Showing papers by "Paulien M. Bongers published in 2006"

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)

Abstract: 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

Should office workers spend fewer hours at their computer? A systematic review of the literature.

Abstract: Worldwide, millions of office workers use a computer. Reports of adverse health effects due to computer use have received considerable media attention. This systematic review summarises the evidence for a relationship between the duration of work time spent using the computer and the incidence of hand-arm and neck-shoulder symptoms and disorders. Several databases were systematically searched up to 6 November 2005. Two reviewers independently selected articles that presented a risk estimate for the duration of computer use, included an outcome measure related to hand-arm or neck-shoulder symptoms or disorders, and had a longitudinal study design. The strength of the evidence was based on methodological quality and consistency of the results. Nine relevant articles were identified, of which six were rated as high quality. Moderate evidence was concluded for a positive association between the duration of mouse use and hand-arm symptoms. For this association, indications for a dose-response relationship were found. Risk estimates were in general stronger for the hand-arm region than for the neck-shoulder region, and stronger for mouse use than for total computer use and keyboard use. A pathophysiological model focusing on the overuse of muscles during computer use supports these differences. Future studies are needed to improve our understanding of safe levels of computer use by measuring the duration of computer use in a more objective way, differentiating between total computer use, mouse use and keyboard use, attaining sufficient exposure contrast, and collecting data on disability caused by symptoms.

Economic evaluation of a multi-stage return to work program for workers on sick leave due to low back pain

Abstract: Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care Design: Economic evaluation alongside a randomised controlled trial (RCT) Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP Interventions: 1 workplace assessment, work modifications and case management) 2 physiotherapy based on operant behavioural principles 3 usual care: provided by an occupational physician Outcomes: The primary outcome was return to work (RTW) Other outcomes were pain intensity, functional status, quality of life and general health The economic evaluation was conducted from a societal perspective Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave Results: The workplace intervention group returned to work 300 days (95% CI=[31, 513]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19) Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 213 days (95% CI= [−741, 292]) later on average The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 509 days (95% CI=[−894, −27]) later on average A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes A clinical intervention was less effective than usual care and associated with higher costs Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP

Physical capacity in relation to low back, neck, or shoulder pain in a working population

Abstract: Aims: To investigate the longitudinal relation between physical capacity (isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine) and low back, neck, and shoulder pain. Methods: In this prospective cohort study, 1789 Dutch workers participated. At baseline, isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine were measured in the pain free workers, as well as potential confounders, including physical workload. Low back, neck, and shoulder pain were self-reported annually at baseline and three times during follow up. Results: After adjustment for confounders, Poisson generalised estimation equations showed an increased risk of low back pain among workers in the lowest sex specific fertile of performance in the static back endurance tests compared to workers in the reference category (RR = 1.42; 95% CI 1.19 to 1.71), but this was not found for isokinetic trunk lifting strength or mobility of the spine. An increased risk of neck pain was shown for workers with low performance in tests of isokinetic neck/shoulder lifting strength (RR = 1.31; 95% CI 1.03 to 1.67) and static neck endurance (RR = 1.22; 95% CI 1.00 to 1.49). Among workers in the lowest fertiles of isokinetic neck/shoulder lifting strength or endurance of the shoulder muscles, no increased risk of shoulder pain was found. Conclusions: The findings of this study suggest that low back or neck endurance were independent predictors of low back or neck pain, respectively, and that low lifting neck/shoulder strength was an independent predictor of neck pain. No association was found between lifting trunk strength, or mobility of the spine and the risk of low back pain, nor between lifting neck/shoulder strength or endurance of the shoulder muscles and the risk of shoulder pain.

Do work-related physical factors predict neck and upper limb symptoms in office workers?

Abstract: Examination of the influence of physical exposure at work on neck and upper limb symptoms in office workers. Data were used from a prospective cohort study with a follow-up period of 3 years. Independent variables were physical exposure at work, observed and self-reported. Outcome measures were neck–shoulder symptoms and elbow–wrist–hand symptoms. Data were analyzed with the generalized estimating equation (GEE) method, with adjustment for age, gender, psychosocial work characteristics and the outcome at baseline. Results are: neck rotation was associated with neck–shoulder symptoms in the analyses with observed data (OR: 1.57; CI: 0.99–2.50) as well as those with self-reported data (OR: 1.43; CI: 1.02–2.01). Neck extension was also statistically significantly associated with neck–shoulder symptoms (OR: 2.42; CI: 1.22–4.80), but only self-reported data were available. Neck flexion, self-reported wrist pronation, self-reported arm elevation and self-reported duration of computer work, were not associated with symptoms. An indication was found of an adverse effect on neck–shoulder symptoms of long working days and on elbow–wrist–hand symptoms of self-reported wrist flexion and full-time work or longer compared to part-time work. A limited number of work-related physical factors were related to neck and upper limb symptoms in office workers. Only neck rotation and self-reported neck extension were identified as risk factors for neck-shoulder symptoms.

Is an imbalance between physical capacity and exposure to work-related physical factors associated with low-back, neck or shoulder pain?

Abstract: Objectives: This study investigates whether an imbalance between physical capacity and exposure to work-related physical factors is associated with low-back, neck, or shoulder pain. Methods: Data of the longitudinal study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), with a follow-up of 3 years (N=1789), were used. At baseline, physical capacity (isokinetic lifting strength, static muscle endurance, and mobility of the spine) and exposure to work-related physical factors were assessed. During the follow-up, low-back, neck, and shoulder pain were self-reported annually. "Imbalance" was defined as lower than median capacity combined with higher than median exposure, "high balance" was high capacity and high exposure, and "low balance" was low capacity and low exposure. Results: For both the low-back and neck, imbalance between static endurance and working with flexed postures was a risk factor for pain [relative risk (RR) 1.35, 95% confidence interval (95% CI) 1.08-1.68, and RR 1.36, 95% CI 0.96-1.91, respectively]. Low balance was also associated with low-back pain (RR 1.29, 95% CI 1.04-1.68). Furthermore, low balance between isokinetic lifting strength and lifting exposure was a risk factor for low-back and neck pain [RR between 1.22 (95% CI 0.99-1.49) and 1.35 (95% CI 1.03-1.79)]. No associations were found with shoulder pain. Conclusions: Some relationship between low-back and neck pain and combined measures of physical capacity with exposure to work-related physical factors seems to exist, but an imbalance between physical capacity and exposure was not found to yield higher risks than high balance or low balance. This work is licensed under a Creative Commons Attribution 4.0 International License.