The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Effect of cushioned insoles on impact forces during running. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Impact of soft and hard insole density on postural stability in older adults. Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers – A two-year, randomized trial* A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers Office ergonomics training and a sit-stand workstation: effects on musculoskeletal and visual symptoms and performance of office workers. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report Improving practice in community-based settings: a randomized trial of supervision – study protocol The effects of commercially available footwear on foot pain and disability in people with gout: a pilot study Viscoelastic shoe insoles: their use in aerobic dancing. A prospective study of psychosocial risk factors and absence due to musculoskeletal disorders--implications for occupational screening. Reduction of discomfort during mammography utilizing a radiolucent cushioning pad. From Evidence to Community Practice in Work Rehabilitation: The Quebec Experience Evaluation of sit-stand workstations in an office setting: a randomised controlled trial Balancing the strengths of systematic and narrative reviews. Efficacy and effectiveness of a balance-enhancing insole. Determination of the effectiveness of materials in attenuating high frequency shock during gait using filterbank analysis. Adaptation of running pattern to the drop of standard cushioned shoes: A randomised controlled trial with a 6-month follow-up. How Effective are Lateral Wedge Orthotics in Treating Medial Compartment Osteoarthritis of the Knee? A Systematic Review of the Recent Literature Frequent short rest breaks from computer work: effects on productivity and well-being at two field sites.
STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers BACKGROUND The use of cushioned or shock-absorbing insoles has been suggested as a mechanism to reduce the impact forces associated with running , thereby protecting against overuse injuries . The purpose of this study was to determine whether the use of cushioned insoles reduced impact forces during running in healthy subjects . METHODS Sixteen recreational runners ( 9 females and 7 males ) ran at a self-selected pace for five trials with and without the use of cushioned insoles . During each trial , ground reaction forces , tibial accelerations , lower-extremity kinematics , and subject-perceived comfort were recorded . All variables were tested with the level of statistical significance set at alpha = .05 . RESULTS The use of cushioned insoles result ed in significant reductions in mean vertical ground reaction force peak impact ( 6.8 % ) and ground reaction force loading rate ( 8.3 % ) , as well as peak tibial acceleration ( 15.8 % ) . Spectral analysis of the tibial acceleration data in the frequency range associated with impact accelerations ( 12 - 25 Hz ) revealed no change in the predominant frequency or the power of the predominant frequency . The knee flexion angle at initial contact and perceived comfort were similar for the two conditions . CONCLUSIONS This study demonstrates the effectiveness of one type of cushioned insole in reducing peak impact force and tibial acceleration at initial foot-ground contact during running . The impact reduction observed was independent of knee kinematic adjustments or changes in perceived comfort . Further study is required to determine whether the reduction in loading that accompanied the use of the cushioned insoles can affect the incidence of running-related injuries A prospect i ve controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities .  The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Isl and , South Carolina .  Polymer and st and ard mesh insoles were systematic ally distributed in boots that were issued to members of odd and even numbered platoons . The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training . To control for the confounding effects of running in running shoes , which occurred for about one and one-half hours per week for the first five weeks , we also examined the association of age of shoes and cost of shoes with injury incidence . A slight trend of increasing stress injuries by increasing age of shoes was observed . However , this trend did not account for the similarity of rates in the two insole groups . In addition , we observed a strong trend of decreasing stress injury rate by history of increasing physical activity , as well as a higher stress injury rate in White compared to Black recruits . The results of the trial were not altered after controlling for these factors . This prospect i ve study confirms previous clinical reports of the association of stress fractures with physical activity history . The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits . The findings are relevant to civilian population A significant predictor of falls in the elderly population is attributed to postural instability . Thus , it is important to identify and implement practical clinical interventions to enhance postural stability in older adults .  Shoe insoles have been identified as a mechanism to enhance postural control , and our study aim ed to evaluate the impact of 2 shoe insoles on static st and ing balance in healthy , older adults compared with st and ing posture while barefoot . We hypothesized that both hard and soft shoe insoles would decrease postural sway compared with the barefoot condition . Indeed , excursion distances and sway areas were reduced , and sway velocity was decreased when wearing insoles . The hard insole was also effective when visual feedback was removed , suggesting that the more rigid an insole , the greater potential reduction in fall risk . Thus , shoe insoles may be a cost-effective , clinical intervention that is easy to implement to reduce the risk of falling in the elderly population Background Special insoles and shoes design ed to prevent foot ulcers caused by repetitive high pressures are recommended for patients with diabetes who have any of the following risk factors : neuropathy ; peripheral vascular disease ; foot deformities ; previous ulcers ; amputation ; and skin pathologies . However , there is a need for increased knowledge regarding : a ) differences in the peak pressure ( PP ) and pressure time integral ( PTI ) for different types of insoles ; and b ) the properties of the pressure distribution for insoles used over a period of several months . We present the results of a r and omized trial to compare the plantar pressures of three commonly used insoles . Objectives The primary objective was to compare the PP and PTI between three types of insoles . The secondary objective was to explore the long-term pattern of peak plantar pressure distribution and variations in specific regions of interest ( ROI ) . The tertiary objective was to investigate the impacts of insole adjustments , how much the insoles were used , and the levels of patient satisfaction . Methods In a 2-year trial , 114 patients with type 1 ( N = 31 ) or type 2 ( N = 83 ) diabetes ( 62 men and 52 women ; mean age , 57.7 ± 15.4 years ; duration of diabetes , 12.3 ± 11.2 years ; neuropathy , 38 % ) , were r and omized to be supplied with one of three different insoles . The ethylene vinyl acetate ( EVA ) insoles were used in outdoor walking shoes . The 35 EVA group ( N = 39 ) received soft custom-made insoles composed of EVA of 35 shore A hardness , the 55 EVA group ( N = 37 ) received custom-made insoles composed of EVA of 55 shore hardness , and the control group ( N = 38 ) received prefabricated insoles composed of a hard core with a top layer of soft 12 shore hardness microfiber . Using F-Scan ® , the in-shoe plantar pressures were measured at seven ROI ( hallux , metatarsal head 1 , metatarsal head 2 , metatarsal head 4 , metatarsal head 5 , lateral aspect of the mid-foot , heel ) on five occasions during the study period . The plantar-pressure variables used were PP ( main outcome ) and PTI . The plantar patterns of load were explored , satisfaction and usage of the insoles were rated by the participants , and insole adjustments were recorded . Results A mixed model analysis estimated lower PP values in the heel regions for the 35 EVA and 55 EVA insoles ( 171 ± 13 and 161 ± 13 kPa , respectively ) than for the prefabricated insoles ( 234 ± 10 kPa ) ( p < 0.001 ) . Also for some of the other six ROI indications of difference in PP or PTI could be observed . The redistribution of peak plantar pressure for all of the insoles , was stable at the mid-foot , while the proportion of load on the distal area changed during the study period According to the self-reported answers ( scale , 0–100 ) , the average usage of the insoles was rated as 79 and satisfaction was rated as 85 ( N = 75 ) . Thirty-two percent of the subjects had not received foot care . Fourteen adjustments to insoles were made during the study period , and 86 pairs of insoles were exchanged due to wear , with 49 % being exchanged in the 35 EVA group . Conclusions Custom-made insoles used in combination with stable walking shoes gave lower pressures at the heel region . The variation makes it difficult to detect a systematic difference in plantar pressure for the 6 ROI , if such a difference indeed exists . The levels of satisfaction and usage for all the insoles tested were high . The insoles maintained their pressure redistribution properties over long periods , and few adjustments were needed Objectives : To examine the efficacy of a participatory ergonomics intervention in preventing musculoskeletal disorders among kitchen workers .  Participatory ergonomics is commonly recommended to reduce musculoskeletal disorders , but evidence for its effectiveness is sparse . Methods : A cluster r and omised controlled trial among the 504 workers of 119 kitchens in Finl and was conducted during 2002–2005 . Kitchens were r and omised to an intervention ( n = 59 ) and control ( n = 60 ) group . The duration of the intervention that guided the workers to identify strenuous work tasks and to seek solutions for decreasing physical and mental workload , was 11 to 14 months . In total , 402 ergonomic changes were implemented . The main outcome measures were the occurrence of and trouble caused by musculoskeletal pain in seven anatomical sites , local fatigue after work , and sick leave due to musculoskeletal disorders . Individual level data were collected by a question naire at baseline and every 3 months during the intervention and 1-year follow-up period . All response rates exceeded 92 % . Results : No systematic differences in any outcome variable were found between the intervention and control groups during the intervention or during the 1-year follow-up . Conclusions : The intervention did not reduce perceived physical work load and no evidence was found for the efficacy of the intervention in preventing musculoskeletal disorders among kitchen workers . It may be that a more comprehensive re design of work organisation and processes is needed , taking more account of workers ’ physical and mental re sources Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Objectives To examine whether the introduction of intermittent st and ing bouts during the workday using a height-adjustable workstation can improve subjective levels of fatigue , musculoskeletal discomfort and work productivity relative to seated work . Methods Overweight/obese office workers ( n=23 ; age 48.2±7.9 years , body mass index 29.6±4 kg/m2 ) undertook two , 5-day experimental conditions in an equal , r and omised ( 1:1 ) order . In a simulated office environment , participants performed their usual occupational tasks for 8 h/day in a : seated work posture ( SIT condition ) ; or interchanging between a st and ing and seated work posture every 30 min using an electric , height-adjustable workstation ( ST AND -SIT condition ) . Self-administered question naires measuring fatigue , musculoskeletal discomfort and work productivity were performed on day 5 of each experimental condition . Results Participants ’ total fatigue score was significantly higher during the SIT condition ( mean 67.8 ( 95 % CI 58.8 to 76.7 ) ) compared with the ST AND -SIT condition ( 52.7 ( 43.8 to 61.5 ) ; p<0.001 ) . Lower back musculoskeletal discomfort was significantly reduced during the ST AND -SIT condition compared with the SIT condition ( 31.8 % reduction ; p=0.03 ) . Despite concentration/focus being significantly higher during the SIT condition ( p=0.006 ) , there was a trend towards improved overall work productivity in favour of the ST AND -SIT condition ( p=0.053 ) . Conclusions Transitioning from a seated to a st and ing work posture every 30 min across the workday , relative to seated work , led to a significant reduction in fatigue levels and lower back discomfort in overweight/obese office workers , while maintaining work productivity . Future investigations should be directed at underst and ing whether sustained use of height-adjustable workstations promote concentration and productivity at work . Trial Registration Number ACTRN12611000632998 Work Related Musculoskeletal Disorders ( WMSDs ) among office workers with intensive computer use is widespread and the prevalence of symptoms is growing . This r and omized controlled trial investigated the effects of an office ergonomics training combined with a sit-st and workstation on musculoskeletal and visual discomfort , behaviors and performance .  Participants performed a lab-based customer service job for 8 h per day , over 15 days and were assigned to :  Ergonomics Trained ( n = 11 ) or Minimally Trained ( n = 11 ) . The training consisted of : a 1.5-h interactive instruction , a sit/st and practice period , and ergonomic reminders . Ergonomics Trained participants experienced minimal musculoskeletal and visual discomfort across the 15 days , varied their postures , with significantly higher performance compared to the Minimally Trained group who had a significantly higher number of symptoms , suggesting that training plays a critical role . The ability to mitigate symptoms , change behaviors and enhance performance through training combined with a sit-st and workstation has implication s for preventing discomforts in office workers Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted Background Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy  Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes . Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision or consultation is required . Supervision is notably under-investigated , particularly as provided in public mental health . The degree to which supervision in this setting includes ‘ gold st and ard ’ supervision elements from efficacy trials ( e.g. , session review , model fidelity , outcome monitoring , skill-building ) is unknown . The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practice s and test the impact of systematic implementation of gold st and ard supervision strategies on treatment fidelity and clinical outcomes .  Evidence -based treatments for child mental health problems are not consistently available in public mental health setting s. Exp and ing availability requires workforce training . However , research has demonstrated that training alone is not sufficient for changing provider behavior , suggesting that ongoing intervention-specific supervision Background There is limited evidence on non-pharmacological interventions for gout . The aim of the study was to determine whether a footwear intervention can reduce foot pain and musculoskeletal disability in people with gout . Methods Thirty-six people with gout participated in a prospect i ve intervention study over 8 weeks . Participants selected one of 4 pairs of shoes and thereafter wore the shoes for 8 weeks . The primary outcome was foot pain using a 100 mm visual analogue scale . Secondary outcomes related to function and disability were also analysed . Results The Cardio Zip shoe was selected by 58 % of participants . Compared with baseline , overall scores for all shoes at 8-weeks demonstrated a decrease in foot pain ( p = 0.03 ) , general pain ( p = 0.012 ) , Health Assessment Question naire (HAQ)-II ( p = 0.016 ) and Leeds Foot Impact Scale ( LFIS ) impairment subscale ( p = 0.03 ) . No significant differences were observed in other patient reported outcomes including patient global assessment , LFIS activity subscale , and Lower Limb Task Question naire subscales ( all p > 0.10 ) . We observed significant improvements between baseline measurements using the participants ’ own shoes and the Cardio Zip for foot pain ( p = 0.002 ) , general pain ( p = 0.001 ) , HAQ-II ( p = 0.002 ) and LFIS impairment subscale ( p = 0.004 ) after 8 weeks . The other three shoes did not improve pain or disability . Conclusions Footwear with good cushioning , and motion control may reduce foot pain and disability in people with gout To determine whether use of viscoelastic insoles would significantly decrease the frequency of musculoskeletal overuse injury in aerobic dancers , 139 high-level aerobic dancers were divided r and omly into two groups . The control group received placebo foam insoles and test subjects were fitted with viscoelastic insoles .  Subjects used these insoles during dance class for 15 weeks . Injury rates were low in both groups and no statistical difference was found . Pain syndromes were fewer in the group using viscoelastic insoles , but the difference was not statistically significant . About a third of dancers fitted with viscoelastic insoles and a tenth of placebo insert wearers found that the insoles made their shoes too tight to be comfortable . No conclusion can be drawn on whether shock-absorbing insoles decrease injuries from aerobic dancing , but use of viscoelastic insoles may improve comfort and provide pain relief for some high-level aerobic dancers if proper fit is achieved OBJECTIVES There is considerable evidence documenting the association between psychosocial risk factors and  work disability due to musculoskeletal disorders , and this has prompted suggestions that psychosocial screening should be administered in the workplace in order to identify individuals at risk of prolonged absence . However , the predictive value of psychosocial risk factors on return-to-work is largely unknown . The present study aim ed to explore the predictive relationship between psychosocial risk factors and absence due to musculoskeletal disorders of the lower back and upper limbs . METHODS A prospect i ve study of 4637 workers from a large , multi-site company in the UK was conducted in which a wide range of established question naires were used to collect baseline psychosocial data . Respondents were then followed over the ensuing 15 months , and absence due to musculoskeletal disorders was recorded . RESULTS 219 workers took absence due to musculoskeletal disorders . Detrimental cut-off scores ( risks ) on the psychosocial instruments were established , and it was found that work-related psychosocial risk factors predicted the likelihood of a future spell of absence ( odds ratios ranging between 1.6 and 3.2 ) , but not the duration of that absence . CONCLUSIONS Although work-related psychosocial factors were associated with the occurrence of absence due to musculoskeletal disorders , these findings do not lend support to the use of routine occupational psychosocial screening in order to predict prolonged absence The purpose of this study was to evaluate the use of a radiolucent cushioning pad during routine screening mammography to determine the degree of reduction in discomfort , any correlation of that reduction with various clinical factors , and the pad 's impact on image quality , compression force , and radiation dose . A total of 512 patients presenting for routine screening mammography were evaluated . The radiolucent cushioning pads ( MammoPad , Biolucent Inc. , Aliso Viejo , CA ) were placed on the bucky and compression paddle of the mammographic equipment ( M-IV , Lorad Corp. , Danbury , CT ) . For each patient , the radiolucent pads were used for imaging one breast while the opposite breast , which served as a control , was imaged without the pads . In all patients , the breast was positioned and compressed in st and ard fashion , using routine craniocaudal ( CC ) and mediolateral oblique ( MLO ) views . Patients completed a question naire before and after the mammogram . A visual analog scale ( VAS ) was used to record anticipated discomfort as well as the discomfort experienced during compression with and without the pads . Age , hormone replacement status , prior experience with mammography , compression force , and breast composition were recorded , as were dose parameters ( mAs and kVp ) , from which midgl and ular dose values were calculated . On the side where the pads were used to cushion the breast , 73.5 % ( 371/505 ) of women experienced a significant decrease in discomfort . Of those who benefited , there was a 47 % decrease in discomfort . On the pad side , compression force was increased an average of 14 % , and there was a 4 % decrease in dose for the CC view and no increase in dose for the MLO view . When comparing benefit versus nonbenefit groups , a significant reduction in discomfort did not correlate with any of the clinical factors evaluated , with the exception of experienced discomfort reported after the mammogram . Use of the MammoPad radiolucent cushion on the bucky and compression paddle was an effective means of reducing discomfort during compression for a majority ( 73.5 % ) of our patients undergoing screening mammography . Image quality and the ability to detect all pertinent anatomy were maintained Background The causes of prolonged disability due to back pain are multiply determined , involving medical , social , and environmental factors . Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence -based programs to large community setting s. Objective This article describes three phases of the process of transfer of evidence from rehabilitation research to community practice in the province of Quebec . Methods and Results Phase A : Based on literature review and expert knowledge , the Sherbrooke model was developed and assessed through a population -based , r and omized clinical trial . Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life ; the 6-year follow-up showed the cost-effectiveness of the method .Phase B : Based on the Sherbrooke model experience and recent evidence , a new program addressing the disability paradigm was developed and implemented in the province of Quebec ( Canada ) . Results at 1- and 3-year follow-ups showed that only 24 % of workers were not working owing to their musculoskeletal disorder . The program is presently being tested through a population -based , r and omized clinical trial in a population of construction workers . Phase C : To implement the program at a provincial level , a network for management , research and education in work rehabilitation was developed . An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various setting Background Excessive sitting time is a risk factor for cardiovascular disease mortality and morbidity independent of physical activity . This aim of this study was to evaluate the impact of a sit-st and workstation on sitting time , and vascular , metabolic and musculoskeletal outcomes in office workers , and to investigate workstation acceptability and feasibility . Methods A two-arm , parallel-group , individually r and omised controlled trial was conducted in one organisation . Participants were asymptomatic full-time office workers aged ≥18 years . Each participant in the intervention arm had a sit-st and workstation installed on their workplace desk for 8 weeks . Participants in the control arm received no intervention . The primary outcome was workplace sitting time , assessed at 0 , 4 and 8 weeks by an ecological momentary assessment diary . Secondary behavioural , cardiometabolic and musculoskeletal outcomes were assessed . Acceptability and feasibility were assessed via question naire and interview . ANCOVA and magnitude-based inferences examined intervention effects relative to controls at 4 and 8 weeks . Participants and research ers were not blind to group allocation . Results Forty-seven participants were r and omised ( intervention n = 26 ; control n = 21 ) . Relative to the control group at 8 weeks , the intervention group had a beneficial decrease in sitting time ( −80.2 min/8-h workday ( 95 % CI = −129.0 , −31.4 ) ; p = 0.002 ) , increase in st and ing time ( 72.9 min/8-h workday ( 21.2 , 124.6 ) ; p = 0.007 ) and decrease in total cholesterol ( −0.40 mmol/L ( −0.79 , −0.003 ) ; p = 0.049 ) . No harmful changes in musculoskeletal discomfort/pain were observed relative to controls , and beneficial changes in flow-mediated dilation and diastolic blood pressure were observed . Most participants self-reported that the workstation was easy to use and their work-related productivity did not decrease when using the device . Factors that negatively influenced workstation use were workstation design , the social environment , work tasks and habits . ConclusionS hort-term use of a feasible sit-st and workstation reduced daily sitting time and led to beneficial improvements in cardiometabolic risk parameters in asymptomatic office workers . These findings imply that if the observed use of the sit-st and workstations continued over a longer duration , sit-st and workstations may have important ramifications for the prevention and reduction of cardiometabolic risk in a large proportion of the working population .Trial registration Clinical Trials.gov NCT02496507 The m and ate of Human Reproduction Up date involves several roles : ( i ) to provide a synthesis of evidence that can aid scientists and clinicians in their daily work ; ( ii ) to help reproductive specialists underst and concepts from related disciplines ; and ( iii ) to summarize current knowledge generated by basic science as the foundation of future scientific and clinical advancement . Given that review and synthesis are central to good scientific and clinical practice , and that a grasp of the current state of knowledge is a prerequisite to design ing new studies , it is pertinent to ask which review s are most likely to fulfil the needs of readers . A related question concerns whether systematic review s meet the needs of all review topics and all readers . Summarizing evidence or knowledge is a difficult problem in reproductive medicine , as in other branches of science and medical care ( Eddy et al. , 1992 ) . For each question there may be multiple studies that use different design s and inclusion criteria . For clinical questions , the interventions , outcomes and measures of effect may vary : the effect measures in treatment studies include odds ratios , relative risks and absolute differences . For scientific questions , the experimental species , models and design s may differ . Moreover , it is always uncertain whether all of the relevant evidence has been evaluated . Even when the search has been exhaustive , there are no simple guides on how to interpret conflicting results and whether to accept apparently outlying studies . The choices that the review er makes to address the variable conditions and uncertainties may be conservative , strict and exclusive , or liberal , open and inclusive . The decisions made by the review er may not be consistent throughout and these choices may or may not satisfy the reader who seeks out the review to address a clinical or research question . Faced with uncertainty and doubt , readers nonetheless must form an impression of the evidence and synthesize the state of knowledge in order to address the clinical or research question that stimulated their interest in the review . We argue that the reader is better served when the choices made in the review , regardless of whether they are strict or open , should be explicit , transparent , clearly stated and reproducible by interested readers . This list of objectives for review s is more easily satisfied by systematic review s , which use explicit methods to method ically search , critically appraise and synthesize the available literature on a specific issue . The question or issue need not be clinical : indeed , the concept evolved primarily in psychology studies ( Light and Pillemer , 1984 ) . The systematic review attempts to reduce review er bias through the use of objective , reproducible criteria to select relevant individual publications and assess their validity . A systematic review may include a meta- analysis or statistical summary of the individual study results : the aggregate of effects from several studies yields an average treatment effect that is more precise than the individual study results ( Schlesselman and Collins , 2003 ) . Thus , the systematic review involves explicit , transparent methods which are clearly stated , and reproducible by others . Whether a systematic review of r and omized controlled trials adheres to the guidelines can easily be evaluated by means of a widely used checklist ( the QUORUM statement ) ( Moher et al. , 1999 ) . The strengths of the systematic review include the narrow focus of the question , the comprehensive search for evidence , the criterion-based selection of relevant evidence , the rigorous appraisal of validity , the objective or quantitative summary , and the evidence -based inferences ( Cook et al. , 1997 ) . For some review topics , however , the strengths of the systematic review may turn into weaknesses . The primary problem is that the narrow focus and prescribed methods of the systematic review do not allow for comprehensive coverage . For example , the historical review is an irreplaceable means of tracing the development of a scientific principle or clinical concept , but the narrative thread could be lost in the strict rules of systematic review . As other examples , it would be burdensome to apply systematic methods to a survey on  aneuploidy and fertility in the aging female or to an assessment of mouse knockout models and polycystic ovarian phenotype . Such topics would require the wider scope of a traditional narrative review , in Human Reproduction Up date , Vol.11 , No.2 pp . 103–104 , 2005 doi:10.1093/humupd/dmh058 Advance Access publication December 23 , BACKGROUND Age-related loss of foot-sole cutaneous sensation is very common and is associated with impaired balance control . This study investigated the effect of a balance-enhancing insole ( design ed to facilitate foot-sole sensation ) on lateral gait stability and evaluated its effectiveness in daily life . METHODS Forty community-dwelling older adults ( age 65 - 75 ) with moderate loss of foot-sole sensation ( unrelated to neuropathy ) were fitted with the same model of walking shoes . Half of the participants were assigned , at r and om , to wear the shoes with a facilitatory insole for 12 weeks ; the other participants wore a conventional insole . A gait perturbation protocol , simulating uneven terrain , was performed at baseline and after wearing the assigned insoles for 12 weeks . Participants were tested with both types of insoles during each gait-testing session and sent in weekly postcards with information pertaining to insole comfort , hours of wear , and falls . RESULTS The facilitatory insole improved lateral stability during gait , and this benefit did not habituate after 12 weeks of wearing the insole in daily life . Nine participants who wore conventional insoles experienced one or more falls , whereas only five of the facilitatory group fell . Although there were initial reports of mild discomfort in 10 cases , all but one participant tolerated the facilitatory insole , and most indicated that they would like to continue wearing the insole on a long-term basis . CONCLUSIONS A relatively simple change in insole design can help to counter effects of age-related ( non-neuropathic ) decline in foot-sole sensitivity , and is a viable intervention to enhance balance control OBJECTIVE To develop an accurate method for quantifying the frequency content of the ground reaction force transient . DESIGN Repeated measures design comparing the impact severity during walking with different  insole material s. BACKGROUND The body experiences a brief but sizeable impact upon heel strike during walking . This impact transient is believed to result in musculoskeletal injuries . It is important to accurately quantify this impact as a step towards decreasing the risk of injury . METHODS Seven subjects walked barefoot at their normal cadence across a force platform , while insole material s ( Spenco , Microcel-puff , and Plastazote ) were placed on the surface of the force platform . A filterbank program was developed to determine the percent root mean square in 10 Hz frequency b and s from zero to 400 Hz . Analysis focused on the impact transient contained in a 20 ms window after heel contact . RESULTS The high frequency ( > 60 Hz ) power was significantly larger in the barefoot condition compared to the insole conditions . The barefoot condition also result ed in significantly higher initial peak forces and force loading rates . CONCLUSIONS The frequency content of the ground reaction force can be effectively quantified using a filterbank approach . Shoe insole material s can reduce the initial peak force , force loading rate , and frequency content of the impact transient in walking . The frequency content of the initial ground reaction force extends up to 400 Hz in some footwear conditions . RELEVANCE The new filterbank procedure illustrates that the vertical ground reaction force in walking has a higher frequency content than previously thought . This signal requires high sampling rates to avoid aliasing , and appropriate signal processing algorithms , such as filter banks , for analysis OBJECTIVES While several cross-sectional studies have investigated the acute effects of shoe drop on running biomechanics , the long-term consequences are currently unknown . This study aim ed to investigate if the drop of st and ard cushioned shoes induces specific adaptations in running technique over a six-month period in leisure-time runners . DESIGN Double-blinded r and omised controlled trial . METHODS The participants ( n=59 ) received a pair of shoes with a heel-to-toe drop of 10 mm ( D10 ) , 6 mm ( D6 ) or 0 mm ( D0 ) and were followed-up regarding running training over 6 months or 500 km , whichever came first . Spatio-temporal variables and kinematics ( foot/ground , ankle and knee joint angles ) were investigated while running at preferred speed on a treadmill before and after the follow-up . RESULTS The participants ran 332±178 km in the study shoes between pre- and post-tests . There was no shoe version by time interaction for any of the spatio-temporal variables nor for lower limb angles at initial ground contact . A small but significant shoe drop effect was found for knee abduction at mid-stance ( p=0.032 ) , as it decreased for the D0 version ( -0.3±3.1 vs. -1.3±2.6 ° ) while it increased for the D6 ( 0.3±2.7 vs. 1.3±3.1 ° ) and D10 version ( -0.2±3.2 vs. 0.5±3.1 ° ) . However , none of the pairwise comparisons was significant in the post-hoc analysis . CONCLUSIONS Apart from knee abduction at mid-stance , no specific adaptation in spatio-temporal variables and kinematics was found between the three shoe versions during this 6-month follow-up . Thus , shoe drop of st and ard cushioned shoes does not seem to influence running biomechanics in the long term Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee but recent review s suggest that lateral wedges do not affect disease progression . We performed a systematic review to analyse the recent literature and define how effective , if at all , lateral wedges are in the management of medial compartment osteoarthritis of the knee . The inclusion criteria were defined as any study published within the last decade , using a sample size of at least twenty patients , and investigating the effect of insoles or wedges on either unilateral or bilateral knee varus osteoarthritis . The st and ardised keyword term ‘ lateral*wedge*OR insole*OR orthotic * OR medial compartment OR varus OR osteoarthri * OR knee * ’ was used . We identified 10 studies that fitted our inclusion criteria . Although there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee  , there is some evidence to suggest that they do have some symptomatic effect .  Patients with early osteoarthritis and higher BMI may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI . The literature is unclear as to what the optimal duration for the use of lateral wedges is , but does support the prolonged use of the wedges as the benefits at one month are maintained at one year . Future studies should be r and omised controlled trials with a large sample size with long follow-up , and use objective clinical , biomechanical and radiological outcome measures Computer operators at two work sites ( n = 73 , n = 19 ) were prompted to take three 30-s and one 3-min break from computer work each hour in addition to conventional rest breaks . Some operators were asked to perform stretching exercises during the short breaks . Mood state and musculoskeletal discomfort were assessed at each work site over a 2- or 3-week baseline period and a 4- or 6-week treatment period , respectively . Operator productivity measures were obtained from company records . Operators complied with about half of the added breaks but favoured 3-min breaks over 30-s breaks . No improvement in productivity or well-being was found at the larger work site . At the smaller work site , productivity , eye , leg and foot comfort all improved when the short breaks included stretching exercises . These results provide evidence that frequent short breaks from continuous computer-mediated work can benefit worker productivity and well-being when the breaks integrate with task dem and
A moderate level of evidence was found in support of using cushioned material s in reducing discomfort/fatigue among st and ing workers .
A limited level of evidence exists in favour of using insoles over anti-fatigue mats .
This systematic review up date s the current state of evidence on the effectiveness of softer flooring and cushioned shoe insoles on reducing  musculoskeletal discomfort amongst workers who are required to st and for prolonged periods to work and the impact of factors such as age and gender on the outcomes .