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 A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders: A Randomized Controlled Trial 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 Effectiveness of Workplace-Based Muscle Resistance Training Exercise Program in Preventing Musculoskeletal Dysfunction of the Upper Limbs in Manufacturing Workers Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Workplace upper limb disorders: a prospective study with intervention. Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol 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 Proximal myofascial dysfunction in complex regional pain syndrome: a retrospective prevalence study. Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: a randomised controlled trial. Effect of two contrasting interventions on upper limb chronic pain and disability: a randomized controlled trial. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. 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. The effect of workplace intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders. Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial. 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. Integrated Case Management for Work-Related Upper-Extremity Disorders: Impact of Patient Satisfaction on Health and Work Status A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? Reliability of the Southampton examination schedule for the diagnosis of upper limb disorders in the general population Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome? Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial
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 Objective : The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain . Methods : Sixty female subjects were r and omly assigned to an intervention group or a control group . The IG was administered of a 6-month , twice-a-week , tailored exercise program , whereas the CG received no intervention . Results : The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures . In addition , reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength . Conclusions : This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders , showing clinical ly meaningful reductions of pain symptoms and disability on upper limb and neck regions 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 Aims Given the high levels of absenteeism due to musculoskeletal disorders of the upper limbs , there is a need for preventive strategies to protect workers exposed to high risk levels . The purpose of this study was to determine the effect of a workplace-based muscle resistance training exercise program in the presence of pain and musculoskeletal dysfunction of the upper extremities in manufacturing workers exposed to repetitive movements and excessive effort in the workplace . Method R and omized controlled trial in manufacturing workers . A sample of 120 healthy workers was allocated at r and om to an experimental group , which received a resistance-based exercise program , and a control group , which performed stretching exercises . Results The muscle resistance training exercise had a protective effect on the intensity of pain perceived by workers in their upper limbs ( RR : 0.62 95 % CI 0.44–0.87 ) compared with the group of workers who performed stretching exercises . Conclusion A workplace-based muscle resistance training exercise program is an effective preventive strategy in factory workers exposed to risk ; however , it is necessary for companies initially to adopt mechanisms to minimize exposure as a prevention strategy [ Purpose ] The purpose of this study was to suggest evidence d information about action observation to improve upper limb function after stroke . [ Methods ] A systematic review of r and omized controlled trials involving adults aged 18 years or over and including descriptions of action observation for improving upper limb function  was undertaken . Electronic data bases were search ed , including MEDLINE , CINAHL , and PEDro ( the Physiotherapy Evidence Data base ) , for articles published between 2000 to 2014 . Following completion of the search es , two review ers independently assessed the trials and extracted data using a data extraction form . The same two review ers independently documented the method ological quality of the trials by using the PEDro scale . [ Results ] Five r and omized controlled trials were ultimately included in this review , and four of them ( 80 % ) reported statistically significant effects for motor recovery of upper limb using action observation intervention in between groups . [ Conclusion ] This review of the literature presents evidence attesting to the benefits conferred on stroke patints result ing from participation in an action observation intervention . The body of literature in this field is growing steadily . Further work needs to be done to evaluate the evidence for different conditions after stroke and different duration of intervention The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey . A question naire was mailed to 21,201 subjects aged 16 - 64 years , selected at r and om from the registers of 34 British general practice s. Information was collected on occupation and on regular use of keyboards ( for > 4 h in an average working day ) , pain in the upper limbs and neck , numbness or tingling in the upper limbs , headaches , and feelings of tiredness or stress . Associations were explored by logistic regression , with the result ant odds ratios converted into prevalence ratios ( PRs ) . Among 12,262 respondents , 4899 held non-manual occupations . These included 1871 regular users of keyboards ( e.g. computer operators , data processors , clerks , administrators , secretaries and typists ) .  Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall ( with 1 week period prevalences of 30 and 15 % , respectively ) , and were associated with older age , smoking , headaches and tiredness or stress . After adjustment for these factors , regular keyboard use was significantly associated with pain in the past week in the shoulders ( PRs 1.2 - 1.4 ) and the wrists or h and s ( PR 1.4 ) , but not with elbow pain or sensory symptoms over the same period , or with neck or upper limb pain that prevented normal activities in the past year . Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers . We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or h and , but risk estimates were lower than generally reported in workplace surveys . Previous estimates of risk in the occupational setting may have been biased by shared expectations , concerns , or other aspects of illness behaviour OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care A prospect i ve longitudinal study was carried out to investigate the occurrence of upper limb disorders in an electromechanical plant between 1980 and 1988 . It included clinical and epidemiological studies , measurement of  vibration produced by the power tools used , ergonomic assessment of the works and time and motion studies . Simultaneously during the same period remedial actions were taken through multidisciplinary interventions when the specific causal factors were known . The study shows the clinical entities of the disorder , identifies the risk factors and evaluates the results of the interventions . It assists in establishing a cause and effect relationship for the condition and demonstrates the way a preventive strategy could be developed 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 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 OBJECTIVE To assess the prevalence of clinical ly evident myofascial dysfunction ( MD ) and its relationship to motor neglect ( MN ) in Complex Regional Pain Syndrome ( CRPS ) . DESIGN Retrospective chart review . PATIENTS Forty-one consecutively evaluated CRPS patients . OUTCOME MEASURES ( a ) Prevalence of trigger points in the proximal musculature of the CRPS limb . ( b ) Prevalence of MN in a subset ( n = 34 ) . RESULTS MD was detected in 61 % of CRPS patients . It was more prevalent in the upper limb ( 70 % ) than in the lower limb ( 47 % ) . MN was more common in those who also had MD . CONCLUSION MD is common in CRPS patients , especially in the upper limb and in those patients with MN . Prospect i ve trials are needed to confirm these intriguing findings , which may have important implication s regarding CRPS pathophysiology and treatment BACKGROUND AND OBJECTIVES Upper extremity musculoskeletal disorders ( MSD ) are very common in regular computer users and leading cause of work related illness . The objective of the present study is to evaluate effectiveness of yogic exercises in the improvement of symptoms of MSDs of upper limbs . MATERIAL S AND METHODS 60 study participants were r and omly divided into two groups that is yoga with counselling and only counselling group for 12 weeks . Symptom severity and functional status were assessed using the self administered Boston Carpal Tunnel Question naire and pre design ed symptom question naire before and after intervention . RESULTS There was significant reduction in symptom severity score ( P = 0.002 ) and improvement in functional status score in yoga with counselling group when compared to only counselling group . There is also a significant decrease in self reported symptoms like CT myalgia symptom ( P = 0.019 ) and improvement in weakness . CONCLUSION The present study showed a yoga based regimen is more effective than counselling alone in relieving symptoms of computer related musculoskeletal disorders 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 OBJECTIVE Since 2002 , an epidemiologic surveillance system of work-related , upper-limb musculoskeletal disorders ( MSDs ) has been implemented in France 's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population . METHODS The surveillance was based on a network of occupational physicians ( OPs ) and used the recommendations of a group of European experts ( criteria document consensus ) . In 2002 - 2003 , 80 of 400 OPs volunteered to participate . All underwent a training program to st and ardize the physical examination .  Health status was assessed by self-administered question naire and physical examination . Occupational risk factors were assessed by self-administered question naire .  Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document . RESULTS More than 50 % of the 2,685 men and women r and omly included in 2002 - 2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and approximately 30 % experienced them in the preceeding week . The prevalence of clinical ly diagnosed MSDs was high : approximately 13 % of workers experienced at least 1 of the MSDs . The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis . The prevalence of MSDs increased with age and varied widely across economic sectors and occupations . More than half of the workers were exposed to at least 2 risk factors of MSDs . Exposure varied according to industrial activity and occupation . According to the criteria document , a high percentage of MSD cases could be classified as probably work related ( 95 % in men and 89 % in women age < 50 , and 87 % in men and 69 % in women age > 50 ) . CONCLUSION Nonspecific upper-limb symptoms and specific upper-limb MSDs are common in the working population . These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs 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 OBJECTIVES The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders . METHODS In this r and omized controlled study , subjects aged 18 - 60 years ( N=177 ) seeking medical advice due to upper-extremity symptoms were included if their symptoms , or the exacerbation of symptoms , had started < 30 days prior to the medical consultation and immediate sick leave was not required .  Workplace ergonomic improvements were made in the intervention group . Data on symptoms and sickness absences were gathered during one-year follow-up . RESULTS Pain intensity , pain interference with work , leisure time , or sleep did not differ between the intervention and control group during the one-year follow-up . During the first three months of follow-up , the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention ( N=89 ) and control ( N=84 ) group , but the total number of sickness absence days in the intervention group was about half of that in the control group ( mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined ) . During 4 - 12 months of follow-up , the percentage of employees with sickness absence due to upper-extremity disorder ( 10.1 % versus 16.7 % , P=0.20 ) or upper-extremity and other musculoskeletal disorders combined ( 20.2 % versus 32.1 % , P=0.07 ) was lower in the intervention than the control group . CONCLUSIONS Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders OBJECTIVE Imbalance between work dem and s and individual re sources can lead to musculoskeletal disorders and reduced work ability . The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability . METHODS Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were r and omly allocated to 10 weeks of either strength training for the shoulder , arm , and h and muscles ( 3 times per week , 10 minutes per session ) or ergonomic training ( usual care control group ) from September to December 2012 . The outcome measure was the change from baseline to 10-week follow-up in the work ability index ( WAI ) . RESULTS A priori hypothesis testing showed a group × time interaction for WAI ( P<0.05 ) . Compared with the ergonomic training group , WAI increased 2.3 [ 95 % confidence interval ( 95 % CI ) 0.9 - 3.7 ] in the strength training group corresponding to a moderate effect size ( Cohen 's d 0.52 ) . Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group . Of the 7 items of WAI , item 2 ( work ability in relation to the dem and s of the job ) and item 7 ( mental re sources ) increased following strength training compared with ergonomic training ( P<0.05 ) . CONCLUSIONS Implementation of strength training at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks . Thus , strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se 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 Compare the effects of integrated case management and usual care on patient satisfaction in employees with work-related upper extremity disorder ( WRUED ) , and consider the implication s of higher levels of satisfaction . Describe those patient-related and work-related factors that predict the severity of upper limb symptoms and the degree of functional limitation 6 and 12 months after intervention . Enumerate the factors influencing the interval before return to work in employees with WRUED who are managed by traditional or integrated case management . An integrated case management ( ICM ) approach ( ergonomic and problem-solving intervention ) to work-related upper-extremity disorders was examined in relation to patient satisfaction , future symptom severity , function , and return to work ( RTW ) .  Federal workers with work-related upper-extremity disorder workers ’ compensation cl aims ( n = 205 ) were r and omly assigned to usual care or ICM intervention .  Patient satisfaction was assessed after the 4-month intervention period . Question naires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention . Time from intervention to RTW was obtained from an administrative data base . ICM group assignment was significantly associated with greater patient satisfaction . Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW . At 12 months , predictors of positive outcomes included male gender , lower distress , lower levels of reported ergonomic exposure , and receipt of ICM . Findings highlight the utility of targeting workplace ergonomic and problem solving skills Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome . However , what is unclear are the parameters underpinning this intervention . This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice . The aim of this review was to evaluate the parameters of exercise programs reported in primary research , to provide clinicians with evidence -based recommendations for exercise prescription for patellofemoral pain . Methods A systematic review of r and omized controlled trials was undertaken . Only trials that identified exercise to be effective in treating patellofemoral pain were included . Appropriate data bases and reference lists were search ed using established keywords . Data relating to common exercise parameters such as the type of exercise , length , and frequency of intervention , intensity , repetitions , sets , and specific technique were extracted , along with details of co- interventions that may have been used . Results A total of ten r and omized controlled trials were included in this review and from these trials 14 interventions arms were evaluated . All 14 interventions focused on active exercises , all but two of which also included a passive stretching component . The current body of evidence demonstrates positive results with exercise interventions such as  knee extension , squats , stationary cycling , static quadriceps , active straight leg raise , leg press , and step-up and down exercises  for patients with patellofemoral pain syndrome . A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more , combined with exercises to address flexibility of the lower limb musculature was commonly used . Conclusion Currently , the primary research on this topic supports the use of closed kinetic chain , strengthening exercises for musculature of the lower limb , combined with flexibility options . The current evidence base supports a prescription of daily exercises of two – four sets of ten or more repetitions over a period of 6 weeks or more Background : Epidemiological research in the field of soft tissue neck and upper limb disorders has been hampered by the lack of an agreed system of diagnostic classification . In 1997 , a United Kingdom workshop agreed consensus definitions for nine of these conditions . From these criteria , an examination schedule was developed and vali date d in a hospital setting . Objective : To investigate the reliability of this schedule in the general population . Methods : Ninety seven adults of working age reporting recent neck or upper limb symptoms were invited to attend for clinical examination consisting of inspection and palpation of the upper limbs , measurement of active and passive ranges of motion , and clinical provocation tests . A doctor and a trained research nurse examined each patient separately , in r and om order and blinded to each other 's findings . Results : Between observer repeatability of the schedule was generally good , with a median κ coefficient of 0.66 ( range 0.21 to 0.93 ) for each of the specific diagnoses considered . Conclusion : As expected , the repeatability of tests is poorer in the general population than in the hospital clinic , but the Southampton examination schedule is sufficiently reproducible for epidemiological research in the general population Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias Background Loss of upper limb function affects up to 85 % of acute stroke patients . Recovery of upper limb function requires regular intensive practise of specific upper limb tasks . To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice . Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities . A wrist-worn device has been developed that monitors and provides ‘ live ’ upper limb activity feedback to remind patients to use their stroke arm in daily activities ( The CueS wristb and ) . The aim of this trial is to assess the feasibility of a multi-centre , observer blind , pilot r and omised controlled trial of the CueS wristb and in clinical stroke services . Methods / design This pilot r and omised controlled feasibility trial aims to recruit 60 participants over 15 months from North East Engl and . Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy . Each participant will be r and omised to an intervention or control group . Intervention participants will wear a CueS wristb and ( between 8 am and 8 pm ) providing “ live ” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme ( review ed twice weekly by an occupational/physiotherapist ) . Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘ sham ’ CueS wristb and that monitors upper limb activity but provides no feedback . Outcomes will determine study feasibility in terms of recruitment , retention , adverse events , adherence and collection of descriptive clinical and accelerometer motor performance data at baseline , 4 weeks and 8 weeks . Discussion The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke . The study will establish whether the study protocol can be supported by clinical stroke services , thereby informing the design of a future multi-centre r and omised controlled trial of clinical and cost-effectiveness . Trial registration IS RCT N:82306027 . Registered 12 July 2016
There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms .
There was limited , but high quality , evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks .
In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms .
There was a lack of high quality evidence to inform workplace management of lateral epicondylitis .
BACKGROUND Upper limb pain is common among working-aged adults and a frequent cause of absenteeism .
AIMS To systematic ally review the evidence for workplace interventions in four common upper limb disorders .