Swenne G. van Den Heuvel

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.

Objectives: The objective of this study was to examine the influence of physical exposure at work on neck and upper limb symptoms in office workers. Methods: 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: 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. Conclusions: Only 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.

The aim of this study was to investigate the relationship between psychosocial work characteristics and neck and upper limb symptoms and to examine to what extent this relationship could be explained by other risk factors. Data were used from a prospective cohort study in a working population, with a follow-up period of 3 years. The 3-year cumulative incidence rates of neck or upper limb symptoms, neck/shoulder symptoms and elbow/wrist/hand symptoms were 32, 24 and 15%, respectively. After adjustment for potential confounders high job demands was identified as a risk factor for neck/shoulder symptoms (RR: 2.1; CI: 1.2-3.6) and elbow/wrist/hand symptoms (RR: 1.9; CI: 1.0-3.7), and low social support of co-workers was identified as a risk factor for elbow/wrist/hand symptoms (RR: 2.2; CI: 1.0-4.9). Partly, but not exclusively, these relationships were intermediated by an increased exposure to physical risk factors and increased stress symptoms. Personal characteristics did not considerably influence the main effects of the identified risk factors.

Objectives: To determine the effects of sporting activity on absenteeism in a working population. Methods: Data were used from a prospective cohort study in a working population with a follow up period of 3 years and were collected with yearly questionnaires or collected from company records. Complete data on absenteeism, sporting activity, and potential confounders were collected for 1228 workers. ANOVA was used to test differences in frequency and duration of absenteeism, correlations were computed to measure the association between number of sporting years (divided by age) and frequency and duration of absenteeism, and survival analysis, according to the Cox proportional hazards model, was used to test differences in relative risk at absenteeism and recovery. All analyses were adjusted for age, gender, smoking, and alcohol consumption, and were stratified for employees with sedentary and with more active jobs. Results: ANOVA showed a statistically significant higher mean duration of absenteeism among employees not practicing sports, of approximately 20 days over a period of 4 years. The survival analysis showed an increased relative risk at absenteeism (relative risk (RR) 1.09; confidence interval (CI) 1.01 to 1.18) and a decreased relative risk at recovery (RR 0.90; CI 0.85 to 0.95) for employees not practicing sports. The effect of sporting activity is larger in employees with sedentary work. No associations were found between number of sporting years and absenteeism. Conclusion: Employees practicing sports take sick leave significantly less often than their colleagues not practicing sports, while their periods of sick leave are shorter, especially when their work is sedentary.

Objectives This study aimed at determining the prognostic factors related to the recurrence of low-back pain and future sickness absence due to low-back pain. Methods Data were used from a prospective cohort study in a working population with a 3-year follow-up period. They were collected with annual questionnaires. A generalized estimating equation model was used to study the relation between pain characteristics, individual characteristics, and work-related factors and the recurrence of low-back pain or sickness absence due to low-back pain in the following year. Adjustments were made for potential confounders. Results All the pain characteristics [odds ratios (OR) varying from 1.4 to 2.4], flexion and rotation of the upper part of the body [OR 1.6, 95% confidence interval (95% CI) 1.1–2.5], low decision authority (OR 1.6, 95% CI 1.0–2.6), and low job satisfaction (OR 1.5, 95% CI 1.0–2.3), increased the risk of recurrent low-back pain. High disability due to low-back pain (OR 2.6, 95% CI 1.2–5.7), low co-worker support (OR 4.1, 95% CI 1.6–10.5), and low job satisfaction (OR 2.4, 95% CI 1.3–4.5) were predictors of sickness absence due to low-back pain. Lifting weights did not influence the risk of recurrences or sick leave. Conclusions According to this study, high disability due to low-back pain is a prognostic factor for recurrent low-back pain and future sickness absence due to low-back pain. In addition, the following work-related factors predict a poor prognosis of low-back pain: flexion or rotation of the trunk, low job satisfaction, low decision authority, and low social support.

Objectives This study evaluated the effects on work-related neck and upper-limb disorders among computer workers stimulated (by a software program) to take regular breaks and perform physical exercises. Possible effects on sick leave and productivity were studied as well. Methods A randomized controlled design was used with cluster randomization. Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were randomized into a control group, one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-week period. Questionnaires were administered before and after the intervention, and questions were generated by the software during the intervention period. Computer usage was recorded online. Results The data on self-reported recovery suggested a favorable effect; more subjects in the intervention groups than in the control group reported recovery (55% versus 34%) from their complaints and fewer reported deterioration (4% versus 20%). However, a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups. No effects on sick leave were observed. The subjects in the intervention groups showed higher productivity. Conclusions The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints. There seems to be no additional effects from performing physical exercises during these breaks.

To determine the effectiveness of a special form of exercise therapy ('Cesar therapy') on self reported recovery and improvement of posture amongst patients with chronic aspecific lower back pain. Prospective randomized controlled and blinded investigation. After informed consent had been obtained, patients with chronic aspecific lower back pain were given, on a randomized basis, either an exercise therapy (experimental group, n = 112) or a standard treatment by their general practitioner (control group, n = 110). Outcome measures were self reported recovery of back pain and improvement of posture (thoracic and lumbar spine, pelvis). Self reported recovery was determined by means of a dichotomized 7-point scale (questionnaire). Posture was measured qualitatively by a panel of 11 Cesar therapists (blinded) and quantitatively by an optical-electronic posture recording system (Vicon). Measurements were taken at baseline (pre-randomization) and at 3, 6 and 12 months after randomization. Three months after randomization, patients who were treated according to Cesar therapy, reported an improvement in their back symptoms (80%) significantly more often than the control group (47%). In both groups, however, only small improvements in posture were found. The judgement of the Cesar panel exhibited a significant difference between the two groups, with respect to the spine, in favour of Cesar therapy. Differences between the groups were still present 6 months after randomization, but could no longer be detected at 12 months after randomization. Cesar therapy was significantly more effective than standard treatment among patients with chronic lower back pain for a period of 6 months after randomization.