Randomized Controlled Trial of Physiotherapy and Feldenkrais Interventions in Female Workers with Neck-Shoulder Complaints

The present study aimed to investigate whether physiotherapy or Feldenkrais interventions resulted in a reduction of complaints from the neck and shoulders (prevalence, pain intensity, sick leave, and disability in leisure and work roles) in 97 female industrial workers (not on long-term sick leave). Range of motion of neck and shoulders, VO₂, endurance score (i.e., summation of pain intensity ratings during a static shoulder flexion), cortical control according to the Feldenkrais methodology, and physiological capacity according to a dynamic endurance test of the shoulder flexors with simultaneous surface EMG were also recorded. The workers were randomized to: (1) physiotherapy group (PT-group; treatment according to the ergonomic program of the PTs of the occupational health care service), (2) Feldenkrais group (F-group; education according to the Feldenkrais methodology), or (3) control group (C-group; no intervention). Pre- and post-tests were made at one-year intervals. The two interventions lasted 16 weeks during paid working time. The F-group showed significant decreases in complaints from neck and shoulders and in disability during leisure time. The two other groups showed no change (PT-group) or worsening of complaints (C-group). The present study showed significant positive changes in complaints after the Feldenkrais intervention but not after the physiotherapy intervention. Possible mechanisms behind the effects in the F-group are discussed.     

Supplementary breaks and stretching exercises for data entry operators: a follow-up field study

BACKGROUND: This study expanded previous NIOSH-IRS research examining the effects of rest breaks and stretching exercises on symptoms and performance in data-entry workers. METHODS: All workers spent 4 weeks with conventional breaks (two 15 min breaks per day) and 4 weeks with supplementary breaks (two 15 min breaks plus four 5 min breaks per day). One-half were assigned at random to a group instructed to perform brief stretching exercises during breaks. The remainder comprised the "no stretching" (control) group. RESULTS: 51 workers (stretch group n = 21; no stretch group n = 30) completed the study symptom questionnaires. Discomfort and eyestrain were significantly lower with supplementary breaks, and supplementary breaks attenuated accumulation of discomfort and eyestrain during work sessions. Data-entry speed was significantly faster with supplementary breaks so that work output was maintained, despite replacing 20 min of work time with break time. In the stretch group, workers reported stretching during only 25% of conventional breaks and 39% of supplementary breaks, and no significant effects of stretching on discomfort or performance were observed. CONCLUSIONS: These results provide further converging evidence that supplementary breaks reliably minimize discomfort and eyestrain without impairing productivity. Low compliance in performing stretches prevented valid assessment of stretching effects. Further research on stretching exercises and exercise compliance is warranted.     

Health-related and work-related aspects associated with sick leave: a comparison of chronically ill and non-chronically ill workers

Objectives: Our aims were to study to what extent chronically ill workers (CIWs) take more sick leave than non-chronically ill workers (NCIWs) and to explore which health-related and work-related aspects are associated with the sick leave patterns of the two groups. Methods: A questionnaire on work, health and sick leave was sent to all employees of a university in The Netherlands (response: 49.1%). Analyses were conducted for 444 CIWs and 1,347 NCIWs. Odds ratios (ORs) were calculated to quantify the contribution of being chronically ill to sick leave in general, frequent sick leave, prolonged sick leave, and present sick leave. The contributions of health-related and work-related aspects to sick leave were investigated by multiple logistic regression analyses for both CIWs and NCIWs separately. Results: CIWs showed significantly increased ORs for general, frequent, prolonged and present sick leave when compared with NCIWs. Fatigue, emotional exhaustion and perceived health complaints showed stronger associations with sick leave for both CIWs and NCIWs than various work-related aspects. Workers of 46 years of age and older showed less sick leave than workers under the age of 36. Male respondents and scientific personnel showed less frequent sick leave than the other respondents, and so did respondents working more than 40 h a week, compared with part-timers. The final regression models explained 8%–16% of the variance in sick leave. Conclusions: CIWs take two to three times more and longer sick leave than NCIWs. Health-related aspects are more strongly associated with sick leave than work-related aspects for both CIWs and NCIWs. Sick leave patterns were, nevertheless, only partly explained by health-related and work-related aspects. In any case, future studies of sick leave should certainly take the presence of chronic disease into account as an important determinant of sick leave.     

Work and Health, a Blind Spot in Curative Healthcare? A Pilot Study

Introduction Most workers with musculoskeletal disorders on sick leave often consult with regular health care before entering a specific work rehabilitation program. However, it remains unclear to what extent regular healthcare contributes to the timely return to work (RTW). Moreover, several studies have indicated that it might postpone RTW. There is a need to establish the influence of regular healthcare on RTW as outcome; “Does visiting a regular healthcare provider influence the duration of sickness absence and recurrent sick leave due to musculoskeletal disorders?”. Methods A cohort of workers on sick leave for 2–6 weeks due to a-specific musculoskeletal disorders was followed for 12 months. The main outcomes for the present analysis were: duration of sickness absence till 100% return to work and recurrent sick leave after initial RTW. Cox regression analyses were conducted with visiting a general health practitioner, physical therapist, or medical specialist during the sick leave period as independent variables. Each regression model was adjusted for variables known to influence health care utilization like age, sex, diagnostic group, pain intensity, functional disability, general health perception, severity of complaints, job control, and physical load at work. Results Patients visiting a medical specialist reported higher pain intensity and more functional limitations and also had a worse health perception at start of the sick leave period compared with those not visiting a specialist. Visiting a medical specialist delayed return to work significantly (HR = 2.10; 95%CI 1.43–3.07). After approximately 8 weeks on sick leave workers visiting a physical therapist returned to work faster than other workers. A recurrent episode of sick leave during the follow up quick was initiated by higher pain intensity and more functional limitations at the moment of fully return to work. Visiting a primary healthcare provider during the sickness absence period did not influence the occurrence of a new sick leave period. Conclusion Despite the adjustment for severity of the musculoskeletal disorder, visiting a medical specialist was associated with a delayed full return to work. More attention to the factor ‘labor’ in the regular healthcare is warranted, especially for those patients experiencing substantial functional limitations due to musculoskeletal disorders.     

Effect of job rotation on need for recovery, musculoskeletal complaints, and sick leave due to musculoskeletal complaints: a prospective study among refuse collectors

BACKGROUND: Job rotation might be an effective preventive measure to reduce the prevalence of musculoskeletal complaints, although its effect has not been yet established. The aim of the present study is to evaluate the effect of job rotation in refuse collecting on need for recovery, prevalence of musculoskeletal complaints, and sick leave due to musculoskeletal complaints. METHODS: A 1-year prospective study among refuse collectors was performed, using standardized questionnaires. Job rotation was performed between collecting two-wheeled containers and driving a refuse truck. The experimental groups of rotating refuse collectors at t(0) and t(1) (group R-R) and non-rotating refuse collectors at t(0) and rotating refuse collectors at t(1) (group NR-R) were compared with a reference group of non-rotating refuse collectors at t(0) and t(1) (group NR-NR). RESULTS: The adjusted need for recovery of group R-R was marginally significantly lower than need for recovery of the reference group. Groups R-R and NR-R had a more than two times higher risk for complaints of the low back than the reference group. No other significant results were found. CONCLUSIONS: Job rotation seemed to coincide with a reduced need for recovery and was associated with an increased risk of low back complaints. No effects were found on sick leave due to musculoskeletal complaints. The results might be influenced by the healthy worker selection effect in the reference group and its inverse in the rotating groups.     

One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers

OBJECTIVES: This study evaluates the effect of two different worksite physical-activity interventions on neck-shoulder symptoms, together with perceived work ability and sick leave among office workers. METHODS: An examiner-blinded randomized controlled trial was conducted with 549 office workers allocated to one of three intervention groups: one with specific resistance training (SRT) of the neck-shoulder region (N=180), one with all-round physical exercise (APE) (N=187), and one which acted as a reference group, which was informed about general health-promoting activities but did not include a physical activity program (N=182). Questionnaires were filled out at baseline and after 1 year of training. RESULTS: The duration and intensity of neck and shoulder symptoms was lower after the specified worksite physical-activity interventions than in the reference group. On an intervention group level, SRT was not more effective than APE in reducing the duration and intensity of neck and shoulder symptoms. However, those asymptomatic at baseline had a significant lower prevalence of neck-shoulder symptoms at follow-up when allocated to the SRT group than placed in the APE group or reference group. At baseline the work ability index (WAI) was close to 90% of the maximum score, and the mean sick leave was 5 days per year, both being unaffected by the interventions. CONCLUSIONS: Different physical-activity interventions were successful in reducing neck-shoulder symptoms, and SRT was superior to APE in the primary prevention of such symptoms. The initially relatively high WAI was the most probable reason for no further increase in WAI. Likewise the mean sick leave the year before the intervention was very low, and it was probably not possible to reduce it further.     

Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain

Aims: To describe the presence of musculoskeletal co-morbidity of the neck and upper extremities among industrial workers with low back pain, and to examine whether it has an impact on healthcare utilisation and sickness absence for low back pain.

Methods: A self administered questionnaire was used to collect data from 505 industrial workers (response 86%).

Results: The 12 month prevalence of low back pain was 50%. Among subjects with low back pain the 12 month prevalence of musculoskeletal co-morbidity of the neck and upper extremities was 68%. Among workers with low back pain, subjects with high pain intensity or disabling low back pain were more likely to have musculoskeletal co-morbidity. In comparison to the subjects who report back pain only, subjects with co-morbidity showed worse general health and health related quality of life. No impact of upper extremity co-morbidity was found on healthcare utilisation, and sickness absence due to low back pain.

Conclusions: This study provides no evidence that musculoskeletal co-morbidity of the neck and upper extremities influences the choice to seek care or take sick leave due to low back pain among industrial manual workers. For occupational health practitioners the finding of a high co-morbidity is important to consider when implementing workplace interventions aimed at the reduction of specific musculoskeletal complaints, since the controls for one musculoskeletal complaint may impact adversely on another musculoskeletal complaint. Researchers who perform low back pain intervention studies using generic health measures, should take into account the impact of musculoskeletal co-morbidity on these measures.

     

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.     

Take some days off,why don't you? Endogenous sick leave and pay

This is a model of endogenous sick leave in the presence of endemic infectious diseases. The prevalence rate elasticity with respect to sick leave is unity, when workers are paid their marginal product, and firms profit maximise. Full information contracts yield a compensating higher wage to the sick than to the healthy workers. Sick leave pay is greater than the healthy working wage. The contracted sick leave period falls with: the external disease transmission, the productivity of the ill, the discomfort when ill on sick leave and reductions in the work discomfort of the ill. Full insurance breaks down under asymmetric information, where implicit contract firms may offer more sick leave than profit maximising firms with the same payment schedule.     

Predictors of changes in sick leave in workers with asthma: a follow-up study

Objective: The aim of this prospective study was to investigate predictors of 1-year changes in sick leave in workers with asthma. Methods: The initial cohort consisted of 111 workers with asthma. One-hundred and one participants completed the follow-up after 1 year. Self-reported sick leave over the past 12 months was reported at baseline and at follow-up. At the start of this study, all participants completed questionnaires on adaptation to functional limitations, psychosocial variables, working conditions, lung function characteristics, disease history characteristics, health complaints and functional limitations, and person characteristics (‘potential predictors’). Three multivariate logistic regression models were calculated, with an increase in sick leave, a decrease in sick leave, and stable high sick leave as dependent (outcome) variables, and the potential predictors as independent (explanatory) variables. Results: An increase in sick leave was predicted by a lower level of education and perceiving more functional limitations in activities of daily life. A decrease in sick leave was predicted by spending all energy at work less often and perceiving fewer health complaints in social activities (adaptation criteria 4 and 5). Stable high sick leave was predicted by less job satisfaction, perceiving more support from the employer and perceiving more health complaints in social activities (adaptation criterion 5). Lung function characteristics, or disease history characteristics were not predictive for changes in sick leave in any of the groups. Conclusion: We conclude that adaptation to functional limitations played a major role in changes in sick leave in workers with asthma. Lung function characteristics hardly played a role.     

Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up

Purpose The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods 168 study participants with sickness absence for 4–16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR?=?0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.     

Health problems lead to considerable productivity loss at work among workers with high physical load jobs

OBJECTIVE: To assess the feasibility and validity of two instruments for the measurement of health-related productivity loss at work. STUDY DESIGN AND SETTING: A cross-sectional study was conducted in two occupational populations with a high prevalence of health problems: industrial workers (n=388) and construction workers (n=182). We collected information on self-reported productivity during the previous 2 weeks and during the last work day with the Health and Labor Questionnaire (HLQ) and the Quantity and Quality instrument (QQ), with added data on job characteristics, general health, presence of musculoskeletal complaints, sick leave, and health-care consumption. For construction workers, we validated self-reported productivity with objective information on daily work output from 19 work site observations. RESULTS: About half the workers with health problems on the last working day reported reduced work productivity (QQ), or 10.7% of all industrial workers and 11.8% of all construction workers, resulting in a mean loss of 2.0 hr/day per worker with reduced work productivity. The proportion of workers with reduced productivity was significantly lower on the HLQ: 5.3% of industrial workers and 6.5% of construction workers. Reduced work productivity on the HLQ and the QQ was significantly associated with musculoskeletal complaints, worse physical, mental and general health, and recent absenteeism. The QQ and HLQ questionnaires demonstrated poor agreement on the reporting of reduced productivity. Self-reported productivity on the QQ correlated significantly with objective work output (r=.48). CONCLUSION: Health problems may lead to considerable sickness presenteeism. The QQ measurement instrument is better understandable, and more feasible for jobs with low opportunities for catching up on backlogs.     

Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention (WDP) interventions in workers with neck pain, whiplash-associated disorders (WAD), or upper extremity disorders. Methods We searched electronic databases from 1990 to 2012. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized and synthesized following best-evidence synthesis methodology. Results Of the 6,359 articles retrieved, 16 randomized controlled trials were eligible for critical appraisal and five were admissible. We found that a return-to-work coordination program (including workplace-based work hardening) was superior to clinic-based work hardening for persistent rotator cuff tendinitis. Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain. Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints. Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms. Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers’ recovery from recent work-related neck and upper extremity complaints. Conclusions At present, no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain, WAD, and upper extremity disorders. Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening. Also, adding computer-prompted breaks to ergonomic and workplace interventions benefits workers’ recovery. The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions.     

Costs, benefits and effectiveness of worksite physical activity counseling from the employer's perspective

OBJECTIVES: This study evaluated the impact of worksite physical activity counseling using cost-benefit and cost-effectiveness analyses. METHODS: Civil servants (N = 299) were randomly assigned to an intervention (N = 131) or control (N = 168) group for 9 months. The intervention costs were compared with the monetary benefits gained from reduced sick leave. In addition, the intervention costs minus the monetary benefits from sick leave reduction were compared with the effects (percentage meeting the public health recommendation for moderate-intensity physical activity, energy expenditure, cardiorespiratory fitness, and upper extremity symptoms). RESULTS: The intervention costs were EUR 430 per participant, and the benefits were EUR 125 due to sick leave during the intervention period, for net total costs of EUR 305 for the intervention. During the same 9-month period the year after the intervention, the benefits from sick leave reduction were EUR 635. No statistically significant differences in costs and benefits were found between the groups. As to the cost-effectiveness, improvement in energy expenditure and cardiorespiratory fitness was observed at higher costs. The point estimates of the cost-effectiveness ratios were EUR 5.2 (without imputation of effect data) and EUR 2.7 (with imputation of effect data) per extra kilocalorie of energy expenditure per day and EUR 235 (without imputation of effect data) and EUR 45.9 (with imputation of effect data) per beat per minute of decrease in submaximal heart rate. CONCLUSIONS: This study does not provide a financial reason for implementing worksite counseling intervention on physical activity on the short-term. However, positive effects were shown for energy expenditure and cardiorespiratory fitness.     

Frequency of musculoskeletal and eye symptoms among computer users at work

Computer users most often complain of the eye and locomotor system disorders. The goal of this paper was to find out the frequency and relation between musculoskeletal and eye symptoms among computer workers.The data on musculoskeletal and eye symptoms were provided by two questionnaires. Forty-nine workers were included in the study. Their mean age was 41 years and average length of service 16 years. The average amount of time they spent in front of computers was 6.73 hours per day. Women spent more time working at a computer per day than men (P=0.025). The most frequent complaint in the past year referred to the upper back pain (30.6 % of the workers). Every fourth worker, i.e. 24.5 % of them experienced neck pain in the past year; women more often than men (P=0.024). A health problem which reduced the range of motion and prompted the workers to ask for sick leave was lower back pain. The relation between eye symptoms and the upper back pain experienced in the past year (P=0.004), and in the last week (P=0.031) was statistically significant.Proper exercises for stretching musculoskeletal system, ergonomic computer equipment, and artificial tears could decrease muscular and eye problems, which in turn could enhance productivity and reduce sick leaves.     

Health of caregivers in child care

BACKGROUND: Child care workers play an important role in caring for children attending child care yet there is little research regarding their health. METHODS: The study consisted of focus groups with child care workers and a survey, conducted as part of a larger study known as the Healthy Child Care Study, which focused on children. The study investigated carers working in formal child care [long day care (LDC) and family day care (FDC)]. RESULTS: Questionnaires to caregivers in centres showed that 86% had taken sick leave in the previous year and 75% of staff had taken leave for infectious illness. Carers in FDC reported that 24% had taken sick leave in the previous year and 12% of carers had taken leave for infectious illness. Of responding caregivers from centres, 22% were cigarette smokers while in FDC homes, 8% of carers smoked. In focus groups, carers reported that their major areas of health concern were stress, infectious illness and physical trauma such as lifting injuries. CONCLUSIONS: Child care workers in LDC took more sick leave than those in FDC but this is not necessarily due to more illness. Child care workers are a diverse and important group that require further research.     

Factors affecting long-term sick leave in an industrial population

Factors affecting long-term absenteeism for non-accident-related sickness leave in a large, remotely located factory (Dead Sea Industry, Israel) were evaluated. About 10% (89 persons) of the workers were found to be on sick leave for more than 20 days/year. This group was designated as high absence workers (HAW). Most of the sickness absence were for repeated short-term leaves due to intercurrent diseases, rather than for continuous periods related to a major or single illness. Average cumulative duration of sick leave in this group was 54 days/year. The average number of spells was 11 per year (4.9 days/spell). There were significantly more HAW among skilled (relative risk, R.R. = 1.6) workers or shift workers (R.R. = 1.3), compared to white collar workers. There were significantly fewer HAW among workers 35–49 years of age (7.6%) than among younger (12.5%) or older workers (13.8%). Except for possible hearing loss in one worker, no occupationally related illness was identified. Sixty-six percent of the HAW took many sick leaves, over 20 days during the year following the study year, and 52% of this group took over 20 days in the preceding year (usually for minor diseases or complaints). This pattern of long-term sickness absence indicates that various socioeconomic factors determine HAW to a greater extent than immediate occupational risks or health problems.This work was partially supported by a grant from the Committee of Prevention, the Israeli Ministry of Labor     

Effect of a general fitness program on musculoskeletal symptoms,clinical status,physiological capacity,and perceived work environment among home care service personnel

The aim of the present controlled study was to evaluate the effect of a general fitness program, performed by an occupational health service, using pre-post assessment for a number of different outcome measures. A total of 160 employees working in the central home care service district of Umeå, Sweden were asked to participate in a program of a 1-year long exercise program. Of the 160 selected, 54 subjects declined to participate and nine subjects were rejected after a medical check up. The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations, questionnaires concerning sociodemography, musculoskeletal and general health complaints and work environment, physiological tests of cardiovascular fitness, and of strength and endurance of shoulder flexors and knee extensors, and registration of sick leave. The subjects were randomly assigned to an exercise (treatment) or control group. The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination, strength/endurance, and fitness. The test schedule was repeated for both groups after 1 year. The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints, better physiotherapy status (less muscle tightness, better neck mobility, and less tender points), increased shoulder strength and increased coordination in thigh muscles. However, the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment (i.e., concerning ergonomy, influence, appreciation and communication with work manager), which might have been due to stress associated with the exercise situation.     

Effects of mailed advice on stress reduction among employees in Japan: a randomized controlled trial.

We conducted a randomized controlled trial (RCT) to examine the effects of mailed advice on reducing psychological distress, blood pressure, serum lipids, and sick leave of workers employed in a manufacturing plant in Japan. Those who indicated higher psychological distress (defined as having GHQ scores of three or greater) in the baseline questionnaire survey (n = 226) were randomly assigned to an intervention group or a control group. Individualized letters were sent to the subjects of the intervention group, informing them of their stress levels and recommending an improvement in daily habits and other behaviors to reduce stress. Eighty-one and 77 subjects in the intervention and control groups, respectively, responded to the one-year follow-up survey. No significant intervention effect was observed for the GHQ scores, blood pressure, serum lipids, or sick leave (p > 0.05). The intervention effect was marginally significant for changes in regular breakfasts and daily alcohol consumption (p = 0.09). The intervention effect was marginally significant for the GHQ scores among those who initially did not eat breakfast regularly (p = 0.06). The study suggests that only sending mailed advice is not an effective measure for worksite stress reduction. Mailed advice which focuses on a particular subgroup (e.g., those who do not eat breakfast regularly) may be more effective.     

An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study

ABSTRACT: BACKGROUND: Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. Methods/design This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients' supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. DISCUSSION: Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. Trial registration NTR2886.