity; intervention met the definition of the technical and/or personal (physical exercises, behavioural training, educational) intervention programme. Eighteen papers were selected for full analysis. The diversification of quantitative indicators of differences between control and intervention groups were carried out using Cohen's d index. The results of analysis showed strong differences in effects among intervention strategies, as well as among different cases within similar intervention strategies. LBP severity before intervention and the length of intervention were discussed as potentially influencing factors. The results of the analysis suggest that the most effective strategies for LBP prevention include technical modifications of the workstand and education based on practical training. Behavioural and physical training seems to be of lesser importance. LBP severity before intervention and the time when the measurements of outcome measures take place play an important role in the effectiveness of intervention.

Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis

QUESTION

What is the effectiveness of interventions that aim to prevent a new episode of neck pain?

DESIGN

Systematic review and meta-analysis of randomised, controlled trials.

PARTICIPANTS

People without neck pain at study entry.

INTERVENTION

Any intervention aiming to prevent a future episode of neck pain.

OUTCOME MEASURES

New episode of neck pain.

RESULTS

Five trials including a total of 3852 individuals met the inclusion criteria. The pooled results from two randomised, controlled trials (500 participants) found moderate-quality evidence that exercise reduces the risk of a new episode of neck pain (OR 0.32, 95% CI 0.12 to 0.86). One of the meta-analysed trials included some co-interventions with the exercise. There was low-quality evidence from three randomised, controlled trials (3352 participants) that ergonomic programs do not reduce the risk of a new neck pain episode (OR 1.00, 95% CI 0.74 to 1.35).

CONCLUSION

This review found moderate-quality evidence supporting the effectiveness of an exercise program for reducing the risk of a new episode of neck pain. There is a need for high-quality randomised, controlled trials evaluating interventions to prevent new episodes of neck pain.

REGISTRATION

PROSPERO CRD42017055174. [de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ (2018) Exercise programs may be effective in preventing a new episode of neck pain: a systematic review. Journal of Physiotherapy 64: 159-165].

Global Postural Reeducation in patients with chronic nonspecific neck pain: cross-over analysis of a randomized controlled trial

Objective:

To compare the effects of Global Postural Reeducation (GPR) with Manual Therapy (MT) in participants with chronic nonspecific neck pain (NP).

Methods:

Pre- and post-treatment analysis of cross-over data from an RCT was done. Seventy-eight subjects with chronic nonspecific NP aged 18 to 80 years completed the trial. The group who had received GPR crossed-over to MT and the previous MT group received GPR for 9 sessions once or twice a week. Measures were assessed at pre-treatment and post-treatment. Outcome measures included pain intensity [Visual Analogue Scale (VAS)], disability (Neck Disability Index), cervical Range of Motion (ROM), and kinesiophobia [Tampa Scale of Kinesiophobia (TSK)].

Results:

GPR targeted to crossed-over participants produced greater improvements in pain [Diff=-8.6; 95%CI=(-13.3; -3.8)], disability [Diff=-1.5; 95%CI=-2.8; -0.1], kinesiophobia [Diff=-1.8; 95%CI=(-3.2; -0.3)], and flexion/extension neck ROM [Diff=5.6; 95%CI=(1.8; 9.3)] at post-treatment compared to the MT group. When evaluating clinical improvement, by means of Minimal Clinically Important Differences, we found that GPR relevantly reduced neck disability with respect to MT [OR=2.13; 95% CI=(1.05; 4.35)], whereas the improvement of pain did not differ between groups [OR=1.84; 95%CI=0.85; 3.99)].

Conclusions:

These results within the crossed-over group confirm previous findings from an RCT with the same sample. Sequence of treatment (GPR-to-MT vs MT-to-GPR) does not seem to weaken the greater effects of GPR compared to MT approach for chronic NP. Our findings suggest that GPR can induce hypoalgesic effects, reduce disability and kinesiophobia, and improve flexion/extension in neck ROM.

A Survey of Work-Related Musculoskeletal Disorders Among Otolaryngologists

There are increased reports of prevalence of work-related musculoskeletal disorders (WRMSDs) in surgeons performing minimal access surgeries. Due to the nature of the speciality, otolaryngologists spend their work days in performing markedly precise procedures in small workspaces i.e. the patients' ear, nose and throat. Due to this, they frequently adopt awkward neck, back and shoulder postures while using devices like otoscope, endoscope and microscope. The field of otolaryngology has barely received any attention with respect to ergonomic assessment. Thus, the aim of this study was to find out the prevalence of WRMSDs in otolaryngologists in Mumbai and Navi Mumbai. A pre-validated, structured questionnaire was distributed to 150 otolaryngologists. Seventy-three otolaryngologists responded to the questionnaire. The questionnaire comprised of demographic and workload data, report of musculoskeletal symptoms and otolaryngologists' interpretation of casual and preventive factors of symptoms at workplace. Response rate of the survey was 48.6%. The total prevalence of WRMSDs in the otolaryngologists was 87.67%. Majority of those surveyed reported that they suffered from musculoskeletal problems which they attributed to the ergonomic flaws encountered during surgery (60.27%) and OPD (69.86%) respectively. Pain and discomfort during surgery experienced by the surgeons were most frequently attributed to the awkward and sustained postures adopted during surgery. Effective time management, ergonomically apt postures, intermittent change of posture, using back rest and availing skilled assistance during OPD and surgery, were the self-assessed corrective measures suggested by the respondents. The otolaryngologists' job profile puts them at high risk for WRMSDs.

Inter-rater reliability of an observation-based ergonomics assessment checklist for office workers

OBJECTIVES

To establish the inter-rater reliability of an observation-based ergonomics assessment checklist for computer workers.

METHODS

A 37-item (38-item if a laptop was part of the workstation) comprehensive observational ergonomics assessment checklist comparable to government guidelines and up to date with empirical evidence was developed. Two trained practitioners assessed full-time office workers performing their usual computer-based work and evaluated the suitability of workstations used. Practitioners assessed each participant consecutively. The order of assessors was randomised, and the second assessor was blinded to the findings of the first. Unadjusted kappa coefficients between the raters were obtained for the overall checklist and subsections that were formed from question-items relevant to specific workstation equipment.

RESULTS

Twenty-seven office workers were recruited. The inter-rater reliability between two trained practitioners achieved moderate to good reliability for all except one checklist component.

CONCLUSIONS

This checklist has mostly moderate to good reliability between two trained practitioners. Practitioner Summary: This reliable ergonomics assessment checklist for computer workers was designed using accessible government guidelines and supplemented with up-to-date evidence. Employers in Queensland (Australia) can fulfil legislative requirements by using this reliable checklist to identify and subsequently address potential risk factors for work-related injury to provide a safe working environment.

Effectiveness of Global Postural Re-education in Patients With Chronic Nonspecific Neck Pain: Randomized Controlled Trial

BACKGROUND

Global postural re-education (GPR) has shown positive results for patients with musculoskeletal disorders, but no previous randomized controlled trial (RCT) has investigated its effectiveness as the sole procedure for adult patients with chronic nonspecific neck pain (NP).

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of applying GPR compared with a manual therapy (MT) intervention to patients with chronic nonspecific NP.

DESIGN

An RCT was conducted.

PATIENTS

Ninety-four patients with chronic nonspecific NP (72 women and 22 men; average age=47.5 years, SD=11.3) were randomly assigned to receive either a GPR intervention or an MT intervention.

OUTCOME MEASURES

Pain intensity (visual analog scale), disability (Neck Disability Index), cervical range of motion, and kinesiophobia (Tampa Scale of Kinesiophobia) were assessed.

METHODS

The experimental group received GPR, and the reference group received MT. Both groups received nine 60-minute-long sessions with one-to-one supervision from physical therapists as the care providers. All participants were asked to follow ergonomic advice and to perform home exercises. Measures were assessed before treatment, following treatment, and at a 6-month follow-up.

RESULTS

No important baseline differences were found between groups. The experimental group exhibited a statistically significant reduction in pain following treatment and in disability 6 months after the intervention compared with the reference group.

LIMITATIONS

Randomization did not lead to completely homogeneous groups. It also was noted that the time spent integrating the movements practiced during the session into daily routines at the end of each session was requested only of participants in the GPR group and may have had an impact on patient adherence that contributed to a better outcome.

CONCLUSIONS

The results suggest that GPR was more effective than MT for reducing pain after treatment and for reducing disability at 6-month follow-up in patients with chronic nonspecific NP.

Shoulder Conditions: Diagnosis and Treatment Guideline

The following guideline covers a wide array of shoulder conditions seen in the workers' compensation, as well as the nonworkers' compensation, population. The guideline is intended to help establish work relatedness and aid in making the diagnosis of shoulder injuries and degenerative conditions. It also provides a nonoperative and operative guideline for the treatment of several shoulder conditions, not limited to rotator cuff tears, subacromial impingement syndrome, acromioclavicular arthritis and dislocations, as well as glenohumeral arthritis.

Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence

The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories.

Pain, Work-related Characteristics, and Psychosocial Factors among Computer Workers at a University Center

[Purpose] Complaint of pain is common in computer workers, encouraging the investigation of pain-related workplace factors. This study investigated the relationship among work-related characteristics, psychosocial factors, and pain among computer workers from a university center. [Subjects and Methods] Fifteen subjects (median age, 32.0 years; interquartile range, 26.8-34.5 years) were subjected to measurement of bioelectrical impedance; photogrammetry; workplace measurements; and pain complaint, quality of life, and motivation questionnaires. [Results] The low back was the most prevalent region of complaint (76.9%). The number of body regions for which subjects complained of pain was greater in the no rest breaks group, which also presented higher prevalences of neck (62.5%) and low back (100%) pain. There were also observed associations between neck complaint and quality of life; neck complaint and head protrusion; wrist complaint and shoulder angle; and use of a chair back and thoracic pain. [Conclusion] Complaint of pain was associated with no short rest breaks, no use of a chair back, poor quality of life, high head protrusion, and shoulder angle while using the mouse of a computer.

A web-based intervention to improve and prevent low back pain among office workers: a randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

OBJECTIVES

To test the feasibility, safety, and efficacy of a web-based multidisciplinary intervention for office workers with subacute, nonspecific low back pain.

BACKGROUND

Low back pain is one of the most frequent ailments seen in primary care consultations.

METHODS

The trial included 100 office workers with subacute low back pain. The intervention group had access to both the study intervention and standard care. The control group had access to standard care only. Standard care was defined as all existing non-web-based interventions offered by the University of Extremadura's Preventive Medicine Service. The web-based program was offered via the Preventive Medicine Service website. The participants in the intervention group were asked to engage in the web-based program at their work site for 11 minutes each day, 5 days a week. Primary outcomes were functional disability, as measured by the Roland-Morris Disability Questionnaire, and health-related quality of life, as measured by the European Quality of Life-5 Dimensions-3 Levels. Secondary outcomes were the number of episodes of low back pain and trunk muscle endurance. Outcomes were measured before and after the 9-month intervention period.

RESULTS

Over the 9-month study, the score on the Roland-Morris Disability Questionnaire for the participants in the web-based intervention group improved by a mean of -7.36 points (95% confidence interval [CI]: -8.41, -6.31) compared to a worsening of 1.89 points (95% CI: 0.71, 2.65) in the control group. The between-group difference in change on the Roland-Morris Disability Questionnaire over the study period was -9.25 points (95% CI: -10.57, -7.89). Similarly, over the 9-month study, the intervention group had a significant improvement in quality of life of 0.24 points (95% CI: 0.20, 0.29) compared to the control group.

CONCLUSION

A 9-month web-based intervention is feasible and effective to improve function and health-related quality of life and to decrease episodes of low back pain among office workers with a history of subacute, nonspecific low back pain.

Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults

BACKGROUND

Work-related upper limb and neck musculoskeletal disorders (MSDs) are one of the most common occupational disorders around the world. Although ergonomic design and training are likely to reduce the risk of workers developing work-related upper limb and neck MSDs, the evidence is unclear.

OBJECTIVES

To assess the effects of workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck MSDs in adults.

SEARCH METHODS

We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED, Web of Science (Science Citation Index), SPORTDiscus, Cochrane Occupational Safety and Health Review Group Database and Cochrane Bone, Joint and Muscle Trauma Group Specialised Register to July 2010, and Physiotherapy Evidence Database, US Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health database, and International Occupational Safety and Health Information Centre database to November 2010.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of ergonomic workplace interventions for preventing work-related upper limb and neck MSDs. We included only studies with a baseline prevalence of MSDs of the upper limb or neck, or both, of less than 25%.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias. We included studies with relevant data that we judged to be sufficiently homogeneous regarding the intervention and outcome in the meta-analysis. We assessed the overall quality of the evidence for each comparison using the GRADE approach.

MAIN RESULTS

We included 13 RCTs (2397 workers). Eleven studies were conducted in an office environment and two in a healthcare setting. We judged one study to have a low risk of bias. The 13 studies evaluated effectiveness of ergonomic equipment, supplementary breaks or reduced work hours, ergonomic training, a combination of ergonomic training and equipment, and patient lifting interventions for preventing work-related MSDs of the upper limb and neck in adults.Overall, there was moderate-quality evidence that arm support with alternative mouse reduced the incidence of neck/shoulder disorders (risk ratio (RR) 0.52; 95% confidence interval (CI) 0.27 to 0.99) but not the incidence of right upper limb MSDs (RR 0.73; 95% CI 0.32 to 1.66); and low-quality evidence that this intervention reduced neck/shoulder discomfort (standardised mean difference (SMD) -0.41; 95% CI -0.69 to -0.12) and right upper limb discomfort (SMD -0.34; 95% CI -0.63 to -0.06).There was also moderate-quality evidence that the incidence of neck/shoulder and right upper limb disorders were not reduced when comparing alternative mouse and conventional mouse (neck/shoulder RR 0.62; 95% CI 0.19 to 2.00; right upper limb RR 0.91; 95% CI 0.48 to 1.72), arm support and no arm support with conventional mouse (neck/shoulder RR 0.67; 95% CI 0.36 to 1.24; right upper limb RR 1.09; 95% CI 0.51 to 2.29), and alternative mouse with arm support and conventional mouse with arm support (neck/shoulder RR 0.58; 95% CI 0.30 to 1.12; right upper limb RR 0.92; 95% CI 0.36 to 2.36).There was low-quality evidence that using an alternative mouse with arm support compared to conventional mouse with arm support reduced neck/shoulder discomfort (SMD -0.39; 95% CI -0.67 to -0.10). There was low- to very low-quality evidence that other interventions were not effective in reducing work-related upper limb and neck MSDs in adults.

AUTHORS' CONCLUSIONS

We found moderate-quality evidence to suggest that the use of arm support with alternative mouse may reduce the incidence of neck/shoulder MSDs, but not right upper limb MSDs. Moreover, we found moderate-quality evidence to suggest that the incidence of neck/shoulder and right upper limb MSDs is not reduced when comparing alternative and conventional mouse with and without arm support. However, given there were multiple comparisons made involving a number of interventions and outcomes, high-quality evidence is needed to determine the effectiveness of these interventions clearly. While we found very-low- to low-quality evidence to suggest that other ergonomic interventions do not prevent work-related MSDs of the upper limb and neck, this was limited by the paucity and heterogeneity of available studies. This review highlights the need for high-quality RCTs examining the prevention of MSDs of the upper limb and neck.

The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers

An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers. Sixty workers were randomly assigned to either: 1) a control group; 2) an office training group that received personal, ergonomic training and workstation adjustments or 3) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the worker's current sitting posture together with the correct posture photo taken earlier during office training. Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment (RULA) method before, during and after the six weeks intervention. Both training methods provided effective short-term posture improvement; however, sustained improvement was only attained with the photo-training method. Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain. The photo-training method had a greater positive effect on women than on men.

Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: an ergonomic school education intervention program

Objectives

The purpose of this study was to evaluate a multidisciplinary, interventional, ergonomic education program designed to reduce the risk of musculoskeletal problems by reducing schoolbag weight and correcting poor sitting posture.

Methods

Data were collected twice before and twice following intervention using the Standardized Nordic Body Map Questionnaire, a rapid upper limb assessment for posture evaluation, and schoolbag weight measurement in children aged 8 and 11 years attending two schools within the central region of Malaysia.

Results

Students who received the ergonomic intervention reported significant improvements in their sitting posture in a classroom environment and reduction of schoolbag weight as compared with the controls.

Conclusion

A single-session, early intervention, group ergonomics education program for children aged 8 and 11 years is appropriate and effective, and should be considered as a strategy to reduce musculoskeletal pain among schoolchildren in this age group.

Manual material handling advice and assistive devices for preventing and treating back pain in workers

BACKGROUND

Training and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH).

OBJECTIVES

To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2011, issue 1), MEDLINE, EMBASE, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to February 2011.

SELECTION CRITERIA

We included randomised controlled trials (RCT) and cohort studies with a concurrent control group that were aimed at changing human behaviour in MMH and measured back pain, back pain-related disability or sickness absence.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data and assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group for RCTs and MINORS for the cohort studies.We based the results and conclusions on the analysis of RCTs only. We compared these with the results from cohort studies.

MAIN RESULTS

We included nine RCTs (20,101 employees) and nine cohort studies (1280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.Six RCTs had a high risk of bias.None of the included studies showed evidence of a preventive effect of training on back pain.There was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.The results of the cohort studies were similar to those of the randomised studies.

AUTHORS' CONCLUSIONS

There is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty.

Impact on the Quality of Life of an Educational Program for the Prevention of Work-Related Musculoskeletal Disorders: a randomized controlled trial

BACKGROUND

Work-related musculoskeletal disorders (WMSD) are a major cause for concern in public health and the main causes of sick leave. Treatments for WMSD have given disappointing results; prevention is the best strategy, but results of preventive measures have not been consistent. To the best of our knowledge there are few studies in literature that evaluated the impact of a specific program aimed at preventing WMSD on the quality of life of employed persons.

METHODS

One hundred and one clerical and production workers in a steel trading company were enrolled in an open-label randomized controlled clinical trial (parallel groups) to compare the efficacy of an educational program for primary prevention of WMSD with control intervention. The primary outcome was a change in the physical functioning domain of the quality of life (QL) measured by Medical Outcomes Study Short Form 36 Health Survey (SF-36). The intervention group underwent six consecutive weekly sessions concerning specific orientations for the prevention of WMSD, while the control group received general health education in an identical schedule. The SF-36 and theses Work Limitation Questionnaire (WLQ) were evaluated at weeks zero, five and 26.

RESULTS

Baseline characteristics of the interventions groups were comparable, and both groups comprised predominantly young healthy individuals. No significant differences in the variation of the SF-36 and WLQ between the groups were observed at weeks five and 26. However, both groups demonstrated improvement in some aspects of SF-36, suggesting that both educational interventions have beneficial impacts on QL.

CONCLUSIONS

A specific educational program aimed at the preventing of WMSD was comparable with general health orientation for the improvement of QL and work capacity in a sample of healthy workers during a six month period.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00874718

Workplace management of upper limb disorders: a systematic review

BACKGROUND

Upper limb pain is common among working-aged adults and a frequent cause of absenteeism.

AIMS

To systematically review the evidence for workplace interventions in four common upper limb disorders.

METHODS

Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology.

RESULTS

1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis.

CONCLUSIONS

Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.

Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time

BACKGROUND

Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries.

METHODS

A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?"

RESULTS

The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects".

CONCLUSION

It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.

Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: a 3 year cross-over trial

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover.

OUTCOMES

Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.

Fisioterapia na avaliação e prevenção de riscos ergonômicos em trabalhadores de um setor financeiro

É freqüente a sobrecarga musculoesquelética em trabalhadores, resultando no aumento da prevalência de distúrbios osteomusculares relacionados ao trabalho (DORT). Visando a saúde do trabalhador, e para reduzir o índice de afastamento, deve-se enfatizar a prevenção desses distúrbios. Os objetivos deste estudo foram analisar a ergonomia de um setor financeiro e as posturas dos funcionários durante as tarefas e propor soluções para minimizar os riscos ergonômicos. A análise foi feita mediante três instrumentos de observação simples - avaliação rápida de membros superiores RULA (sigla em inglês de rapid upper limb assessment), checklist de Couto e análise ergonômica focada na atividade - e aplicação do questionário SF-36 aos funcionários. Verificou-se a presença de fator biomecânico de moderada importância, com risco de DORT improvável, porém possível; em outro instrumento, os resultados indicam que o ambiente de trabalho está próximo do ideal. Em análise mais detalhada, as posturas de trabalho foram classificadas como as piores possíveis, requerendo mudanças imediatas. No SF-36 os escores foram elevados, sugerindo qualidade de vida adequada. Assim, embora o ambiente de trabalho se apresente adequado, o uso incorreto dos equipamentos, a má distribuição e forma incorreta de realização das tarefas ocasiona riscos ergonômicos. Visando minimizar estes, são propostas estratégias de intervenção preventiva, sugerindo-se ações específicas nos domínios que apontaram maiores riscos ergonômicos.

Ergonomic intervention in the treatment of a patient with upper extremity and neck pain

BACKGROUND AND PURPOSE

Work-related musculoskeletal disorders are widespread among computer users and costly to the health care system. Workstation setup and worker postures contribute to upper-extremity and neck symptoms among computer users. Ergonomic interventions such as work risk analysis and workstation modifications can improve workers' symptoms. However, ergonomic interventions do not appear to be a common component of traditional physical therapy treatment.

CASE DESCRIPTION

The patient was a 26-year-old woman with right upper-extremity and neck pain referred for physical therapy. A course of traditional physical therapy treatment was performed followed by an ergonomic intervention.

OUTCOMES

Following 4 weeks of traditional physical therapy, the patient showed a 1.0-cm improvement in her resting pain level but no change in her pain level during exacerbations on the visual analog scale. An ergonomic intervention was performed following traditional physical therapy. At the conclusion of the full course of treatment (traditional physical therapy plus ergonomic intervention), resting pain level decreased by 4.6 cm and exacerbation pain level decreased by 3.2 cm. Improvements in Rapid Upper Limb Assessment and Workstyle scores also were realized.

DISCUSSION

This case report demonstrates the importance of examining the work habits and work-related postures of a patient who complains of upper-extremity and neck pain that is exacerbated by work. Providing an ergonomic intervention in concert with traditional physical therapy may be the most beneficial course of treatment.

Prevention of upper limb symptoms and signs of nerve afflictions in computer operators: The effect of intervention by stretching

BACKGROUND

In a previous study of computer operators we have demonstrated the relation of upper limb pain to individual and patterns of neurological findings (reduced function of muscles, sensory deviations from normal and mechanical allodynia of nerve trunks). The identified patterns were in accordance with neural afflictions at three specific locations (brachial plexus at chord level, posterior interosseous and median nerve on elbow level). We have introduced an intervention program aiming to mobilize nerves at these locations and tested its efficacy.

METHODS

125 and 59, respectively, computer operators in two divisions of an engineering consultancy company were invited to answer a questionnaire on upper limb symptoms and to undergo a blinded neurological examination. Participants in one division were subsequently instructed to participate in an upper limb stretching course at least three times during workdays in a six month period. Subjects from the other division served as controls. At the end of the intervention both groups were invited to a second identical evaluation by questionnaire and physical examination. Symptoms and findings were studied in the right upper limb. Perceived changes of pain were recorded and individual and patterns of physical findings assessed for both groups at baseline and at follow-up. In subjects with no or minimal preceding pain we additionally studied the relation of incident pain to the summarized findings for parameters contained in the definition of nerve affliction at the three locations.

RESULTS

Summarized pain was significantly reduced in the intervention group but unchanged in controls. After the intervention, fewer neurological abnormalities in accordance with nerve affliction were recorded for the whole material but no conclusion could be drawn regarding the relation to the intervention of this reduction. Incident pain correlated to findings in accordance with the three locations of nerve affliction.

CONCLUSION

A six month course of stretching seems to reduce upper limb symptoms in computer operators but we could not demonstrate an influence on neurological physical findings in this sample. The relation of incident symptoms to identified neurological patterns provides additional support to the construct validity of the employed neurological examination.