The effects of neck–shoulder pain development on sensory–motor interactions among female workers in the poultry and fish industries. A prospective study Predictive risk factors for chronic regional and multisite musculoskeletal pain: A 5-year prospective study in a working population Differential effects of mental load on proximal and distal arm muscle activity Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. An occupational pain study Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers Test-retest reliability of a WRULD functional capacity evaluation in healthy adults. Sickness absence in patients with arm, neck and shoulder complaints presenting in physical therapy practice: 6 months follow-up. The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders 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. The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals Cost-effectiveness of postural exercise therapy versus physiotherapy in computer screen-workers with early non-specific work-related upper limb disorders (WRULD); a randomized controlled trial No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial. Effect of two contrasting interventions on upper limb chronic pain and disability: a randomized controlled trial. Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial Prognostic indicators for non-recovery of non-traumatic complaints at arm, neck and shoulder in general practice--6 months follow-up. Impact of rest-break interventions on the neck and shoulder posture of symptomatic VDU operators during prolonged computer work Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting Work Related Risk Factors for Neck, Shoulder and Arms Complaints: A Cohort Study Among Dutch Computer Office Workers Musculoskeletal disorders and occupational exposures: How should we judge the evidence concerning the causal association? The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers Social and psychological factors influenced the course of arm, neck and shoulder complaints.
Abstract Objectives . The purpose of this prospect i ve laboratory study was to follow newly employed workers in the fish or poultry industry for 6 months and investigate possible changes in sensory manifestations and motor performance during low load , repetitive work simulation . It was investigated whether the changes were an effect of employment duration and of development of neck – shoulder complaints . Methods . Twelve newly employed female filleting employees without any sign of neck – shoulder tenderness/pain at the time of employment of 0 months took part in two laboratory recording sessions planned within 1 month of employment and after 6 months of employment at the plant . After 6 months , six workers out of 12 had developed pain and /or tenderness in the neck – shoulder region . The recording sessions evaluated sensory-motor aspects by measuring pressure pain threshold , work-task timing , cutting forces , surface electromyographic activity of four shoulder muscles , displacement of the centre of pressure , and 3D movements of the arm and trunk during simulation of low load , repetitive filleting . Results . Effects due to the duration of employment were observed in both groups , i.e. decreased sensibility to pressure , decrease in the duration of the work cycle , increased arm starting position with respect to the upright position , and decreased range of motion of the arm and trunk ( P<0.05 ) after 6 months . Among the workers with neck – shoulder complaints , increased sensibility to pressure , lower force level , higher electromyographic activity , decreased amplitude of arm movement , and increased trunk posture and movement amplitude ( P<0.05 ) were observed , compared with workers without complaints . Conclusions . Differences in terms of sensory manifestations and motor control strategy were seen after 6 months of employment with or without neck – shoulder complaints . In general , changes in sensory manifestations and motor control strategy after 6 months work were most likely of importance , as they underlined a learning process as employment duration increased . Moreover , the present sensory – motor changes observed among workers with neck – shoulder complaints highlighted the potential physical risk factors associated with low load , repetitive work Summary Physical and psychological work‐related factors pertaining to the 5‐year incidence of multiple body sites musculoskeletal pain ( MSP ) may be gender specific . In particular , psychological factors seem to be predictive of onset of MSP , but only in women . Only the physical work factor ( ie , forceful effort constraints ) was an important robust predictor of multisite MSP , but only in men . ABSTRACT The role of psychosocial and physical factors in the development of musculoskeletal pain ( MSP ) has now been clearly demonstrated . However , it is unclear whether these factors contribute to specific regional MSP or to multisite pain . The main goal of this study was to assess the impact of work‐related factors  according to gender on the development of regional and multisite MSP . A total of 12,591 subjects ( 65 % men and 35 % women ) who were born in 1938 , 1943 , 1948 , and 1953 and were participating in a French longitudinal prospect i ve epidemiological survey ( ESTEV ) in 1990 to 1995 were eligible . Personal factors and work exposure were assessed by self‐administered question naires . Statistical associations between chronic MSP ( regional body site or multisite ) , personal factors , and occupational factors were analyzed using logistic regression modeling . The incidence of regional MSP and multisite pain in 1995 were , respectively , 17 % and 25.6 % . For women , highly repetitive movements predicted neck/shoulder pain ; posture and vibrations predicted arm and low back pain ; and effort with tools predicted arm pain . For men , forceful effort and vibrations predicted neck/shoulder pain ; posture and forceful effort predicted lower limb and low back pain ; and forceful effort and effort with tools predicted arm pain . Physical constraints ( ie , forceful effort or vibrations ) were associated with multisite pain in both genders . Only for women , psychological factors were risk factors predictive of upper limb pain and in 3 or 4 painful anatomical sites . These results support the hypothesis that some physical and psychological work‐related factors are predictive of regional or multisite MSP but differ according to gender . Gender differences and risk factors for work‐related musculoskeletal pain should be also taken into account to more effectively target preventive measures Work-related upper extremity disorders ( WRUEDs ) that result from keyboarding  tasks are prevalent and costly . Although the precise mechanisms causing the disorder are not yet fully understood , several risk factors have been proposed . These include the repetitive nature of the motor task and the associated sustained static working postures , but also more psychological factors such as mental load . Epidemiological surveys have shown that WRUEDs are more prone to develop in the postural muscles of the neck/shoulder area than in the executive muscles controlling the h and . The present study investigated whether the activation patterns of these two muscle types are differentially affected by an additional mental load during the performance of a repetitive tapping task .  Participants tapped various keying patterns with their dominant index finger at two prescribed tempi . Mental load was manipulated by means of an auditory short-term memory task . We recorded the  EMG activity of two neck/shoulder muscles ( trapezius and deltoid ) , two upper arm muscles ( biceps and triceps ) , and four forearm muscles ( flexor digitorum superficialis , extensor digitorum , extensor carpi radialis longus and extensor carpi ulnaris ) and analyzed the kinematics and impact forces of the index finger . The results confirmed that the upper limb has two functions . Specifically , activity of the executive distal musculature was increased during tapping at the higher pace , while the activity of the postural upper limb musculature was elevated due to the memory task . We argue that continuously increased muscular activity can lead to fatigue and thus eventually cause musculoskeletal complaints . The results are discussed with respect to biomechanical adaptation strategies that deal with the consequences of increased noise in the neuromotor system due to enhanced mental processing Abstract Little is known about the mechanisms leading to chronic neck-shoulder musculoskeletal disorders  ( MSD ) . The aim of the present study was to investigate and compare motor function during controlled , low load , repetitive work together with chronic or acute experimental neck-shoulder pain . The clinical study was performed on workers with ( n = 12 ) and without ( n = 6 ) chronic neck-shoulder pain . In the experimental study , experimental muscle pain was induced in healthy subjects by intra-muscular injection of hypertonic saline into the trapezius muscle ( n = 10 ) . The assessed parameters related to motor performance were : work task event duration , cutting forces , surface electromyogram ( EMG ) activity in four shoulder muscles , displacement of the centre of pressure , and arm and trunk 3D movements . For controlled cutting force levels , chronic and acute experimental pain provoked a series of changes : a decreased working rhythm and a protective reorganisation of muscle synergy ( experimental study ) , higher EMG frequency contents which may indicate altered motor unit recruitment , and greater postural activity and a tendency towards increased arm and trunk movements . These pain-related changes can play a role in the development of MSD . The present clinical and experimental study demonstrated similar interactions between motor co-ordination and neck-shoulder pain in occupational setting s. We therefore suggest that this experimental model can be used to study mechanisms related to MSD . Information on such modulatory processes may help in the design of new strategies aim ed at reducing the development of MSD Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Abstract This study assessed the effectiveness of a single intervention targeting work style and a combined intervention targeting work style and physical activity on the recovery from neck and upper limb symptoms . Computer workers with frequent or long‐term neck and upper limb symptoms were r and omised into the work style group ( WS , n = 152 ) , work style and physical activity group ( WSPA , n = 156 ) , or usual care group ( n = 158 ) . The WS and WSPA group attended six group meetings . All meetings focused on behavioural change with regard to body posture , workplace adjustment , breaks and coping with high work dem and s ( WS and WSPA group ) and physical activity ( WSPA group ) . Pain , disability at work , days with symptoms and months without symptoms were measured at baseline and after 6 ( T1 ) and 12 months ( T2 ) . Self‐reported recovery was assessed at T1/T2 . Both interventions were ineffective in improving recovery . The work style intervention but not the combined intervention was effective in reducing all pain measures . These effects were present in the neck/shoulder , not in the arm/wrist/h and . For the neck/shoulder , the work style intervention group also showed an increased recovery‐rate . Total physical activity increased in all study groups but no differences between groups were observed . To conclude , a group‐based work style intervention focused on behavioural change was effective in improving recovery from neck/shoulder symptoms and reducing pain on the long‐term . The combined intervention was ineffective in increasing total physical activity . Therefore we can not draw conclusions on the effect of increasing physical activity on the recovery from neck and upper limb symptoms The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders ( WRULD FCE ) . The study sample included 33 healthy adults , consisting of 14 males and 19 females with a mean age of 29.2 years . The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements , duration , working in awkward positions , forceful movements and static postures . Two FCE sessions were held with a 10-day interval . Means , 95 % confidence intervals , one-way r and om Intraclass Correlation Coefficients ( ICCs ) , 95 % limits of agreement and repeated measures were calculated . An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability . The results showed that 14 of 26 items ( 54 % ) had excellent reliability , 9 of 26 items ( 35 % ) had good reliability and 3 of 26 items ( 11 % ) had moderate reliability based on ICC values . Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test . It is concluded that the WRULD FCE is reliable in healthy adults OBJECTIVE To describe  sickness absence in patients with arm , neck and /or shoulder complaints and to evaluate determinants of sickness absence during 6 months follow-up . METHODS A prospect i ve cohort study in physical therapy practice with follow-up measurements at 3 and 6 months . The main outcome measure was the occurrence of sickness absence due to arm , neck and shoulder complaints during 6 months follow-up . Determinants were tested in univariate and multivariate GEE ( Generalized Estimating Equations ) analysis . RESULTS At baseline 161 patients ( 33 % ) reported absence from work . The multivariate analysis showed that self-reported work-relatedness of complaints , previous musculoskeletal trauma , higher severity of complaints at baseline , more somatization and low decision authority at work were associated with sickness absence during the follow-up period . CONCLUSION In physical therapy practice , social and psychological factors ( at work ) influence the occurrence of sickness absence in patients with arm , neck and /or shoulder complaints . These factors can be taken into account when developing and evaluating interventions to reduce sickness absence among these patients There is evidence that performing job tasks involving repetition , vibration , sustained posture or forceful movement may contribute to symptoms of work related upper extremity disorders . Typing is one such activity ; symptoms that develop as a result of this activity can affect performance of work , self-care and leisure occupations . Studies investigating the impact of ergonomic keyboards on symptom reduction are limited , and little research exists regarding the reduction of key activation force as an intervention . Methods : This r and omized , prospect i ve study used a sample of 68 symptomatic workers employed by a single company . One group received a commercially available ergonomic keyboard , a second group used a modified version of the same keyboard design ed to reduce activation force , vibration and key travel . We measured symptoms and clinical signs , functional status , and device satisfaction in both groups over a six-month study period . Results : Between-groups analyses indicated that the groups performed similarly on the outcomes of interest . Repeated-measure analysis identified a reduction of symptoms , an improvement in functional status , preference for and increased satisfaction with the intervention keyboards , and maintenance of typing speed and accuracy for both groups . Conclusions 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 Objectives To assess the influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users . Methods The study is a prospect i ve cohort study with an observation period of 10 months . A baseline question naire about symptoms in the neck , shoulder and arm/h and during previous month , individual factors , work content , physical and psychosocial work-related exposures was answered by 1,283 computer operators ( response rate 84 % ) . Incidence data were collected by ten monthly question naires regarding the occurrence of symptoms categorized into three gross body regions : neck , shoulders and arms/h and s. A case , in the specific gross body region , was defined as a subject who was classified as non-symptomatic in that region at baseline or during minimum one follow-up period and later reported symptoms ( ≥3 days ) . Univariable and multivariable incidence rate ratios with 95 % confidence intervals for first occurrence of neck , shoulder and arm/h and cases , respectively , were calculated with Cox regression analysis . Results The incidence rate was 67 , 41 and 47 cases per 100 person years for neck , shoulder and arm/h and symptoms , respectively . In the multivariable analyses , comfort of the computer work environment and gender were related to the incidence of symptoms in all body regions ( RR = 1.5–1.9 for low comfort and 1.8–2.1 for females , respectively ) . Duration of mouse use predicted arm/h and symptoms ( RR = 1.7 for ≥3 h/day ) and job strain ( high dem and s and low decision latitude ) predicted neck symptoms ( RR = 1.6 and 2.2 for medium and high strain , respectively ) . Additionally , age was related to neck and shoulder symptoms . Conclusion Preventive strategies to reduce neck and upper limb symptoms among computer users should include measures to reduce mouse use  , to increase the comfort of the work environment and to reduce job strain . Although the effect estimates were relatively weak to moderate , preventive measures may have a marked impact on the incidence of neck and upper limb symptoms in the general population because of the widespread use of computers in working life as well as at home Background and Purpose The purpose of this study was to evaluate the efficacy of a preventive ergonomic intervention , which was provided by physical therapists , on spinal and upper-extremity work-related posture and symptom complaints of workers who use video display terminals ( VDT ) . Subjects Two hundred employees who spent at least 20 hours per week at a VDT were r and omly divided into 2 groups . Group E received the ergonomic intervention and an informative brochure , and group I received only the brochure . Methods Both groups were evaluated at the beginning of the study and at a follow-up 5 months later . The following tools were used : a pain drawing and the Rapid Entire Body Assessment ( REBA ) method to assess spinal and upper-extremity work-related posture . Results Group E had a lower REBA score and reduced lower back , neck , and shoulder symptoms compared with group I. Discussion and Conclusion The results suggest that a personalized preventive ergonomic intervention can improve spinal and upper-extremity work-related posture and musculoskeletal symptoms for workers who use VDTs Background Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders ( WRULD ) . Aims To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints , both from health care and societal perspective . Methods Prospect i ve r and omized trial including cost-effectiveness analysis ; one year follow-up . Participants : Eighty-eight screen-workers with early non-specific WRULD ; six drop-outs . Interventions : A ten week postural exercise program versus regular physiotherapy .  Outcome measures : Effectiveness measures : Pain : visual analogous scale ( VAS ) , self-perceived WRULD ( yes/no ) . Functional outcome : Disabilities of Arm , Shoulder and H and - Dutch Language Version ( DASH-DLV ) . Quality of life outcome : EQ-5D.Economic measures : health care costs including patient and family costs and productivity costs result ing in societal costs . Cost-effectiveness measures : health care costs and societal costs related to the effectiveness measures . Outcome measures were assessed at baseline ; three , six and twelve months after baseline . Results At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs . No significant differences between the groups concerning effectiveness at one year follow-up were found . Effectiveness scores slightly improved over time . After one year 55 % of participants were free of complaints . After one year the postural exercise group had higher mean total health care costs , but lower productivity costs compared to the physiotherapy group . Mean societal costs after one year ( therefore ) were in favor of postural exercise therapy [ - € 622 ; 95 % CI -2087 ; + 590 ) ] . After one year , only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy ; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs  , postural exercise therapy had a probability of over 80 % to be cost-effective over a wide range of cost-effectiveness ceiling ratios ; however based on a marginal QALY-difference of 0.1 over a 12 month time frame . Conclusion Although our trial failed to find significant differences in VAS , QALYs and ICERs based on VAS and QALYs at one-year follow-up , CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy ; however further research is required . Trial registration IS RCT N QUESTION Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain , reducing disability and improving health-related quality of life in visual display unit workers with early non-specific work-related upper limb disorders than strength and fitness exercises delivered by physiotherapists ? DESIGN R and omised trial with concealed allocation and intention-to-treat analysis . PARTICIPANTS Eighty-eight ( 6 drop-outs ) visual display unit workers with early non-specific work-related upper limb disorders . INTERVENTION One group received 10 weeks of postural exercises while the other group received 10 weeks of strength and fitness exercises . OUTCOME MEASURES Pain was measured with a 10-cm visual analogue scale , disability was measured with the Disabilities of Arm , Shoulder and H and question naire , and health-related quality of life was measured with the Short Form-36 . Number of participants experiencing upper limb complaints was also collected . Outcome measures were collected at baseline and again at 3 , 6 , and 12 months . RESULTS There was no significant difference in decrease in pain between the groups at 3 months ( 0.6 cm , 95 % CI 0.0 to 1.2 ) , 6 months ( 0.2 , 95 % CI -0.3 to 0.7 ) , or at 12 months ( 0.1 , 95 % CI -0.6 to 0.8 ) . Differences between the groups in upper limb complaints , disability , and health related quality of life were also small and not significant at any measurement occasion . CONCLUSION Postural exercises did not result in a better outcome than strength and fitness exercises . However , 55 % of visual display unit workers with early non-specific work-related upper limb disorders reported being free of complaints one year after both interventions were commenced . TRIAL REGISTRATION IS RCT N15872455 BACKGROUND Chronic pain and disability of the arm , shoulder , and h and severely affect labor market participation . Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain . An alternative strategy could be to increase physical capacity of the worker by physical conditioning . OBJECTIVES To investigate the effect of 2 contrasting interventions , conventional ergonomic training ( usual care ) versus resistance training , on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual work . STUDY DESIGN Examiner-blinded , parallel-group r and omized controlled trial with allocation concealment . SETTING Slaughterhouses located in Denmark , Europe . METHODS Sixty-six adults with chronic pain in the shoulder , elbow/forearm , or h and /wrist and work disability were r and omly allocated to 10 weeks of specific resistance training for the shoulder , arm , and h and muscles for 3 x 10 minutes per week , or ergonomic training and education ( usual care control group ) .  Pain intensity ( average of shoulder , arm , and h and , scale 0 - 10 ) was the primary outcome , and disability ( Work module of DASH question naire ) as well as isometric shoulder and wrist muscle strength were secondary outcomes . RESULTS Pain intensity , disability , and muscle strength improved more following resistance training than usual care ( P < 0.001 , P = 0.05 , P < 0.0001 , respectively [ corrected ] ) . Pain intensity decreased by 1.5 points ( 95 % confidence interval -2.0 to -0.9 ) following resistance training compared with usual care , corresponding to an effect size of 0.91 ( Cohen 's d ) . LIMITATIONS Blinding of participants is not possible in behavioral interventions . However , at baseline outcome expectations of the 2 interventions were similar . CONCLUSION Resistance training at the workplace results in clinical relevant improvements in pain , disability , and muscle strength in adults with upper limb chronic pain exposed to highly repetitive and forceful manual work . TRIAL REGISTRATION NCT01671267 Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use . Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists . The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments . Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area . Our study investigates the effect of the latter approach . Methods / Design A r and omized controlled trial of 10 weeks duration is currently being conducted . Employed office workers with severe neck-shoulder pain are r and omized to  3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active . Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius . An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work . The first 100 positive replies entered the study . Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0 - 9 scale . Exclusion criteria were cardiovascular disease , trauma , hypertension , or serious chronic disease . Before and after the intervention period the participants replied to a question naire about musculoskeletal disorders and work disability , and underwent a st and ardized clinical examination of the neck and shoulder girdle . Further , on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week . The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination . Secondary outcomes are strength and work disability . Trial Registration Clinical Trials ( NCT ) : OBJECTIVES To identify predictors of non-recovery in non-traumatic complaints at the arm , neck and shoulder in general practice 6 months after the first consultation . METHODS A prospect i ve cohort study was set in 21 Dutch general practice s. Consulters with a first or new episode of non-traumatic arm , neck or shoulder complaints and age 18 through 64 yrs entered the cohort . Complaint , patient , physical , psychosocial and work characteristics were investigated as possible predictors of non-recovery at 6 months using multiple logistic regression analyses ( backward Wald ) . RESULTS At 6 months , 46 % of the total population ( n = 612 ) and 42 % of the working sub population ( n = 473 ) still reported complaints . Complaint characteristics ( long duration of the complaint before consultation , recurrent complaint , musculoskeletal comorbidity and complaint mainly located at wrist or h and ) were most predictive of non-recovery followed by psychosocial characteristics ( more somatization and experiencing less social support ) . Having a specific diagnosis was associated with recovery . In the working sub population , the same variables were predictors of non-recovery . Additionally , low supervisory support was associated with non-recovery . The models correctly classified 72 - 75 % of the patients ( explained variance 0.27 - 0.28 ) . CONCLUSIONS Besides questions on complaint characteristics , information on somatization and support can help a general practitioner to recognize patients at risk of persistent complaints There is limited research on the effects of different types of rest-break interventions for visual display unit ( VDU ) operators on neck and shoulder postures . This study examined the effect of rest-break interventions on the neck and shoulder postures of symptomatic VDU operators during prolonged computer work . Thirty subjects were r and omly and equally assigned to breaks with stretching , breaks with dynamic movement and passive breaks . Subjects performed the typing task for 60 min and received 3-min breaks after 20 min of work . The craniovertebral and forward shoulder angles were obtained from a 3D motion analysis system . Results showed that there were no significant differences in the craniovertebral and forward shoulder angles among any types of rest breaks . It can be concluded that the three types of rest-break interventions had positive effects on neck and shoulder posture during prolonged computer terminal work Background Arm , shoulder and neck symptoms are very prevalent among computer workers . In an attempt to reduce these symptoms , a large occupational health service in the Netherl and s developed a preventive programme on exposure to risk factors , prevalence of arm , shoulder and neck symptoms , and sick leave in computer workers . The purpose of this study was to assess the effectiveness of this intervention programme . Methods The study was a r and omised controlled trial . The participants were assigned to either the intervention group or the usual care group by means of cluster r and omisation . At baseline and after 12 months of follow-up , the participants completed the RSI QuickScan question naire on exposure to the risk factors and on the prevalence of arm , shoulder and neck symptoms . A tailor-made intervention programme was proposed to participants with a high risk profile at baseline . Examples of implemented interventions are an individual workstation check , a visit to the occupational health physician and an education programme on the prevention of arm , shoulder and neck symptoms . The primary outcome measure was the prevalence of arm , shoulder and neck symptoms . Secondary outcome measures were the scores on risk factors for arm , shoulder and neck symptoms and the number of days of sick leave . Sick leave data was obtained from the companies . Multilevel analyses were used to test the effectiveness . Results Of the 1,673 persons invited to participate in the study , 1,183 persons ( 71 % ) completed the baseline question naire and 741 persons participated at baseline as well as at 12-month follow-up . At 12-month follow-up , the intervention group showed a significant positive change ( OR = 0.48 ) in receiving information on healthy computer use , as well as a significant positive change regarding risk indicators for work posture and movement , compared to the usual care group . There were no significant differences in changes in the prevalence of arm , shoulder and neck symptoms or sick leave between the intervention and usual care group . Conclusions The effects of the RSI QuickScan intervention programme were small , possibly as a result of difficulties with the implementation process of the proposed interventions . However , some significant positive effects were found as to an increase in receiving education and a decrease in exposure to adverse postures and movements . With regard to symptoms and sick leave , only small and non-significant effects were found . Trial registration Netherl and s National Trial Register Introduction This study aims to investigate the relationship between work-related physical and psychosocial characteristics and complaints of the neck , shoulder and forearm/h and s. Methods Data were used from a prospect i ve Dutch cohort study among computer office workers with a follow-up period of 2 years . The study was conducted among 264 computer users . Physical and psychosocial risk factors were tested to predict the occurrence of neck , shoulder and forearm/h and s complaints . Bivariate and multivariable logistic regression was used to identify the association between risk factors and outcome variables . Results The 2 year follow-up prevalence rates with 95 % CI for neck complaints were 0.31 ( 0.28–0.37 ) , for shoulder complaints 0.33 ( 0.27–0.39 ) and for forearm/h and s complaints 0.21 ( 0.14–0.28 ) . Four main predictors for the occurrence of neck and shoulder complaints were identified : ( 1 ) Irregular head and body posture [ OR : 1.1 ( 1.0–1.2 ) P = 0.04 ] ; ( 2 ) task difficulty ( job dem and s ) [ OR : 1.2 ( 1.0–1.5 ) P = 0.01 ] ; ( 3 ) number of working hours/day with the computer [ OR : 1.20 ( 1.0–1.4 ) P = 0.03 ] ; and ( 4 ) having had a previous history of complaints [ OR : 7.2 ( 3.8–13.2 ) P = 0.01 ] . Two predictors were identified for forearm/h and s complaints : time pressure ( job dem and s ) [ OR : 1.20 ( 1.0–1.4 ) P = 0.03 ] and having had a previous history of complaints [ OR : 7.1 ( 3.5–14.1 ) P = 0.06 ] . Conclusion This longitudinal study suggests that risk factors of upper musculoskeletal complaints in computer workers consist of a mixture of physical and psychosocial characteristics Musculoskeletal disorders ( MSDs ) affecting the back , upper and lower extremities are widespread in the general population , implying a variety of causal factors . Multiple causes are not mutually exclusive , and a high background rate does not preclude associations with specific factors that are uncommon in the general population . MSDs have well-documented associations with occupational ergonomic stressors such as repetitive motion , heavy lifting , non-neutral postures , and vibration . Organizational features of the work environment , such as time pressure and low decision latitude , may also play a role , at least by potentiating the effects of physical loading . Numerous systematic review s have mostly concurred with these overall findings . Nevertheless , some continue to debate whether MSDs are sometimes work-related , even for those performing jobs with repetitive and routinized tasks , heavy lifting , and /or pronounced postural strain . This article discusses ( 1 ) some epidemiologic features of MSDs that underlie that debate ; and ( 2 ) the question of what should appropriately be considered a gold st and ard for scientific evidence on an etiological question such as the health effects of a non-voluntary exposure , such as an occupational or environmental agent . In particular , r and omized clinical trials have little relevance for determining the health effects of non-therapeutic risk factors Background Neck and upper limb symptoms are frequently reported by computer workers .  Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms . A combined approach targeting work style and lifestyle physical activity seems promising , but little is known on the effectiveness of such combined interventions . Methods / design The RSI@Work study is a r and omised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers . Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and /or the last two weeks are r and omised into three groups : ( 1 ) work style group , ( 2 ) work style and physical activity group , or ( 3 ) control group . The work style intervention consists of six group meetings in a six month period that take place at the workplace , during work time , and under the supervision of a specially trained counsellor . The goal of this intervention is to stimulate workplace adjustment and to improve body posture , the number and quality of breaks and coping behaviour with regard to high work dem and s. In the combined ( work style and physical activity ) intervention the additional goal is to increase moderate to heavy physical activity . The control group receives usual care . Primary outcome measures are degree of recovery , pain intensity , disability , number of days with neck and upper limb symptoms , and number of months without neck and upper limb symptoms . Outcome measures will be assessed at baseline and six and 12 months after r and omisation . Cost-effectiveness of the group meetings will be assessed using an employer 's perspective . Discussion This study will be one of the first to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention in reducing neck and upper limb symptoms of computer workers . The results of the study are expected in 2007 OBJECTIVE To investigate the clinical course and prognostic factors of complaints of arm , neck , and shoulder . STUDY DESIGN AND SETTING A prospect i ve cohort study in physical therapy practice . Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and /or upper extremities . Participants filled in question naires at baseline , 3 months , and 6 months . The main outcome measure was the persistence of complaints over 6-month follow-up . Possible predictors like social and psychological factors , physical factors , and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements . RESULTS Of the 624 participants at baseline 543 ( 87 % ) returned at least one follow-up question naire . At 6-month follow-up , 40 % had persisting pain and discomfort . Somatization , kinesiophobia , catastrophizing , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population . In those with paid work ( 77 % ) , catastrophizing , low decision authority at work , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months . CONCLUSION 40 % of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course
None of the ergonomic interventions was more beneficial for any outcome measures when compared with another treatment or with no treatment or with placebo .
Behavioural interventions had inconsistent effects on pain and disability , with some subgroups showing benefit and others showing no significant improvement when compared with no treatment , minor intervention controls or other behavioural interventions .In the eight studies that evaluated various other interventions , there was no evidence of a clear beneficial effect of any of the interventions provided .
We found very low- quality evidence indicating that pain , recovery , disability and sick leave are similar after exercises when compared with no treatment , with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm , neck or shoulder .
Low- quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up .
There was no evidence of an effect on other outcomes .
For behavioural and other interventions , there was no evidence of a consistent effect on any of the outcomes .
BACKGROUND Work-related upper limb disorder ( WRULD ) , repetitive strain injury ( RSI ) , occupational overuse syndrome ( OOS ) and work-related complaints of the arm , neck or shoulder ( CANS ) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements , awkward postures and impact of external forces such as those associated with operating vibrating tools .
Work-related CANS , which is the term we use in this review , severely hampers the working population .
OBJECTIVES To assess the effects of conservative interventions for work-related complaints of the arm , neck or shoulder ( CANS ) in adults on pain , function and work-related outcomes .