Is peak exposure to computer use a risk factor for neck and upper-extremity symptoms?

OBJECTIVES

Epidemiologic studies on physical exposure during computer use have mainly focused on average exposure duration. In this study, we aimed to relate periods of high peak exposure during computer use with the occurrence of neck-shoulder (NS) and arm-wrist-hand (AWH) symptoms.

METHODS

A prospective cohort study among 1951 office workers was carried out for two years, with periodical questionnaires and continuous measurements of computer input use. To define peak exposure, a distinction was made between peak days and weeks. Peak days were defined as days with a long duration of computer (ie, ≥4 hours) or mouse use (ie, ≥2.5 hours) or days with high frequency of mouse (ie, ≥20 clicks per minute) or keyboard use (ie, ≥160 keystrokes per minute). Weeks containing ≥3 peak days were considered peak weeks. Independent variables were numbers of peak days and peak weeks during a 3-month measurement period; dependent variables were self-reported NS and AWH symptoms during the following 3-month measurement period.

RESULTS

Valid data were available for 2116 measurements of 774 office workers. No relation was found between any of the peak exposure parameters and AWH symptoms or with peak exposure in duration and NS symptoms. Most parameters referring to high frequency-related peak exposure were associated with less NS symptoms, but the effect estimates were very small and the confidence intervals close to the null.

CONCLUSION

In this study, we found no indication that high peaks in computer use were related to the occurrence of NS or AWH symptoms.

An individually based lifestyle intervention for workers at risk for cardiovascular disease: a process evaluation

PURPOSE

Evaluate counselors' adherence to an intervention protocol, counselors' competence, and the associations between three process indicators and body weight at follow-up in a 6-month individually based lifestyle intervention for construction workers.

DESIGN

Process evaluation with qualitative and quantitative data.

SETTING

Occupational health service.

SUBJECTS

A total of 408 male construction workers with an elevated risk of cardiovascular disease received the intervention, and 27 occupational health professionals delivered the intervention.

INTERVENTION

Seven counseling sessions, the first during which four prescribed items had to be discussed. Motivational interviewing (MI) was used as a counseling technique.

MEASURES AND ANALYSIS

The number of sessions and the items discussed were registered by the counselors. Adherence to MI was determined by expert scoring of transcripts of random segments of 19 counseling sessions. Counselors' competence was rated by participants and counselors separately. Associations between three process indicators and body weight at follow-up were determined by linear and logistic regression analyses.

RESULTS

Two-thirds of all participants attended five or more sessions, and 38.5% attended all seven sessions. In 90.2% of all cases, the counselor discussed all obligatory items in the first session. MI adherence was reached in one audiotaped fragment. Most (86.3%) of all participants agreed with the counselor being competent. Neither counselors' competence nor number of sessions or items discussed was significantly associated with body weight loss.

CONCLUSIONS

Performing five sessions and discussing four prescribed items was feasible for the counselors, whereas performing MI was not. Still, participants were positive about the counselors' competence and willing to attend the intervention sessions. Investigators are encouraged to report the evaluation of their intervention process to improve future lifestyle interventions in research or in practice.

Effectiveness of an interactive website aimed at empowerment of disability benefit claimants: results of a pragmatic randomized controlled trial

INTRODUCTION

The aim of this study was to investigate the effectiveness of an interactive website aimed at empowerment of disability claimants, prior to the assessment of disability by an insurance physician.

METHODS

A randomized controlled trial was conducted. Claimants applying for a work disability pension after being sick-listed for 104 weeks, were randomized into either an intervention group or control group. Participants who were randomized into the intervention group were able to logon to the website www.wiagesprek.nl , which mainly consisted of five interactive modules aimed at increasing knowledge, self-awareness, expectations, self-efficacy, and active participation. Participants from the control group were directed to a 'sham' website with commonly available information only. The primary outcome was empowerment. Secondary outcomes included coping, knowledge, claimant satisfaction, perceived justice, and physician satisfaction. Outcomes were assessed at baseline, 2 days before the disability assessment, as well as 1 day after, 6 weeks, and 4 months after the disability assessment.

RESULTS

Claimants were randomly assigned to the intervention group (n = 123) or a control group (n = 119). The intervention had no significant short- and long-term effects on empowerment, but the intervention increased claimants' knowledge significantly compared to the control group. Claimant satisfaction with the disability assessment interview and claimant perceived justice on the outcome of the assessment were lower in the intervention group (statistically not significant). Furthermore, the intervention had a significant negative effect on claimants perceived procedural justice.

CONCLUSION

Although knowledge increased significantly, the intervention www.wiagesprek.nl was not successful in reaching its primary target, that is, to increase levels of empowerment among disability claimants, prior to the assessment of disability.

A participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: results of a randomized controlled trial

INTRODUCTION

Within the labour force workers without an employment contract represent a vulnerable group. In most cases, when sick-listed, these workers have no workplace/employer to return to. Therefore, the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers, sick-listed due to musculoskeletal disorders.

METHODS

The workers, sick-listed for 2-8 weeks due to musculoskeletal disorders, were randomly allocated to the participatory return-to-work program (n = 79) or to usual care (n = 84). The new program is a stepwise procedure aimed at making a consensus-based return-to-work plan, with the possibility of a temporary (therapeutic) workplace. Outcomes were measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure was time to sustainable first return-to-work. Secondary outcome measures were duration of sickness benefit, functional status, pain intensity, and perceived health.

RESULTS

The median duration until sustainable first return-to-work was 161 days in the intervention group, compared to 299 days in the usual care group. The new return-to-work program resulted in a non-significant delay in RTW during the first 90 days, followed by a significant advantage in RTW rate after 90 days (hazard ratio of 2.24 [95% confidence interval 1.28-3.94] P = 0.005). No significant differences were found for the measured secondary outcomes.

CONCLUSIONS

The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.

Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews

OBJECTIVE

Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians.

METHODS

PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn.

RESULTS

Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions.

CONCLUSION

Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies.

PRACTICE IMPLICATIONS

To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established.

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

BACKGROUND

Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course.

METHODS

A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation.

RESULTS

A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial.

CONCLUSIONS

The feasibility and practical relevance of the communication skills training course that was developed seem promising. Such a course may be relevant for physicians in many countries who perform work disability assessments. The development of the first training course of this type represents an important advancement in this field.

Relation between perceived health and sick leave in employees with a chronic illness

INTRODUCTION

To improve work participation in individuals with a chronic illness, insight into the role of work-related factors in the association between health and sick leave is needed. The aim of this study was to gain insight into the contribution of work limitations, work characteristics, and work adjustments to the association between health and sick leave in employees with a chronic illness.

METHODS

All employees with a chronic illness, between 15 and 65 years of age (n = 7,748) were selected from The Netherlands Working Conditions Survey. The survey included questions about perceived health, working conditions, and sick leave. Block-wise multivariate linear regression analyses were performed and, in different blocks, limitations at work, work characteristics, and work adjustments were added to the model of perceived health status. Changes in regression coefficient (B) (%) were calculated for the total group and for sub-groups per chronic illness.

RESULTS

When work limitations were added to the model, the B between health and sick leave decreased by 18% (5.0 to 4.1). Adding work characteristics did not decrease the association between health and sick leave, but the B between work limitations and sick leave decreased by 14%, (5.3 to 4.5). When work adjustments were added to the model, the Bs between sick leave and work limitations and work characteristics changed from 4.5 to 3.4 for work limitations and from 2.1 to 1.9 for temporary contract and from -0.8 to -1.0 for supervisor support.

CONCLUSIONS

The association between health and sick leave was explained by limitations at work, work characteristics, and work adjustments. Paying more attention to work limitations, characteristics and adjustments offers opportunities to reduce the negative consequences of chronic illness.

Economic evaluations of occupational health interventions from a company's perspective: a systematic review of methods to estimate the cost of health-related productivity loss

OBJECTIVES

To investigate the methods used to estimate the indirect costs of health-related productivity in economic evaluations from a company's perspective.

METHODS

The primary literature search was conducted in Medline and Embase. Supplemental searches were conducted in the Cochrane NHS Economic Evaluation Database, the National Institute for Occupational Safety and Health database, the Ryerson International Labour, Occupational Safety and Health Index database, scans of reference lists and researcher's own literature database. Article selection was conducted independently by two researchers based on title, keywords, and abstract, and if needed, full text. Differences were resolved by a consensus procedure. Articles were selected based on seven criteria addressing study population, type of intervention, comparative intervention, outcome, costs, language and perspective, respectively. Characteristics of the measurement and valuation of health-related productivity were extracted and analyzed descriptively.

RESULTS

A total of 34 studies were included. Costs of health-related productivity were estimated using (a combination of) data related to sick leave, compensated sick leave, light or modified duty or work presenteeism. Data were collected from different sources (e.g. administrative databases, worker self-report, supervisors) and by different methods (e.g. questionnaires, interviews). Valuation varied in terms of reported time units, composition and source of the corresponding price weights, and whether additional elements, such as replacement costs, were included.

CONCLUSIONS

Methods for measuring and valuing health-related productivity vary widely, hindering comparability of results and decision-making. We provide suggestions for improvement.

The role of work ability in the relationship between aerobic capacity and sick leave: a mediation analysis

OBJECTIVES

To examine: (1) the relationships between aerobic capacity, work ability and sick leave; (2) the potential mediating effect of work ability in the relationship between aerobic capacity and sick leave; and (3) the influence of age on these relationships.

METHODS

Information on aerobic capacity (predicted VO(2max)), age, gender, type of work, cardiovascular risk and body mass index was collected from 580 workers at baseline. Work ability was assessed with the Work Ability Index at first follow-up (mean 3.4±1.3 years after baseline). The second follow-up period was defined as the time between completing the Work Ability Index and the first registered sick leave episode. Mediation analyses were performed using linear and Cox regression models.

RESULTS

A lower aerobic capacity was found to be significantly related to sick leave (HR=0.98; τ=-0.018; 95% CI 0.970 to 0.994). There was a significant positive relationship between aerobic capacity and work ability (α=0.165; 95% CI 0.122 to 0.208). Also, lower work ability was significantly related to sick leave after controlling for aerobic capacity (HR=0.97; β=-0.033; 95% CI 0.949 to 0.987). The mediating effect of work ability in the relationship between aerobic capacity and sick leave was -0.005 (SE=0.002), and mediated 27.8% (95% CI 10.4 to 45.2) of the total effect of aerobic capacity on sick leave. Age did not influence the relationship between aerobic capacity and sick leave.

CONCLUSIONS

Fit workers had better work ability, and both fit workers and workers with higher work ability were at lower risk of starting an episode of sick leave.

Process evaluation of a web-based intervention aimed at empowerment of disability benefit claimants

Background

The objective of this process evaluation study was to gain insight into the reach, compliance, appreciation, usage barriers, and users' perceived effectiveness of a web-based intervention http://www.wiagesprek.nl. This intervention was aimed at empowerment of disability claimants, prior to the assessment of disability by an insurance physician.

Methods

Reach was determined by registering claimants exposed to the study's invitation brochures, and by comparing trial participant characteristics with non-participants and nationwide claimant data. Compliance was registered by analyzing weblogs, which were automatically collected during the period of the trial. This made it possible to analyze individual use of the intervention. Appreciation, usage barriers, and users' perceived effectiveness were assessed using an online questionnaire that was sent to participants from the intervention group, 6 weeks after enrolment.

Results

Only 9% of the target population enrolled in the internet program. Because of selective enrolment, more females, higher educated claimants, and less ethnical minorities were reached. Compliance was ambiguous: out of the 123 participants randomized into the intervention group, a significant proportion (33%) did not use the intervention at all, while, at the same time, many participants (32%) used the intervention for more than two hours (i.e. in approximately two weeks). Overall satisfaction with the intervention was good. Claimants perceived the intervention most effective in increasing knowledge, while also a fair amount of users perceived the intervention effective in gaining right expectations or being able to communicate better with their physician.

Conclusions

The uptake of the intervention http://www.wiagesprek.nl was disappointing. Specifically, the poor reach and compliance of the intervention resulted in a small proportion of the target population using the intervention as intended. Improvements in the implementation process are desirable to increase the reach and compliance and, thereby possibly, the impact of the intervention.

Trial registration

NTR-1414

The dimensional structure of the functional abilities in cases of long-term sickness absence

BACKGROUND

The health problems that working people suffer can affect their functional abilities and, consequently, can cause a mismatch between those abilities and the demands of the work, leading to sickness absence. A lasting decrease in functional abilities can lead to long-term sickness absence and work disability, with negative consequences for both the worker and the larger society. The objective of this study was to identify common disability characteristics among large groups of long-term sick-listed and disabled employees.

METHODS

As part of the disability benefit entitlement procedure in the Netherlands, an insurance physician assesses the functional abilities of the claimant in a standardised form, known as the List of Functional Abilities (LFA), which consists of six sections containing a total of 106 items. For the purposes of this study, we compiled data from 50,931 assessments. These data were used in an exploratory factor analyses, and the results were then used to construct scales. The stability of dimensional structure of the LFA and of the internal consistency of the scales was studied using data from 80,968 assessments carried out earlier, under a slightly different legislation.

RESULTS

Three separate factor analyses carried out on the functional abilities of five sections of the LFA resulted in 14 scale variables, and one extra scale variable was based on the items from the sixth section. The resulting scale variables showed Cronbach's Alphas ranging from 0.59 to 0.97, with the exception of one of 0.54. The dimensional structure of the LFA in the verification population differed in some aspects. The Cronbach's Alphas of the verification population ranged from 0.58 to 0.97, again with the exception of the same scale: Alpha = 0.49.

CONCLUSION

The differences between the dimensional structures of the primary data and the earlier data we found in this study restrict the possibilities to generalise the results. The scales we constructed can be utilised to produce a compact description of the functional abilities of groups of claimants in the Netherlands. Moreover, the matching work demands can be used to identify jobs low on those demands as being the most accessible for the specific type of disabled employees, particularly severely disabled individuals.

The effects of shift work on body weight change - a systematic review of longitudinal studies

OBJECTIVE

This systematic review aims to summarize the available evidence to elucidate the effects of shift work, which includes night work, on body weight change.

METHODS

A systematic search strategy using longitudinal studies was performed. Articles were included based on strict inclusion criteria; methodological quality was assessed by a standardized quality checklist. The results were summarized using a levels of evidence synthesis.

RESULTS

The search strategy resulted in eight articles that met the inclusion criteria. Five of them were considered to be high- and three of them low-quality studies. Seven studies presented crude results for an association between shift work exposure and change in body weight: five high- and two low-quality studies. There was strong evidence for a crude relationship between shift work and body weight increase. Five studies presented weight-related outcomes adjusted for potentially relevant confounders (age, gender, bodyweight at baseline, and physical activity). Two studies found a significant difference between groups in the same direction. Consequently, the evidence for a confounders-adjusted relationship between shift work exposure and body weight was considered to be insufficient.

CONCLUSIONS

Strong evidence for a crude association between shift work exposure and body weight increase was found. In order to further clarify the underlying mechanisms, more and better high quality studies about this subject are necessary.

Intervention mapping for the development of a strategy to implement the insurance medicine guidelines for depression

BACKGROUND

This article describes the development of a strategy to implement the insurance medicine guidelines for depression. Use of the guidelines is intended to result in more transparent and uniform assessment of claimants with depressive symptoms.

METHODS

The implementation strategy was developed using the Intervention Mapping (IM) method for alignment with insurance-medical practice. The ASE behavioural explanation model (Attitude, Social Influence and Self-Efficacy) was used as theoretical basis for the development work. A literature study of implementation strategies and interviews with insurance physicians were performed to develop instruments for use with the guideline. These instruments were designed to match the needs and the working circumstances of insurance physicians. Performance indicators to measure the quality of the assessment and the adherence to the guidelines were defined with input from insurance physicians.

RESULTS

This study resulted in the development of a training course to teach insurance physicians how to apply the guidelines for depression, using the aforementioned instruments. The efficacy of this training course will be evaluated in a Randomized Controlled Trial.

CONCLUSIONS

The use of IM made it possible to develop guideline support instruments tailored to insurance medical practice.

Associations between VO2max and vitality in older workers: a cross-sectional study

Background

To prevent early exit from work, it is important to study which factors contribute to healthy ageing. One concept that is assumed to be closely related to, and therefore may influence healthy ageing, is vitality. Vitality consists of both a mental and a physical component, and is characterised by a perceived high energy level, decreased feelings of fatigue, and feeling fit. Since VO_2max gives an indication of one's aerobic fitness, which can be improved by increased levels of physical activity, and because feeling fit is one of the main characteristics of vitality, it is hypothesised that VO_2max is related to vitality. Therefore, the aim of this study was to investigate the associations between VO_2max and vitality.

Methods

In 427 older workers (aged 45 + years) participating in the Vital@Work study, VO_2max was estimated at baseline using the 2-km UKK walk test. Vitality was measured by both the UWES Vitality Scale and the RAND-36 Vitality Scale. Associations were analysed using linear regression analyses.

Results

The linear regression models, adjusted for age, showed a significant association between VO_2max and vitality measured with the RAND-36 Vitality Scale (β = 0.446; 95% CI: 0.220-0.673). There was no significant association between VO_2max and vitality measured with the UWES (β = -0.006; 95% CI:-0.017 - 0.006), after adjusting for age, gender and chronic disease status.

Conclusions

VO_2max was associated with a general measure of vitality (measured with the RAND-36 Vitality Scale), but not with occupational health related vitality (measured with the UWES Vitality Scale). The idea that physical exercise can be used as an effective tool for improving vitality was supported in this study.

Trial registration

NTR1240

Software-recorded and self-reported duration of computer use in relation to the onset of severe arm-wrist-hand pain and neck-shoulder pain

Objectives

In both science and media, the adverse effects of a long duration of computer use at work on musculoskeletal health have long been debated. Until recently, the duration of computer use was mainly measured by self-reports, and studies using more objective measures, such as software-recorded computer duration, were lacking. The objective of this study was to examine the association between duration of computer use at work, measured with software and self-reports, and the onset of severe arm–wrist–hand and neck–shoulder symptoms.

Methods

A 2-year follow-up study was conducted between 2004 and 2006 among 1951 office workers in The Netherlands. Self-reported computer duration and other risk factors were collected at baseline and at 1-year follow-up. Computer use at work was recorded continuously with computer software for 1009 participants. Outcome questionnaires were obtained at baseline and every 3 months during follow-up. Cases were identified based on the transition within 3 months of no or minor symptoms to severe symptoms.

Results

Self-reported duration of computer use was positively associated with the onset of both arm–wrist–hand (RR 1.9, 95% CI 1.1 to 3.1 for more than 4 h/day of total computer use at work) and neck–shoulder symptoms (RR 1.5, 95% CI 1.1 to 2.0 for more than 4 h/day of mouse use at work). The recorded duration of computer use did not show any statistically significant association with the outcomes.

Conclusions

In the present study, no association was found between the software-recorded duration of computer use at work and the onset of severe arm–wrist–hand and neck–shoulder symptoms using an exposure window of 3 months. In contrast, a positive association was found between the self-reported duration of computer use at work and the onset of severe arm–wrist–hand and neck–shoulder symptoms. The different findings for recorded and self-reported computer duration could not be explained satisfactorily.

Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: results of a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease (CVD).

METHODS

In a randomized controlled trial performed in the Netherlands between 2007 and 2009, usual care was compared to 6 months of individual counseling using motivational interviewing techniques, delivered face to face and by telephone. Participants aimed at improving energy balance-related behavior or smoking cessation. Linear regression analyses were performed to determine the effects.

RESULTS

Body weight had significantly decreased at 6 (β=-1.9, 95% CI -2.6; -1.2) and 12 months (β=-1.8, 95%CI -2.8; -1.1). The intervention effects were also significant for diastolic blood pressure at 6 months (β=-1.7, 95% CI -3.3; -0.1). Among participants who had aimed at energy balance, the intervention had a significant favorable effect on body weight at 6 (β=-2.1, 95% CI -2.9; -1.3) and 12 months (β=-2.2, 95% CI -3.1; -1.3) and at HDL cholesterol (β=0.05, 95% CI 0.01; 0.10) and HbA1c (β=-0.06, 95%CI -0.12; -0.001) at 12 months, although there was no intervention effect on these variables over time.

CONCLUSION

Individual-based counseling resulted in significant beneficial long-term effects on body weight. This is an important finding for occupational health, considering the rising prevalence of obesity and CVD.

Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers

Background

Both low back pain (LBP) and neck pain (NP) are major occupational health problems. In the workplace, participatory ergonomics (PE) is frequently used on musculoskeletal disorders. However, evidence on the effectiveness of PE to prevent LBP and NP obtained from randomised controlled trials (RCTs) is scarce. This study evaluates the process of the Stay@Work participatory ergonomics programme, including the perceived implementation of the prioritised ergonomic measures.

Methods

This cluster-RCT was conducted at the departments of four Dutch companies (a railway transportation company, an airline company, a steel company, and a university including its university medical hospital). Directly after the randomisation outcome, intervention departments formed a working group that followed the steps of PE during a six-hour working group meeting. Guided by an ergonomist, working groups identified and prioritised risk factors for LBP and NP, and composed and prioritised ergonomic measures. Within three months after the meeting, working groups had to implement the prioritised ergonomic measures at their department. Data on various process components (recruitment, reach, fidelity, satisfaction, and implementation components, i.e., dose delivered and dose received) were collected and analysed on two levels: department (i.e., working group members from intervention departments) and participant (i.e., workers from intervention departments).

Results

A total of 19 intervention departments (n = 10 with mental workloads, n = 1 with a light physical workload, n = 4 departments with physical and mental workloads, and n = 4 with heavy physical workloads) were recruited for participation, and the reach among working group members who participated was high (87%). Fidelity and satisfaction towards the PE programme rated by the working group members was good (7.3 or higher). The same was found for the Stay@Work ergocoach training (7.5 or higher). In total, 66 ergonomic measures were prioritised by the working groups. Altogether, 34% of all prioritised ergonomic measures were perceived as implemented (dose delivered), while the workers at the intervention departments perceived 26% as implemented (dose received).

Conclusions

PE can be a successful method to develop and to prioritise ergonomic measures to prevent LBP and NP. Despite the positive rating of the PE programme the implementation of the prioritised ergonomic measures was lower than expected.

Trial registration

Current Controlled Trials ISRCTN27472278

What are possible barriers and facilitators to implementation of a Participatory Ergonomics programme?

Background

Low back pain (LBP) and neck pain (NP) are common among workers. Participatory Ergonomics (PE) is used as an implementation strategy to prevent these symptoms. By following the steps of PE, working groups composed and prioritised ergonomic measures, and developed an implementation plan. Working group members were responsible to implement the ergonomic measures in their departments. Little is known about factors that hamper (barriers) or enhance (facilitators) the implementation of ergonomic measures. This study aimed to identify and understand the possible barriers and facilitators that were perceived during implementation.

Methods

This study is embedded in a cluster randomised controlled trial that investigated the effectiveness of PE to prevent LBP and NP among workers. For the purpose of the current study, questionnaires were sent to 81 working group members. Their answers were used to make a first inventory of possible barriers and facilitators to implementation. Based on the questionnaire information, 15 semi-structured interviews were held to explore the barriers and facilitators in more detail. All interviews were audio taped, transcribed verbatim, and analysed according to a systematic approach.

Results

All possible barriers and facilitators were obtained from questionnaire data, indicating that the semi-structured interviews did not yield information about new factors. Various barriers and facilitators were experienced. The presence of implementation plans for ergonomic measures that were already approved by the management facilitated implementation before the working group meeting. In these cases, PE served as a strategy to improve the implementation of the approved measures. Furthermore, the findings showed that the composition of a working group (i.e., including decision makers and a worker who led the implementation process) was important. Moreover, stakeholder involvement and collaboration were reported to considerably improve implementation.

Conclusions

This study showed that the working group as well as stakeholder involvement and collaboration were important facilitating factors. Moreover, PE was used as a strategy to improve the implementation of existing ergonomic measures. The results can be used to improve PE programmes, and thereby may contribute to the prevention of LBP and NP.

Trial registration number

ISRCTN27472278

Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis

BACKGROUND

Patient empowerment is growing in popularity and application. Due to the increasing possibilities of the Internet and eHealth, many initiatives that are aimed at empowering patients are delivered online.

OBJECTIVE

Our objective was to evaluate whether Web-based interventions are effective in increasing patient empowerment compared with usual care or face-to-face interventions.

METHODS

We performed a systematic review by searching the MEDLINE, EMBASE, and PsycINFO databases from January 1985 to January 2009 for relevant citations. From the 7096 unique citations retrieved from the search strategy, we included 14 randomized controlled trials (RCTs) that met all inclusion criteria. Pairs of review authors assessed the methodological quality of the obtained studies using the Downs and Black checklist. A meta-analysis was performed on studies that measured comparable outcomes. The GRADE approach was used to determine the level of evidence for each outcome.

RESULTS

In comparison with usual care or no care, Web-based interventions had a significant positive effect on empowerment measured with the Diabetes Empowerment Scale (2 studies, standardized mean difference [SMD] = 0.61, 95% confidence interval [CI] 0.29 - 0.94]), on self-efficacy measured with disease-specific self-efficacy scales (9 studies, SMD = 0.23, 95% CI 0.12 - 0.33), and on mastery measured with the Pearlin Mastery Scale (1 study, mean difference [MD] = 2.95, 95% CI 1.66 - 4.24). No effects were found for self-efficacy measured with general self-efficacy scales (3 studies, SMD = 0.05, 95% CI -0.25 to 0.35) or for self-esteem measured with the Rosenberg Self-Esteem Scale (1 study, MD = -0.38, 95% CI -2.45 to 1.69). Furthermore, when comparing Web-based interventions with face-to-face deliveries of the same interventions, no significant (beneficial or harmful) effects were found for mastery (1 study, MD = 1.20, 95% CI -1.73 to 4.13) and self-esteem (1 study, MD = -0.10, 95% CI -0.45 to 0.25).

CONCLUSIONS

Web-based interventions showed positive effects on empowerment measured with the Diabetes Empowerment Scale, disease-specific self-efficacy scales and the Pearlin Mastery Scale. Because of the low quality of evidence we found, the results should be interpreted with caution. The clinical relevance of the findings can be questioned because the significant effects we found were, in general, small.

The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review

Ergonomic interventions (physical and organisational) are used to prevent or reduce low back pain (LBP) and neck pain among workers. We conducted a systematic review of randomised controlled trials (RCTs) on the effectiveness of ergonomic interventions. A total of 10 RCTs met the inclusion criteria. There was low to moderate quality evidence that physical and organisational ergonomic interventions were not more effective than no ergonomic intervention on short and long term LBP and neck pain incidence/prevalence, and short and long term LBP intensity. There was low quality evidence that a physical ergonomic intervention was significantly more effective for reducing neck pain intensity in the short term (ie, curved or flat seat pan chair) and the long term (ie, arm board) than no ergonomic intervention. The limited number of RCTs included make it difficult to answer our broad research question and the results should be interpreted with care. This review, however, provides a solid overview of the high quality epidemiological evidence on the (usually lack of) effectiveness of ergonomic interventions on LBP and neck pain.

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

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 Netherlands 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 randomised controlled trial. The participants were assigned to either the intervention group or the usual care group by means of cluster randomisation. At baseline and after 12 months of follow-up, the participants completed the RSI QuickScan questionnaire 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 questionnaire 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

Netherlands National Trial Register NTR1117

Economic evaluations of occupational health interventions from a corporate perspective - a systematic review of methodological quality

OBJECTIVE

Using a standardized quality criteria list, we appraised the methodological quality of economic evaluations of occupational safety and health (OSH) interventions conducted from a corporate perspective.

METHODS

The primary literature search was conducted in Medline and Embase. Supplemental searches were conducted in the Cochrane NHS Economic Evaluation Database, the National Institute for Occupational Safety and Health (NIOSH) database, the Ryerson International Labour, Occupational Safety and Health Index, scans of reference lists, and researchers' own literature database. Independently, two researchers selected articles based on title, keywords, and abstract, and if needed, fulltext. Disagreements were resolved by a consensus procedure. Articles were selected based on seven criteria addressing study population, type of intervention, comparative intervention, outcome, costs, language, and perspective. Two reviewers independently judged methodological quality using the Consensus on Health Economic Criteria (CHEC-list), a 19-item standardized quality criteria list. Disagreements in judgment were also resolved by consensus. Data were analyzed descriptively.

RESULTS

A total of 34 studies were included. Of these, only 44% of the studies met more than 50% of the quality criteria. Of the 19 quality criteria, 8 were met by 50% or more of the studies. The 11 least fulfilled criteria related to (i) performance of a sensitivity analysis, (ii) selection of perspective, (iii) description of study population, (iv) discussion of generalizability, (v) description of competing alternatives, (vi) presentation of the research question, (vii) measurement of outcomes, (viii) measurement of costs, (ix) valuation of costs, (x) declaration of researchers' independence, and (xi) discussion of ethical and distributional issues.

CONCLUSIONS

Apart from a few exceptions, the overall methodological quality of the economic evaluations of OSH interventions from a corporate perspective was poor. As such, there is a risk of biased results. The quality of future evaluations needs to be improved to increase the validity of their conclusions and recommendations.

Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial

Background

Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.

The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care.

Methods/Design

The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study.

Discussion

For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System.

Trial registration

Trial registration number: NTR1047.

Lifestyle-focused interventions at the workplace to reduce the risk of cardiovascular disease--a systematic review

OBJECTIVE

The goal of this review was to summarize the evidence for an effect of lifestyle-targeted interventions at the workplace on the main biological risk factors for cardiovascular disease (CVD).

METHODS

We performed an extensive systematic literature search for randomized controlled trials (RCT) that met the following inclusion criteria: (i) targeted at workers; (ii) aimed at increasing physical activity and/or improving diet; and (iii) measured body weight, body fat, blood pressure, blood lipids and/or blood glucose. We used a nine-item methodological quality list to determine the quality of each study. A best-evidence system was applied, taking into account study quality and consistency of effects.

RESULTS

Our review included 31 RCT, describing a diversity of interventions (eg counseling, group education, or exercise). Of these studies, 18 were of high quality. Strong evidence was found for a positive effect on body fat, one of the strongest predictors of CVD risk. Among populations "at risk", there was strong evidence for a positive effect on body weight. Due to inconsistencies in results between studies, there was no evidence for the effectiveness of interventions on the remaining outcomes.

CONCLUSIONS

We found strong evidence for the effectiveness of workplace lifestyle-based interventions on body fat and, in populations at risk for CVD, body weight. Populations with an elevated risk of CVD seemed to benefit most from lifestyle interventions; supervised exercise interventions appeared the least effective intervention strategy. To gain better insight into the mechanisms that led to the intervention effects, the participants' compliance with the intervention and the lifestyle changes achieved should be reported in future studies.

Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease

BACKGROUND

Non-response and drop-out are problems that are commonly encountered in health promotion trials. Understanding the health-related characteristics of non-participants and drop-outs and the reasons for non-participation and drop-out may be beneficial for future intervention trials.

METHODS

Male construction workers with an elevated risk of cardiovascular disease (CVD) were invited to participate in a lifestyle intervention study. In order to investigate the associations between participation and CVD risk factors, and drop-out and CVD risk factors, crude and multiple logistic regression analyses were performed. The reasons for non-participation and drop-out were assessed qualitatively.

RESULTS

20% of the workers who were invited decided to participate; 8.6% of the participants dropped out before the first follow-up measurement. The main reasons for non-participation were 'no interest', 'current (para-)medical treatment', and 'feeling healthy', and for drop-out they were 'lack of motivation', 'current (para-)medical treatment', and 'disappointment'. Participants were 4.2 years older, had a higher blood pressure, higher total cholesterol, and lower HDL cholesterol than non-participants, and were more likely to report 'tiredness and/or stress' and 'chest pain and/or shortness of breath'. After adjusting for age, most risk factors were not significantly associated with participation. Drop-outs were 4.6 years younger than those who completed the study. The prevalence of smoking was higher among non-participants and drop-outs.

CONCLUSION

Participants had a worse CVD risk profile than non-participants, mainly because of the difference in age. Non-participants and drop-outs were younger and more likely to be smokers. The main reasons for non-participation and drop-out were health-related. Investigators in the field of health promotion should be encouraged to share comparable information.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN60545588.

The Vital@Work Study. The systematic development of a lifestyle intervention to improve older workers' vitality and the design of a randomised controlled trial evaluating this intervention

Background

A major contributor of early exit from work is a decline in health with increasing age. As healthy lifestyle choices contribute to better health outcomes, an intervention aimed at an improved lifestyle is considered a potentially effective tool to keep older workers healthy and vital, and thereby to prolong labour participation.

Methods

Using the Intervention Mapping (IM) protocol, a lifestyle intervention was developed based on information obtained from 1) literature, 2) a short lifestyle questionnaire aimed at indentifying the lifestyle behaviours among the target group, and 3) focusgroup (FG) interviews among 36 older workers (aged 45⁺ years) aimed at identifying: a) key determinants of lifestyle behaviour, b) a definition of vitality, and c) ideas about how vitality can be improved by lifestyle.

The main lifestyle problems identified were: insufficient levels of physical activity and insufficient intake of fruit and vegetables. Using information from both literature and FG interviews, vitality consists of a mental and a physical component. The interviewees suggested to improve the mental component of vitality by means of relaxation exercises (e.g. yoga); physical vitality could be improved by aerobic endurance exercise and strength training.

The lifestyle intervention (6 months) consists of three visits to a Personal Vitality Coach (PVC) combined with a Vitality Exercise Programme (VEP). The VEP consists of: 1) once a week a guided yoga group session aimed at relaxation exercises, 2) once a week a guided aerobic workout group session aimed at improving aerobic fitness and increasing muscle strength, and 3) older workers will be asked to perform once a week for at least 45 minutes vigorous physical activity without face-to-face instructions (e.g. fitness). Moreover, free fruit will be offered at the group sessions of the VEP. The lifestyle intervention will be evaluated in a RCT among older workers of two major academic hospitals in the Netherlands. At baseline, after 6 and 12 months, measurements (primary: lifestyle and vitality, and secondary: work-engagement and productivity) will take place.

Discussion

The lifestyle programme is developed specifically tailored to the needs of the older workers and which is aimed at improving their vitality.

Trial registration

NTR1240

The feasibility of a web-based counselling program for occupational physicians and employees on sick leave due to back or neck pain

Background

The objective of this feasibility study was to gain insight into occupational physicians' (OPs) and employees' use of, and attitudes towards, 'Snelbeter' (Get Well Fast), a new web-based counselling program for employees on sick leave due to non-specific back or neck pain and their OPs.

Methods

Registered user information was collected from the website to get insight in the use of the program by employees (n = 24). Qualitative information was obtained through semi-structured in-depth interviews with 19 OPs and nine employees in order to get insight in the actual use of the provided information, the attitudes towards the program and possible improvements of the program.

Results

Actual use of the program among OPs was low. The majority of OPs, eight out of 11 (73%), never or only occasionally signed in. The greatest obstacle for OPs to use the program was the low number of eligible employees involved. Employees appreciated the program but their use was moderate. A small majority of the employees who used the program, 14 out of 24 (58%), opened 50% to 100% of the provided documents, a majority of the interviewed employees, seven out of nine (78%), used the provided information sometimes or regularly. The absence of personal contact was found to be a major barrier towards use of the program by employees.

Conclusion

Although both OPs and employees appreciated the idea of the program and employees appreciated using it, program utilization was moderate to low. The discussion section reveals that before implementation can be started to any extent, the program will need adaptations that make it more attractive to use. The program should be considered for both return to work (RTW) and the prevention of sick leave. Adding personal contact (e.g. involving physiotherapists) to the program may also be promising.

A theoretical framework to describe communication processes during medical disability assessment interviews

BACKGROUND

Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context.

OBJECTIVE

The objective of this paper is to describe the conceptualization of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. CONCEPTUALIzATION: The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication.

CONCLUSION

The conceptualization of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessments.

Equal task, equal exposure? Are men and women with the same tasks equally exposed to awkward working postures?

The aim of the study was to determine whether men and woman with equal tasks perform these tasks in the same way. Video recordings of 37 male and 43 female workers in six task groups were observed, from which data regarding frequency and duration of exposure to awkward postures were derived. These data were also compared to self-reported exposures. The results showed that when level, duration and frequency of exposure were analysed at the same time, men and women had slightly different exposure patterns. However, these differences were not found when duration and frequency were analysed separately. From the questionnaires it appeared that men and women generally report similar exposures, but they seemed to over-report their exposure compared to the observed exposures. It is concluded that gender differences in exposure to awkward postures within the same task were small at most and cannot explain the female excess in musculoskeletal symptoms.

Challenges at work and financial rewards to stimulate longer workforce participation

BACKGROUND

Because of the demographic changes, appropriate measures are needed to prevent early exit from work and to encourage workers to prolong their working life. To date, few studies have been performed on the factors motivating continuing to work after the official age of retirement. In addition, most of those studies were based on quantitative data. The aims of this study were to examine, using both quantitative and qualitative data: (1) the reasons for voluntary early retirement; (2) the reasons for continuing working life after the official retirement age; and (3) the predictive value of the reasons mentioned.

METHODS

Quantitative data analyses were performed with a prospective cohort among persons aged 55 years and older. Moreover, qualitative data were derived from interviews with workers together with discussions from a workshop among occupational physicians and employers.

RESULTS

Results showed that the presence of challenging work was among the most important reasons for not taking early retirement. In addition, this motive appeared to positively predict working status after three years. The financial advantages of working and the maintenance of social contacts were the reasons reported most frequently for not taking full retirement, with the financial aspect being a reasonably good predictor for working status after three years. From the interviews and the workshop, five themes were identified as important motives to prolong working life: challenges at work, social contacts, reward and appreciation, health, and competencies and skills. Further, it was brought forward that each stakeholder can and should contribute to the maintenance of a healthy and motivated ageing workforce.

CONCLUSION

Based on the findings, it was concluded that measures that promote challenges at work, together with financial stimuli, seem to be promising in order to prolong workforce participation.

The effect of a resistance-training program on muscle strength, physical workload, muscle fatigue and musculoskeletal discomfort: an experiment

The aim of the study was to investigate the effectiveness of a resistance-training program on muscle strength of the back and neck/shoulder muscles, relative physical workload, muscle fatigue and musculoskeletal discomfort during a simulated assembly and lifting task. Twenty-two workers were randomized over an 8-week resistance-training group, and a control group. Isokinetic muscle strength was assessed using the Cybex dynamometer, muscle fatigue was measured using EMG, and perceived discomfort was measured using a 10-point scale. At the follow-up, we found no effect of the resistance-training program on isokinetic muscle strength of the back and shoulder muscles. Furthermore, we did not find any effect on EMG data, nor on musculoskeletal discomfort during the simulated work tasks. However, trained workers performed the lifting tasks for a longer time before reporting considerable discomfort than those in the control group.

Age-related differences in muscular capacity among workers

Purpose

To quantify the age-related changes in muscular capacity in a working population, and to investigate whether these changes are dependent on sports participation.

Methods

Data were used from the longitudinal study on musculoskeletal disorders, absenteeism, stress and health (n = 1,800). At baseline, isokinetic lifting strength and static muscle endurance were assessed, and endurance measurements were repeated after 3 years of follow-up. Sports participation was assessed using a questionnaire.

Results

Cross-sectionally, static endurance of the neck/shoulder muscles was highest among older workers, but decreased longitudinally among all age groups. Younger workers who participated in sports 3 h per week or more had the best performance, but older workers who participated between 0 and 3 h per week had better performance than those who participated in sports more frequently.

Conclusions

There were age-related differences on muscular capacity. Younger workers who participated in sports frequently had the best muscular capacity. For aging workers, moderate sports participation seems to be effective in keeping them suitable for the relatively growing work demands.

Communication about work between general practitioners and patients consulting for musculoskeletal disorders

BACKGROUND

Work-related musculoskeletal disorders (MSDs) are common in general practice. The communication between a general practitioner (GP) and patient is a key element of adequate general practice. No study has investigated the characteristics of communication about work-related matters during consultation of the GP by working patients with MSDs.

OBJECTIVES

The aim of this study was to describe the communication about work-related matters between the GP and his patients with paid work who are consulting for MSDs.

METHOD

Descriptive analysis of 680 systematic observations of GP consultations of patients in paid work who were consulting for MSDs.

RESULTS

Work was discussed in 227 of 680 consultations in general practice. In 69% of these consultations the patient started communication concerning work-related matters, with an average number of 38.5 (standard deviation 45.7) verbal utterances, equalling, on average, 15% of the total consultation time. In 36% of consultations the patient's working conditions were discussed and in 12% the GP advised on whether to stay at home or return to work. There was a statistically significant positive correlation between the extent to which GPs rated the patient's MSDs to be work related and the number of utterances the GP and patient made about work-related matters during the consultation.

CONCLUSIONS

Work is not a standard topic of conversation during the GP consultation. GPs could more often start communication about patients' work. A challenge for future GP practice and education is to include discussion of patients' work to optimise patient-centred care.

Test-retest reliability and concurrent validity of a web-based questionnaire measuring workstation and individual correlates of work postures during computer work

INTRODUCTION

"Ergonomic" questionnaires are widely used in epidemiological field studies to study the association between workstation characteristics, work posture and musculoskeletal disorders among office workers. Findings have been inconsistent regarding the putative adverse effect of work postures. Underestimation of the true association might be present in studies due to misclassification of subjects to risk (i.e. exposed to non-neutral working postures) and no-risk categories (i.e. not exposed to non-neutral working postures) based on questionnaire responses. The objective of this study was to estimate the amount of misclassification resulting from the use of questionnaires.

METHODS

Test-retest reliability and concurrent validity of a newly developed questionnaire was assessed. This questionnaire collects data on workstation characteristics and on individual characteristics during computer work (i.e. work postures, movements and habits). Pictures were added where possible to provide visual guidance. The study population consisted of 84 office workers of a research department. They filled out the questionnaire on the Internet twice, with an in-between period of 2 weeks. For a subgroup of workers (n=38), additional on-site observations and multiple manual goniometer measurements were performed.

RESULTS

Percentage agreement ranged between 71% and 100% for the test-retest analysis, between 31% and 100% for the comparison between questionnaire and on-site observation, and between 26% and 71% for the comparison between questionnaire and manual goniometer measurements. For 9 out of 12 tested items, the percentage agreement between questionnaire and manual goniometer measurements was below 50%.

CONCLUSIONS

The questionnaire collects reliable data on workstation characteristics and some individual characteristics during computer work (i.e. work movements and habits), but does not seem to be useful to collect data on work postures during computer work in epidemiological field studies among office workers.

Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness

Background

Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP among workers.

Methods

In a randomised controlled trial (RCT), a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline. The departments consisting of about 150 workers are pre-stratified and randomised. The control departments receive usual practice and the intervention departments receive PE. Within each intervention department a working group is formed including eight workers, a representative of the management, and an occupational health and safety coordinator. During a one day meeting, the working group follows the steps of PE in which the most important risk factors for LBP and NP, and the most adequate ergonomic measures are identified on the basis of group consensus. The implementation of ergonomic measures at the department is performed by the working group. To improve the implementation process, so-called 'ergocoaches' are trained.

The primary outcome measure is an episode of LBP and NP. Secondary outcome measures are actual use of ergonomic measures, physical workload, psychosocial workload, intensity of pain, general health status, sick leave, and work productivity. The cost-effectiveness analysis is performed from the societal and company perspective. Outcome measures are assessed using questionnaires at baseline and after 6 and 12 months. Data on the primary outcome as well as on intensity of pain, sick leave, work productivity, and health care costs are collected every 3 months.

Discussion

Prevention of LBP and NP is beneficial for workers, employers, and society. If the intervention is proven (cost-)effective, the intervention can have a major impact on LBP and NP prevention and, thereby, on work disability prevention. Results are expected in 2010.

Trial registration

ISRCTN27472278

Underlying mechanisms of improving physical activity behavior after rehabilitation

BACKGROUND

Regular physical activity is beneficial for the health and functioning of people with a disability. Effective components of successful physical activity promotion interventions should be identified and disseminated.

PURPOSE

To study the underlying mechanisms of the combined sport stimulation program "Rehabilitation & Sports" (R&S) and daily physical activity promotion program "Active after Rehabilitation" (AaR).

METHOD

Subjects in four rehabilitation centers received R&S + AaR (n = 284). Subjects in six control centers (n = 603) received usual care. Physical activity and its determinants were assessed with questionnaires at seven weeks before and nine weeks and one year after rehabilitation.

RESULTS

Variables that were determinants of the intervention-induced improvement in physical activity behavior at both follow-up measurements were attitude, the perceived benefits "improved health and reduced risk of disease," "better feeling about oneself," and "improved fitness," and the barrier "limited environmental possibilities." The percentage change in the intervention coefficient caused by these determinants ranged from -35.3% to -16.3% and from -28.4% to -11.3% at nine weeks and one year after rehabilitation, respectively.

CONCLUSION

Personalized tailored counseling interventions can improve physical activity behavior in people with a disability by targeting both personal and environmental determinants of physical activity behavior.

Test-retest reliability and validity of self-reported duration of computer use at work

OBJECTIVES

The aims of this study were to evaluate the test-retest reliability and the validity of self-reported duration of computer use at work.

METHODS

Test-retest reliability was studied among 81 employees of a research department of a university medical center. The employees filled out a web-based questionnaire twice with an in-between period of 14 days. Validity was studied among a group of 572 office workers who participated in an epidemiologic field study. A software program recorded the duration of computer use at work during the 3 months preceding the questionnaire.

RESULTS

The percentages of agreement for test-retest reliability were 75% [95% confidence interval (95% CI) 64-84] for total computer use and 67% (95% CI 55-77) for mouse use. The percentages of agreement between self-report and registration were 18% (95% CI 15-21) for total computer use and 16% (95% CI 13-19) for mouse use. Misclassification was mainly nondifferential in nature, since all of the evaluated subgroups showed at least 75% misclassification.

CONCLUSIONS

The use of self-reports lead to the misclassification of exposure to computer use for more than 80% of all persons. This misclassification is predominantly nondifferential in nature and can only partly be explained by limited test-retest reliability.

What makes men and women with musculoskeletal complaints decide they are too sick to work?

OBJECTIVE

The objective of this study was to determine what makes men and women with musculoskeletal complaints decide to call in sick for work.

METHODS

Qualitative, face-to-face interviews were used with employees (16 men and 14 women) who had called in sick due to a musculoskeletal complaint and who expected to be absent from work for at least 2 weeks on sick leave.

RESULTS

The participants fell into the following two main groups: those who were off sick because of a diagnosed medical condition, such as a fracture, and those who were off sick because of an unidentifiable complaint, such as low-back pain. Employees in the former group called in sick because they were in the hospital or because they reckoned that their condition was too serious to warrant a continuation of work. Employees in the latter group felt hesitant and insecure and found it hard to judge whether absenteeism was justified. They decided either to "play it safe" and stay off work to prevent the complaints from worsening or to seek advice from medical professionals. Their advice did not include explicit instructions to stay at home, but were usually interpreted as such. Finally, women, but not men, were likely to call in sick if they felt that their home situation was being negatively affected by attempts to keep working while suffering physical complaints.

CONCLUSIONS

The decision to call in sick is not taken lightly. Employees with nonspecific disorders base their decision on several factors, including advice from medical professionals. A factor found only among women was work-home interference.

Does musculoskeletal discomfort at work predict future musculoskeletal pain?

The objective of this prospective cohort study was to evaluate if peak or cumulative musculoskeletal discomfort may predict future low-back, neck or shoulder pain among symptom-free workers. At baseline, discomfort per body region was rated on a 10-point scale six times during a working day. Questionnaires on pain were sent out three times during follow-up. Peak discomfort was defined as a discomfort level of 2 at least once during a day; cumulative discomfort was defined as the sum of discomfort during the day. Reference workers reported a rating of zero at each measurement. Peak discomfort was a predictor of low-back pain (relative risk (RR) 1.79), neck pain (RR 2.56), right or left shoulder pain (RR 1.91 and 1.90). Cumulative discomfort predicted neck pain (RR 2.35), right or left shoulder pain (RR 2.45 and 1.64). These results suggest that both peak and cumulative discomfort could predict future musculoskeletal pain.

Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: the health under construction study

BACKGROUND

Of all workers in Dutch construction industry, 20% has an elevated risk of cardiovascular disease (CVD). A major risk factor for CVD risk is an unhealthy lifestyle. The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk, and to evaluate its (cost-) effectiveness.

METHODS/DESIGN

In a RCT, 692 participants will be randomised to either the control or the intervention group. The control group will receive usual care. For the intervention group, a lifestyle intervention has been designed based on interviews and current literature. The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts, consisting of individual counselling aimed at increasing daily physical activity (PA) and improving dietary behaviour, and/or smoking cessation. Counselling will take place at the Occupational Health Service (OHS), and will be done according to motivational interviewing (MI). Additional written information about healthy lifestyle will also be provided to those in the intervention group. At baseline, after 6 and after 12 months, measurements will take place. Primary outcome variables will be the lifestyle behaviours of concern, i.e. daily PA, dietary intake, and smoking status. Secondary outcome variables will be body mass index (BMI), systolic and diastolic blood pressure, total and HDL blood cholesterol, Hba1c and cardio-respiratory fitness (CRF). Sickness absenteeism and cost-effectiveness will be assessed as well. Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group.

DISCUSSION

By improving lifestyle, CVD risk may be lowered, yielding benefits for both employee and employer. If proven effective, this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN60545588.

Workstyle and overcommitment in relation to neck and upper limb symptoms

Few studies have examined the concepts of workstyle and overcommitment in relation to the occurrence of neck and upper limb symptoms. The aim of this study was to examine whether a high-risk workstyle is a mediator in the relation of work-related exposure (job demands and computer work) and overcommitment to neck and upper limb symptoms. The study participants comprised 3,855 office workers of a European institute. The Sobel test was applied to test the intermediate effects of 4 workstyle dimensions and of the total workstyle score. The results show that most mediated effects were statistically significant, meaning that the workstyle dimensions acted as a mediator in the relation between work-related exposure and symptoms as well as in the relation between overcommitment and symptoms. Given the results with the total workstyle score, 34% of the effect of prolonged computer work, 64% of the effect of job demands, and 84% of the effect of overcommitment was mediated by workstyle. However, due to possible bias in the assessment of workstyle factor and the cross-sectional design of the study, the conclusions should be drawn with care.

Work-related physical and psychosocial risk factors for sick leave in patients with neck or upper extremity complaints

Objectives

To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upper extremity complaints.

Methods

Three hundred and forty two patients with neck or upper extremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upper extremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models.

Results

In the subgroup of patients who scored high on the pain copying scale “worrying” the hazard ratio of sick leave was 1.32 (95% CI 1.07–1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale “worrying” (adjusted HR = 0.17, 95%-CI 0.04–0.72). Other work-related risk factors were not significantly related to sick leave.

Conclusions

Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upper extremity complaints are needed to confirm our results.

Consensus-based findings and recommendations for estimating the costs of health-related productivity loss from a company’s perspective

OBJECTIVES

There were two study objectives: (i) to identify, via consensus, a key set of items for estimating the costs of productivity loss from a company's perspective and (ii) to develop recommendations for the costs of estimating productivity loss on the basis of consensus findings.

METHODS

A modified Delphi procedure was utilized in which a predetermined set of 26 items formed the basis for inquiry in the first round. Thirty-six experts from five stakeholder groups in the Netherlands (employers, employees, policy makers and insurers, occupational health professionals, and researchers) participated in the panel. Opinions were sought regarding the relevance and retrievability of data on items related to the following three forms of work loss: work presenteeism (ie, decreased work performance while at work), short-term absenteeism (<2 weeks), and long-term absenteeism (>2 weeks). The data were analyzed quantitatively and qualitatively. The consensus for relevance was set at 70%.

RESULTS

After two rounds, 4 items were found relevant for estimating the costs of productivity loss due to work presenteeism, 6 items were relevant for short-term absenteeism, and 11 items remained for long-term absenteeism. The retrievability of data varied. Three sets of recommendations were formulated for estimating the costs of productivity loss from a company's perspective.

CONCLUSION

A streamlined set of relevant items has been identified via consensus and formulated into recommendations for estimating the costs of productivity loss from a company's perspective. Although not definitive, these recommendations represent an important step towards standardizing the way these costs are estimated, and, in turn, facilitate the comparability and utility of economic evaluations of occupational health interventions.

Successfully improving physical activity behavior after rehabilitation

PURPOSE

To determine the effects of the physical activity promotion programs Rehabilitation & Sports (R&S) and Active after Rehabilitation (AaR) on sport and daily physical activity 1 year after in- or outpatient rehabilitation.

DESIGN

Subjects in intervention rehabilitation centers were randomized into a group receiving R&S only (n = 315) and a group receiving R&S and AaR (n = 284). Subjects in six control centers (n = 603) received usual care.

SETTING

Ten Dutch rehabilitation centers.

SUBJECTS

Subjects consisted of 1202 rehabilitation patients. Most frequent diagnoses were stroke, neurological disorders, and back disorders.

INTERVENTION

Both the sport stimulation program (R&S) and the daily physical activity promotion program (AaR) consisted of personalized tailored counseling.

MEASURES

Two sport outcomes and two daily physical activity outcomes were assessed with questionnaires at baseline and 1 year after rehabilitation.

ANALYSIS

Multilevel analyses comparing both intervention groups to the control group.

RESULTS

The R&S program showed no significant effects. Intention-to-treat analyses in the R&S + AaR group showed borderline significant improvements in one sport (odds ratio [OR] = 1.66, p = .02) and both physical activity outcomes (OR = 1.68, p = .01 and regression coefficient = 10.78, p = .05). On-treatment analyses in the R&S + AaR group showed similar but stronger effects.

CONCLUSIONS

The combination of the R&S and AaR programs improved physical activity behavior and sport participation 1 year after in- or outpatient rehabilitation. The R&S program alone did not have any effects.

The Physical Activity Scale for Individuals with Physical Disabilities: Test-Retest Reliability and Comparison With an Accelerometer

Background:

The objective was to determine the test-retest reliability and criterion validity of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD).

Methods:

Forty-five non-wheelchair dependent subjects were recruited from three Dutch rehabilitation centers. Subjects’ diagnoses were: stroke, spinal cord injury, whiplash, and neurological-, orthopedic- or back disorders. The PASIPD is a 7-d recall physical activity questionnaire that was completed twice, 1 wk apart. During this week, physical activity was also measured with an Actigraph accelerometer.

Results:

The test-retest reliability Spearman correlation of the PASIPD was 0.77. The criterion validity Spearman correlation was 0.30 when compared to the accelerometer.

Conclusions:

The PASIPD had test-retest reliability and criterion validity that is comparable to well established self-report physical activity questionnaires from the general population.