Documents neck disorders 34 results

"Objective The aim of this randomized controlled trial (RCT) was to investigate the effectiveness of the Stay@Work participatory ergonomics (PE) program to prevent low-back and neck pain. Methods A total of 37 departments were randomly allocated to either the intervention (PE) or control group (no PE). During a six-hour meeting, working groups followed the PE steps and composed and prioritized ergonomic measures aimed at preventing low-back and neck pain. Subsequently, working groups were requested to implement the ergonomic measures in the departments. The primary outcomes were low-back and neck pain prevalence and secondary outcomes were pain intensity and duration. Data were collected by questionnaires at baseline, and after 3-, 6-, 9-, and 12-months follow-up. Additionally, the course of low-back and neck pain (transitions from no symptoms to symptoms and from symptoms to no symptoms) was modeled. Results The randomization procedure resulted in 19 intervention departments (N=1472 workers) and 18 control departments (N=1575 workers). After 12 months, the intervention was not more effective than the control group in reducing the prevalence of low-back and neck pain or reducing pain intensity and duration. PE did not increase the probability of preventing low-back pain [odds ratio (OR) 1.23, 95% confidence interval (95% CI) 0.97–1.57) or neck pain (OR 1.01, 95% CI 0.74–1.40). However, PE increased the probability of recovering from low-back pain (OR 1.41, 95% CI 1.01–1.96), but not from neck pain (OR 0.95, 95% CI 0.72–1.26).Conclusion PE neither reduced low-back and neck pain prevalence nor pain intensity and duration nor was it effective in the prevention of low-back and neck pain or the recovery from neck pain. However, PE was more effective in the recovery from low-back pain."

"Objective: Numerous studies has shown that regular physical exercise can reduce musculoskeletal pain, but the optimal setting to achieve high adherence and effectiveness remains unknown. This study investigated the effect of workplace versus home-based physical exercise on musculoskeletal pain among healthcare workers.Methods: The randomized controlled trial (RCT) comprised 200 female healthcare workers from 18 departments at 3 hospitals. Participants were randomly allocated at the cluster level to ten weeks of: (i) workplace physical exercise (WORK) performed during working hours for 5×10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed during leisure time for 5×10 minutes per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. Average pain intensity (0–10 scale) in the low back and neck/shoulder was the primary outcome.Results: Per week, 2.2 (SD 1.1) and 1.0 (SD 1.2) training sessions were performed in WORK and HOME groups, respectively. Pain intensity, back muscle strength and use of analgesics improved more following WORK than HOME (P<0.05). Between-group differences at follow-up (WORK versus HOME) was -0.7 points for pain intensity [95% confidence interval (95% CI) -1.0– -0.3], 5.5 Nm for back muscle strength (95% CI 2.0–9.0), and -0.4 days per week for use of analgesics (95% CI -0.7– -0.2). The effect size for between-group differences in pain intensity was small (Cohen's d=0.31).Conclusions: Workplace physical exercise is more effective than home-based exercise in reducing musculoskeletal pain, increasing muscle strength and reducing the use of analgesics among healthcare workers."

The systematic review by Konijnenberg et al (1) in this issue of the Scandinavian Journal of Work Environment & Health deals with conservative treatment methods for the great problem of neck and upper-limb disorders in working populations. Fifteen randomized controlled trials (RCT) or controlled clinical trials (CCT) fulfilled the inclusion criteria of the review. Five of these scored 6/12 or higher according to their internal validity criteria and were considered high-quality studies. In the presence of a wide range of treatments, no treatment modality could be evaluated on the basis of a remarkable number of high-quality studies. There was, however, limited evidence in favor of physiotherapy, exercises, and ergonomic improvements. Repetitive strain injury (RSI) is a loose concept used in this review broadly to encompass a range of disorders from the neck and thoracic spinal area to the fingertip. In principle, outcomes in treatment or intervention studies should be based on symptoms or findings or both independently of the etiologic factors of the disease, and we should avoid concepts that include the assumed etiologic factor. To me, "neck and upper-limb disorders in working populations" would have seemed to be a more appropriate concept, especially since the work-relatedness of the conditions is difficult to assess; in fact it was not even addressed in some of the studies reviewed. Moreover, the requirement of work-relatedness resulted in the exclusion of some potentially high-quality studies (2) that did not have "work-relatedness" as an inclusion criterion, but still probably dealt with a largely similar group of disorders. For instance, in the study of Taimela et al (2), one inclusion criterion was the possession of a permanent job. But if we accept the concept of repetitive strain injury and assume that repetitive movements are one of the major causes of this strain, would not then modification of exposure (or engineering control) be a natural component in a treatment aimed to enhance recovery and prevent recurrence? Many of us would probably say yes, but a look at the tables in the review shows that only very few studies had workplace adjustment as a treatment or as one constituent in the treatment protocol. Another conspicuous feature of this review and also of some other related recent reviews (for an example, see reference 3) is that ergonomic intervention has usually been carried out in the office environment. While there is no doubt that office workers do have work-related musculoskeletal problems, such problems are even more frequent in the construction, transportation, and manufacturing industries and in some branches of the service sector, for example, hospital, kitchen, and cleaning work (4). Hopefully, the target workplaces for future workplace intervention studies will be determined by the size and seriousness of the problems and not only by the feasibility of carrying out an intervention study, such as stationary work in an office environment versus a changing work environment at a construction site, or the marketing of new input devices or computers. The magnitude or the duration of the treatment effects did not deserve much attention in this review, which is understandable since high-quality studies were few in number. However, a look at the high-quality studies shows that a modest reduction in pain was typical, and this effect was no longer present in the later phases of follow-up. Cost-effectiveness aspects were not considered in any of the studies included in this review. The relatively meager results in most studies do not suggest that the treatments were cost-effective in general. Many risk factors contribute to the occurrence of neck and upper-limb disorders among working populations (5, 6, 7). In a multifactorial condition, it is unlikely that a single measure would result in significant relief, something that is suggested by the meager results in several studies accepted for review. With regard to the etiology of most neck and upper-limb disorders, multidisciplinary approaches should have a higher potential. Unfortunately, multidisciplinary rehabilitation had been tried in only one controlled clinical trial, which received a very low score. The authors are correct in being worried about the use of multiple outcomes in intervention studies, the result being a high likelihood that a positive result is obtained by one of the outcomes by chance. Researchers should be more critical in the design of their studies. They should select only the most relevant outcome measures and restrict the outcomes only to them. Most studies relied solely on subjective outcome parameters, since few generally accepted objective methods exist. This is a major scientific problem, especially since blinding subjects for treatment is hardly possible. A major question of treatment policy in relation to neck and upper-limb disorders among working populations is whether the focus should be on treating the individual or his or her environment, especially in the control of workload. Trying to get an answer from workplace intervention studies, especially randomized controlled trials, involves an inherent potential of bias. As it is much easier to randomize individuals into different physical therapies, exercise or other treatment modalities, than it is to randomize workstations to be changed or not, there will always be more randomized controlled trials with treatments directed toward the individual. Therefore, there are greater chances of obtaining positive results from such treatments at the cost of engineering controls. Moreover, the current instability at workplaces, with high turnover rates and frequent reorganizations, makes it increasingly difficult to carry out workplace intervention studies successfully. It is easy to share the authors' worry about the absence of high-quality studies as evidence for the effect of most currently used treatment modalities. As the authors say, there is a higher possibility of bias, for example, an erroneous positive result of a treatment, in a low-quality study than in one of high-quality. This issue was systematically addressed in a review on acupuncture trials involving chronic neck and back pain (8), in which the authors were able to show that the most valid trials tended to have negative results. Konijnenberg and his collaborators' review shows convincingly that the scientific basis for current treatment practices with respect to neck and upper-limb disorders in working populations is limited and based largely on low-quality studies. More high-quality studies are definitely needed. Moreover, research priorities should not be restricted to groups of workers and treatment modalities that are easy to study. Instead, studies should be undertaken on treatment modalities that carry a potential to be efficacious. Worker groups with the highest risk of neck and upper-limb disorders should be the focus. Such studies are often laborious and should therefore be supported by sufficient funding. It is possible that new knowledge from such studies may change our understanding of the efficacy of some treatments and, therefore, create pressure to change current treatment practices. What should the practitioner do now while we are still waiting for the results of such studies? The Panel on Musculoskeletal Disorders established by the National Research Council and the Institute of Medicine concluded in their review that the epidemiologic evidence for upper-extremity disorders supports the important role of physical load factors (7). Based on this evidence, primary and secondary intervention at the workplace, including engineering and administrative controls, was recommended. As there are still few prospective studies on incident neck and upper-limb disorders, it is difficult, on the basis of epidemiologic studies, to estimate the relative potential of these measures in primary versus secondary prevention.

Objectives This study determined the prevalence of neck pain and its relation to occupation and occupational activities in the general population.Methods A questionnaire was mailed to 21 201 subjects aged 16-64 years, randomly selected from the patient registers of general practices in England, Scotland, and Wales, and to 993 subjects randomly selected from pay records of the armed services. Information was collected on occupation, workplace physical activities, neck pain in the past week and year, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, the resultant odds ratios being converted to prevalence ratios (PR).Results Among 12 907 respondents, 4348 and 2528 reported neck pain in past year (1421 with pain interfering with normal activities) and week, respectively. Symptoms were the most prevalent among male construction workers [past week and year 24% and 38% (pain interfering with activities 11%), respectively], followed by nurses, armed services members, and the unemployed. Generally the age-standardized prevalence of neck pain varied little by occupation. Work with arms above the shoulders for >1 hours/day was associated with a significant excess of symptoms [PR 1.3-1.7 (women) and 1.2-1.4 (men)], but no associations existed for typing, lifting, vibratory tool use, or professional driving. Stronger neck-pain associations were found with frequent headaches (PR 2.3-2.8) and frequent tiredness or stress (PR 2.2-2.5) than with occupational activities.Conclusions The data provide evidence against a strong association between neck pain and the examined occupational physical activities. They suggest that psychosocial factors may be more important.

"OBJECTIVES:
The objective of this study was to determine whether there are gender differences in the effect of exposure to work-related physical and psychosocial risk factors on low back, neck, shoulder, or hand-arm symptoms and related sickness absence.
METHODS:
Data of a prospective cohort (study on musculoskeletal disorders, absenteeism stress and health) with a follow-up period of three years were used. Questionnaires were used to assess exposure to risk factors and musculoskeletal symptoms. Sickness absence was registered continuously. Female-to-male gender ratios (GR) were calculated to determine whether there were any differences in the effect. A GR value >1.33 or <0.75 was regarded as relevant.
RESULTS:
Except for the effect of bending the wrist and the neck backwards (GR 1.52-2.55), men generally had a higher risk of symptoms (GR range 0.50-0.68) with equal exposure. For sickness absence, a GR value of >1.33 was found for twisting the upper body, working in uncomfortable postures, twisting the wrist, bending the neck backwards, and coworker and supervisor support (GR range 1.66-2.63). For driving vehicles, hand-arm vibration, squeezing, working above shoulder level or below knee level, reaching, twisting the neck, job demands, and skill discretion, the GR value was <0.75. For job satisfaction, a GR value of 0.50 was found for absence due to back symptoms, while the GR value was 1.78 for sickness absence due to neck, shoulder, or hand-arm symptoms.
CONCLUSIONS:
Although women are expected to be more vulnerable to exposure to work-related risk factors, the results of this study show that, in many cases, men are more vulnerable. This study could not explain the gender difference in musculoskeletal symptoms among workers."

"The aim of this prospective study was to detect a possible development of trapezius myalgia likely to be work-related in initially healthy female packers. Symptoms were recorded on a five-step intensity scale in a daily diary and in an interview at ten-week intervals. All of the subjects were interviewed concerning assumed risk factors during work and leisure time, and a clinical examination was performed. Within their first year of employment, 17 of 30 subjects developed work-related trapezius myalgia of sufficient intensity to be classified as patients. The median time before a clinically confirmed patient status was 23 (range 6-51) weeks. The symptoms showed a fluctuating pattern, decreasing on the weekends and during some holidays. In conclusion, likely work-related trapezius myalgia of a nonchronic character showed a high one-year cumulative incidence at a plant with repetitive light work."

"OBJECTIVES: Prolonged sitting at work has been found to increase risk for musculoskeletal pain. The office-based intervention "Take a Stand!" was effective in reducing sitting time at work. We aimed to study the effect of the intervention on a secondary outcome: musculoskeletal pain.
METHODS:Take a Stand! included 19 offices (317 workers) at four workplaces cluster randomized to intervention or control. The multicomponent intervention lasted three months and included management support, environmental changes, and local adaptation. Control participants behaved as usual. Musculoskeletal pain was measured by self-report questionnaire assessing pain in neck-shoulders, back and extremities in three categories at baseline, and one and three months follow-up.
RESULTS: At one month, there was no difference in odds ratio (OR) for pain in neck-shoulders between the two groups. However, after three months, the OR was 0.52 [95% confidence interval (95% CI) 0.30–0.92] for pain in neck-shoulders in the intervention compared to the control group. No differences were found between the intervention and control group for pain in back and extremities over the three months. For total pain score a slight reduction was found in the intervention compared to the control group at one and three months [-0.13 (95% CI -0.23– -0.03) and -0.17 (95% CI -0.32– -0.01)].
CONCLUSIONS: The secondary analyses showed that the office-based intervention Take a Stand! reduced neck-shoulder pain after three months and total pain score after one and three months among office workers, but not neck-shoulder pain after one month or pain in the back and extremities.

"Objectives
Bi-directional associations between perceived effort‒reward imbalance (ERI) at work and neck-shoulder pain have been reported. There is also evidence of associations between ERI and depressive symptoms, and between depressive symptoms and pain while the links between ERI, depressive symptoms and pain have not been tested. We aimed to assess whether depressive symptoms mediate the association between ERI and neck-shoulder pain, as well as the association between neck-shoulder pain and ERI.
Methods
We used prospective data from three consecutive surveys of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. ERI was assessed with a short version of the ERI questionnaire, and pain was defined as having had neck-shoulder pain that affected daily life during the past three months. Depressive symptoms were assessed with a continuous scale based on six-items of the (Hopkins) Symptom Checklist. Counterfactual mediation analyses were applied using exposure measures from 2010/2012 (T1), depressive symptoms from 2012/2014 (T2), and outcomes from 2014/2016 (T3), and including only those free of outcome at T1 and T2 (N=2876‒3239).
Results
ERI was associated with a higher risk of neck-shoulder pain [risk ratio (RR) for total effect 1.22, 95% confidence interval (CI) 1.00–1.48] and 41% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.34 (95% CI 1.09–1.64), but the mediating role of depressive symptoms was less consistent.
Conclusions
Depressive symptoms appear to be an intermediate factor in the relationship between ERI and neck-shoulder pain."

"Objectives:
Sustained activity of the upper trapezius muscle during work has been linked to the development of neck pain. Women have higher occurrences of neck pain than men, even in the same occupations. This study aimed to investigate sex-specific associations between upper trapezius muscle activity time-related variables and neck pain using a meta-analysis of pooled data.
Methods:
Seven Scandinavian research institutes provided surface electromyographic (EMG) data on the upper trapezius muscle activity during work and related questionnaire-based data on neck pain severity. EMG and questionnaire data were harmonized and pooled. Associations between upper trapezius muscle activity variables [median muscle activity, frequency of muscular rest periods, and periods with sustained muscle activity (SUMA)] and neck pain severity were investigated separately for women (N=293) and men (N=418) using linear regression analyses.
Results:
In the cross-sectional analyses, women showed significant positive associations between the number of short SUMA periods and negative associations for long SUMA periods in regard to neck pain severity. In the longitudinal analyses, women showed no significant associations. In the cross-sectional analysis for men, one significant positive association was found between median upper trapezius muscle activity and neck pain severity.
Conclusions:
Compared to men, neck pain severity among women appears to be more dependent on upper trapezius muscle activity patterns at work. Therefore, ergonomic and organizational recommendations for work should be sex-specific or adjusted for women to reduce their prevalence of neck pain. Further research is needed to elucidate the underlying mechanisms of these sex differences."