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1.  Design of the Bottom-up Innovation project - a participatory, primary preventive, organizational level intervention on work-related stress and well-being for workers in Dutch vocational education 
BMC Public Health  2013;13:760.
Background
In the educational sector job demands have intensified, while job resources remained the same. A prolonged disbalance between demands and resources contributes to lowered vitality and heightened need for recovery, eventually resulting in burnout, sickness absence and retention problems. Until now stress management interventions in education focused mostly on strengthening the individual capacity to cope with stress, instead of altering the sources of stress at work at the organizational level. These interventions have been only partly effective in influencing burnout and well-being. Therefore, the “Bottom-up Innovation” project tests a two-phased participatory, primary preventive organizational level intervention (i.e. a participatory action approach) that targets and engages all workers in the primary process of schools. It is hypothesized that participating in the project results in increased occupational self-efficacy and organizational efficacy. The central research question: is an organization focused stress management intervention based on participatory action effective in reducing the need for recovery and enhancing vitality in school employees in comparison to business as usual?
Methods/Design
The study is designed as a controlled trial with mixed methods and three measurement moments: baseline (quantitative measures), six months and 18 months (quantitative and qualitative measures). At first follow-up short term effects of taking part in the needs assessment (phase 1) will be determined. At second follow-up the long term effects of taking part in the needs assessment will be determined as well as the effects of implemented tailored workplace solutions (phase 2). A process evaluation based on quantitative and qualitative data will shed light on whether, how and why the intervention (does not) work(s).
Discussion
“Bottom-up Innovation” is a combined effort of the educational sector, intervention providers and researchers. Results will provide insight into (1) the relation between participating in the intervention and occupational and organizational self-efficacy, (2) how an improved balance between job demands and job resources might affect need for recovery and vitality, in the short and long term, from an organizational perspective, and (3) success and fail factors for implementation of an organizational intervention.
Trial registration number
Netherlands Trial Register NTR3284
doi:10.1186/1471-2458-13-760
PMCID: PMC3751794  PMID: 23947538
Stress management; Controlled trial; Need for recovery; Vitality; Occupational self-efficacy; Teachers
2.  Effectiveness of an intervention at construction worksites on work engagement, social support, physical workload, and need for recovery: results from a cluster randomized controlled trial 
BMC Public Health  2012;12:1008.
Background
To prolong sustainable healthy working lives of construction workers, a worksite prevention program was developed which aimed to improve the health and work ability of construction workers. The aim of the current study was to investigate the effectiveness of this program on social support at work, work engagement, physical workload and need for recovery.
Methods
Fifteen departments from six construction companies participated in this cluster randomized controlled trial; 8 departments (n=171 workers) were randomized to an intervention group and 7 departments (n=122 workers) to a control group. The intervention consisted of two individual training sessions of a physical therapist to lower the physical workload, a Rest-Break tool to improve the balance between work and recovery, and two empowerment training sessions to increase the influence of the construction workers at the worksite. Data on work engagement, social support at work, physical workload, and need for recovery were collected at baseline, and at three, six and 12 months after the start of the intervention using questionnaires.
Results
No differences between the intervention and control group were found for work engagement, social support at work, and need for recovery. At 6 months follow-up, the control group reported a small but statistically significant reduction of physical workload.
Conclusion
The intervention neither improved social support nor work engagement, nor was it effective in reducing the physical workload and need for recovery among construction workers.
Trial registration
NTR1278
doi:10.1186/1471-2458-12-1008
PMCID: PMC3534539  PMID: 23171354
Construction industry; Sustainable employability; Intervention study; Empowerment; Physical therapist
3.  The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial 
Background
The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave.
Methods
The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping.
Results
The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found.
Conclusions
In this study, the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies' perspective and, therefore, this study does not provide a financial reason for implementing this intervention. However, with a relatively small investment, the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement.
Trial registration
Trial registration number: NTR1117
doi:10.1186/1471-2474-11-259
PMCID: PMC2994546  PMID: 21070621
4.  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.
doi:10.1136/oem.2010.056267
PMCID: PMC3112366  PMID: 21045214
Computers; neck; upper extremity; longitudinal studies; epidemiology; ergonomics; musculoskeletal; longitudinal studies; video-display units
5.  A worksite prevention program for construction workers: design of a randomized controlled trial 
BMC Public Health  2010;10:336.
Background
A worksite prevention program was developed to promote the work ability of construction workers and thereby prolong a healthy working life. The objective of this paper is to present the design of a randomized controlled trial evaluating the effectiveness of that intervention program compared with usual care for construction workers.
Methods
The study is designed as a randomized controlled trial with a follow-up of one year. Employees eligible for this study are construction workers performing actual construction work. The worksite intervention will be compared with usual care. This intervention was developed by using the Intervention Mapping approach and consists of the following components: (1) two individual training sessions of a physical therapist to lower the physical workload, (2) a Rest-Break tool to improve the balance between work and recovery, and (3) two empowerment training sessions to increase the influence of the construction workers at the worksite. Outcome measures are assessed at baseline, 3, 6, and 12 months. The primary outcome measures of this study are work ability and health-related quality of life. Secondary outcome measures include need for recovery, musculoskeletal complaints, work engagement and self efficacy. Cost-effectiveness will be evaluated from the company perspective. Moreover, a process evaluation will be conducted.
Discussion
The feasibility of the intervention and the study has been enhanced by creating an intervention program that explicitly appeals to construction workers and will not interfere too much with the ongoing construction. The feasibility and effectiveness of this worksite prevention program will be investigated by means of an effect- and a process evaluation. If proven effective, this worksite prevention program can be implemented on a larger scale within the construction industry.
Trial Registration
NTR1278
doi:10.1186/1471-2458-10-336
PMCID: PMC2896359  PMID: 20546568
6.  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
doi:10.1186/1471-2474-11-99
PMCID: PMC2890602  PMID: 20507548
7.  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.
doi:10.1186/1472-6947-9-46
PMCID: PMC2779794  PMID: 19895689
8.  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.
doi:10.1007/s00420-009-0407-8
PMCID: PMC2746892  PMID: 19253020
Muscle strength; Muscle endurance; Muscular capacity; Age-related differences; Aging; Workers
9.  Effectiveness of physical training for self-employed persons with musculoskeletal disorders: a randomized controlled trial 
BMC Public Health  2009;9:200.
Background
Despite the fact that the population of self-employed persons is still growing and at risk for long term disability due to a number of risk factors, there is still a lack of information on the effectiveness of interventions for this specific group.
Methods
To determine the effectiveness of physical training without a cognitive behavioral component and workplace specific exercises (PT) and physical training with a cognitive behavioral component and workplace specific exercises (PTCBWE), we conducted a pragmatic Randomized Controlled Trial, stratified into two groups. Self-employed persons with a new work disability claim because of musculoskeletal disorders were randomized to PT (n = 53) or PTCBWE (n = 76), or to a corresponding usual care group (n = 50 and n = 75 respectively). Both types of training consisted of cardiovascular training, strengthening, relaxation and posture exercises and took place two or three times a week, for 1–1.5 hours, during three months, also if someone had already returned to work full-time. The primary outcome measure was claim duration (in days) during 12 months follow-up. Pain severity and functional status were secondary outcome measures. All data were assessed at baseline and at 6 and 12 months follow-up. The data with regard to claim duration were analyzed by survival analysis and Cox regression analysis. Secondary outcome measures were analyzed by means of linear regression analysis.
Results
After 12 months of follow-up there was no difference in claim duration between PT and usual care (Hazard Ratio 0.7; 95%CI, 0.4–1.1; p = 0.12) or PTCBWE and usual care (Hazard Ratio 0.9; 95%CI, 0.6–1.4; p = 0.72). Both types of physical training and usual care improved in pain and functional status over time, but there was only a statistically significant difference in favor of PT on pain improvement at 6 months.
Conclusion
In this study, physical training with and without a cognitive behavioral component and workplace specific exercises for self-employed persons with musculoskeletal disorders was not shown to be effective on claim duration, pain severity and functional status at 12 months follow-up.
Trial registration
Current Controlled Trials ISRCTN67766245.
doi:10.1186/1471-2458-9-200
PMCID: PMC2709895  PMID: 19549294
10.  Loss of Productivity Due to Neck/Shoulder Symptoms and Hand/Arm Symptoms: Results from the PROMO-Study 
Introduction
The objective of the present study is to describe the extent of productivity loss among computer workers with neck/shoulder symptoms and hand/arm symptoms, and to examine associations between pain intensity, various physical and psychosocial factors and productivity loss in computer workers with neck/shoulder and hand/arm symptoms.
Methods
A cross-sectional design was used. The study population consisted of 654 computer workers with neck/shoulder or hand/arm symptoms from five different companies. Descriptive statistics were used to describe the occurrence of self-reported productivity loss. Logistic regression analyses were used to examine the associations.
Results
In 26% of all the cases reporting symptoms, productivity loss was involved, the most often in cases reporting both symptoms (36%). Productivity loss involved sickness absence in 11% of the arm/hand cases, 32% of the neck/shoulder cases and 43% of the cases reporting both symptoms. The multivariate analyses showed statistically significant odds ratios for pain intensity (OR: 1.26; CI: 1.12–1.41), for high effort/no low reward (OR: 2.26; CI: 1.24–4.12), for high effort/low reward (OR: 1.95; CI: 1.09–3.50), and for low job satisfaction (OR: 3.10; CI: 1.44–6.67). Physical activity in leisure time, full-time work and overcommitment were not associated with productivity loss.
Conclusion
In most computer workers with neck/shoulder symptoms or hand/arm symptoms productivity loss derives from a decreased performance at work and not from sickness absence. Favorable psychosocial work characteristics might prevent productivity loss in symptomatic workers.
doi:10.1007/s10926-007-9095-y
PMCID: PMC2039785  PMID: 17636455
Productivity; Musculoskeletal symptoms; Presenteeism; Computer workers; Psychosocial factors
11.  Prospective research on musculoskeletal disorders in office workers (PROMO): study protocol 
Background
This article describes the background and study design of the PROMO study (Prospective Research on Musculoskeletal disorders in Office workers). Few longitudinal studies have been performed to investigate the risk factors responsible for the incidence of hand, arm, shoulder and neck symptoms among office workers, given the observation that a large group of office workers might be at risk worldwide. Therefore, the PROMO study was designed. The main aim is to quantify the contribution of exposure to occupational computer use to the incidence of hand, arm, shoulder and neck symptoms. The results of this study might lead to more effective and/or cost-efficient preventive interventions among office workers.
Methods/Design
A prospective cohort study is conducted, with a follow-up of 24 months. In total, 1821 participants filled out the first questionnaire (response rate of 74%). Data on exposure and outcome is collected using web-based self-reports. Outcome assessment takes place every three months during the follow-up period. Data on computer use are collected at baseline and continuously during follow-up using a software program.
Discussion
The advantages of the PROMO study include the long follow-up period, the repeated measurement of both exposure and outcome, and the objective measurement of the duration of computer use. In the PROMO study, hypotheses stemming from lab-based and field-based research will be investigated.
doi:10.1186/1471-2474-7-55
PMCID: PMC1550718  PMID: 16822300

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