Work related neck and upper limb symptoms have a multi-factorial origin Possible risk factors are of a physical, psychosocial or personal origin These factors can reinforce each other and their influence can also be mediated by cultural or societal factors Initially, most research on neck and upper limb symptoms focused on work-related physical exposure Nowadays, psychosocial work characteristics are recognized as important risk factors Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies These studies show that high work demands or little control at work are often related to these symptoms However, this relationship is neither very strong nor very specific Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms This also applies to general distress or other pain (co-morbidity) Job dissatisfaction does not contribute to neck and upper limb symptoms Too little research on personal characteristics is available to draw any conclusions It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms However, studies concerning these factors are promising but too scarce to draw conclusions Future studies should address these behavioural aspects In part II, the recent studies on the effectiveness of preventive measures for work related neck and upper limb problems are discussed Few randomised or non randomised controlled trials have been carried out to evaluate the effectiveness of individual or organisational interventions to improve work related psychosocial factors Very few have reported on the preventive effect for work related neck and upper limb symptoms Therefore, there is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made From the low back pain intervention research can be learned that interventions should best be targeted to both the worker and the organisation and that interventions will only be successful when all stakeholders are involved

Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II)

Adjustments to McConville et al. and Young et al. body segment inertial parameters

Study design Best evidence synthesis. Objective To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders. Summary of background data No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. Methods We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. Results Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. Conclusion Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.

Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

Background
Neck pain is common, disabling and costly Exercise is one treatment approach

Objectives
To assess the effectiveness of exercises to improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain

Search methods
We searched MEDLINE, MANTIS, ClinicalTrialsgov and three other computerized databases up to between January and May 2014 plus additional sources (reference checking, citation searching, contact with authors)

Selection criteria
We included randomized controlled trials (RCTs) comparing single therapeutic exercise with a control for adults suffering from neck pain with or without cervicogenic headache or radiculopathy

Data collection and analysis
Two review authors independently conducted trial selection, data extraction, 'Risk of bias' assessment and clinical relevance The quality of the evidence was assessed using GRADE Meta-analyses were performed for relative risk and standardized mean differences (SMD) with 95% confidence intervals (CIs) after judging clinical and statistical heterogeneity

Main results
Twenty-seven trials (2485 analyzed /3005 randomized participants) met our inclusion criteria

For acute neck pain only, no evidence was found

For chronic neck pain, moderate quality evidence supports 1) cervico-scapulothoracic and upper extremity strength training to improve pain of a moderate to large amount immediately post treatment [pooled SMD (SMDp) -071 (95% CI: -133 to -010)] and at short-term follow-up; 2) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post treatment and short-term follow-up; 3) combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied from a small to large magnitude of beneficial effect on pain at immediate post treatment [SMDp -033 (95% CI: -055 to -010)] and up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term follow-up [SMDp -045 (95%CI: -072 to -018)]; 4) cervico-scapulothoracic strengthening/stabilization exercises to improve pain and function at intermediate term [SMDp -1490 (95% CI:-2240 to -739)]; 5) Mindfulness exercises (Qigong) minimally improved function but not global perceived effect at short term Low evidence suggests 1) breathing exercises; 2) general fitness training; 3) stretching alone; and 4) feedback exercises combined with pattern synchronization may not change pain or function at immediate post treatment to short-term follow-up Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may improve pain and function at short-term follow-up

For chronic cervicogenic headache, moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback immediate post treatment and probably improves pain, function and global perceived effect at long-term follow-up Low grade evidence supports sustained natural apophyseal glides (SNAG) exercises

For acute radiculopathy, low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical stretch/strengthening/stabilization exercises

Authors' conclusions
No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain Using specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function However, when only stretching exercises were used no beneficial effects may be expected Future research should explore optimal dosage

Exercises for mechanical neck disorders

Conventional and innovative office concepts can be described according to three dimensions: (1) the office location (e.g. telework office versus conventional office); (2) the office lay-out (e.g. open lay-out versus cellular office); and (3) the office use (e.g. fixed versus shared workplaces). This review examined how these three office dimensions affect the office worker's job demands, job resources, short- and long-term reactions. Using search terms related to the office concept (dimensions), a systematic literature search starting from 1972 was conducted in seven databases. Subsequently, based on the quality of the studies and the consistency of the findings, the level of evidence for the observed findings was assessed. Out of 1091 hits 49 relevant studies were identified. Results provide strong evidence that working in open workplaces reduces privacy and job satisfaction. Limited evidence is available that working in open workplaces intensifies cognitive workload and worsens interpersonal relations; close distance between workstations intensifies cognitive workload and reduces privacy; and desk-sharing improves communication. Due to a lack of studies no evidence was obtained for an effect of the three office dimensions on long-term reactions. The results suggest that ergonomists involved in office innovation could play a meaningful role in safeguarding the worker's job demands, job resources and well-being. Attention should be paid, in particular, to effects of workplace openness by providing acoustic and visual protection.

The effect of office concepts on worker health and performance: a systematic review of the literature

The aim of this review was to provide an overview of assistive exoskeletons that have specifically been developed for industrial purposes and to assess the potential effect of these exoskeletons on reduction of physical loading on the body. The search resulted in 40 papers describing 26 different industrial exoskeletons, of which 19 were active (actuated) and 7 were passive (non-actuated). For 13 exoskeletons, the effect on physical loading has been evaluated, mainly in terms of muscle activity. All passive exoskeletons retrieved were aimed to support the low back. Ten-forty per cent reductions in back muscle activity during dynamic lifting and static holding have been reported. Both lower body, trunk and upper body regions could benefit from active exoskeletons. Muscle activity reductions up to 80% have been reported as an effect of active exoskeletons. Exoskeletons have the potential to considerably reduce the underlying factors associated with work-related musculoskeletal injury. Practitioner Summary: Worldwide, a significant interest in industrial exoskeletons does exist, but a lack of specific safety standards and several technical issues hinder mainstay practical use of exoskeletons in industry. Specific issues include discomfort (for passive and active exoskeletons), weight of device, alignment with human anatomy and kinematics, and detection of human intention to enable smooth movement (for active exoskeletons).

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Exoskeletons for industrial application and their potential effects on physical work load

The concepts of comfort and discomfort in sitting are under debate. There is no widely accepted definition, although it is beyond dispute that comfort and discomfort are feelings or emotions that are subjective in nature. Yet, beside several subjective methodologies, several objective methods (e.g. posture analysis, pressure measurements, electromyography (EMG) are in use to assess sitting comfort or discomfort. In the current paper a theoretical framework is presented, in which comfort and discomfort were defined and the hypothetical associations with underlying factors were indicated. Next, the literature was reviewed to determine the relationships between objective measures and subjective ratings of comfort and discomfort. Twenty-one studies were found in which simultaneous measures of an objective parameter and a subjective rating of comfort or discomfort were obtained. Pressure distribution appears to be the objective measure with the most clear association with the subjective ratings. For other variables, regarding spinal profile or muscle activity for instance, the reported associations are less clear and usually not statistically significant. ©Medline

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Michiel P. de Looze

Papers

Exoskeletons for industrial application and their potential effects on physical work load

Sitting comfort and discomfort and the relationships with objective measures

The effects of a passive exoskeleton on muscle activity, discomfort and endurance time in forward bending work.

Validation of a full body 3-D dynamic linked segment model

Assessment of an active industrial exoskeleton to aid dynamic lifting and lowering manual handling tasks