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1.  Work-life conflict and musculoskeletal disorders: a cross-sectional study of an unexplored association 
Background
The health consequences of work-family or rather work-life conflict (WLC) have been studied by numerous researchers. The work-related causes of musculoskeletal disorders (MSD) are also well explored. And stress (at work) has been found to be a consequence of WLC as well as a cause of MSD. But very little is known about a potential association between WLC and MSD and the possible mediating role of stress in this relationship.
Methods
Survey data collected in 2007 among the workforces of four large companies in Switzerland were used for this study. The study population covered 6091 employees. As the exposure variable and hypothesized risk factor for MSD, WLC was measured by using a 10-item scale based on an established 18-item scale on work-family conflict. The outcome variables used as indicators of MSD were (low) back pain and neck/shoulder pain. Stress as the assumed intervening variable was assessed by a validated single-item measure of general stress perception. Correlation coefficients (r), standardized regression coefficients (β) and multiple adjusted odds ratios (OR) were calculated as measures of association.
Results
WLC was found to be quite strongly associated with MSD (β = .21). This association turned out to be substantially confounded by physical strain at work, workload and job autonomy and was considerably reduced but far from being completely eliminated after adjusting for general stress as another identified risk factor of MSD and a proven strong correlate of WLC (r = .44). A significant and relevant association still remained (β = .10) after having controlled for all considered covariates. This association could be fully attributed to only one direction of WLC, namely the work-to-life conflict. In subsequent analyses, a clear gradient between this WLC direction and both types of MSD was found, and proved to be consistent for both men and women. Employees who were most exposed to such work-to-life conflict were also most at risk and showed a fivefold higher prevalence rate (19%-42%) and also an up to sixfold increased relative risk (OR = 3.8-6.3) of suffering greatly from these types of MSD compared with the least exposed reference group showing very low WLC in this direction. Including stress in the regression models again reduced the strength of the association significantly (OR = 1.9-4.1), giving an indication for a possible indirect effect of WLC on MSD mediated by stress.
Conclusion
Future research and workplace interventions for the prevention of MSD need to consider WLC as an important stressor, and the MSD risk factor identified in this study.
doi:10.1186/1471-2474-12-60
PMCID: PMC3073966  PMID: 21410950
2.  Symptomatology of recurrent low back pain in nursing and administrative professions 
European Spine Journal  2007;16(11):1789-1798.
The aim of the present study was to explore if (a) recurrent low back pain (LBP) has different symptomatologies in cases from occupations with predominantly sitting postures compared to cases from occupations involving dynamic postures and frequent lifting and (b) if in the two occupational groups, different factors were associated with the presence of recurrent LBP. Hundred and eleven female subjects aged between 45 and 62 years with a long-standing occupation either in administrative or nursing professions, with and without recurrent LBP were examined. An extensive evaluation of six areas of interest (pain and disability, clinical examination, functional tests, MR examination, physical and psychosocial workplace factors) was performed. The variables from the six areas of interest were analyzed for their potential to discriminate between the four groups of subjects (administrative worker and nurses with and without recurrent LBP) by canonical discriminant analysis. As expected, the self-evaluation of physical and psychosocial workplace factors showed significant differences between the two occupational groups, which holds true for cases as well as for controls (P < 0.01). The functional tests revealed a tendency for rather good capacity in nurses with LBP and a decreased capacity in administrative personnel with LBP (P = 0.049). Neither self completed pain and disability questionnaires nor clinical examination or MR imaging revealed any significant difference between LBP cases from sedentary and non-sedentary occupations. When comparing LBP cases and controls within the two occupational groups, the functional tests revealed significant differences (P = 0.0001) yet only in administrative personnel. The clinical examination on the other hand only discriminated between LBP cases and controls in the nurses group (P < 0.0001). Neither MRI imaging nor self reported physical and psychosocial workplace factors discriminated between LBP cases and controls from both occupational groups. Although we used a battery of tests that have broad application in clinical and epidemiological studies of LBP, a clear difference in the pattern of symptoms between LBP cases from nursing and hospital administration personnel could not be ascertained. We conclude that there is no evidence for different mechanisms leading to non-specific, recurrent LBP in the two occupations, and thus no generalizable recommendations for the prevention and therapy of non-specific LBP in the two professions can be given.
doi:10.1007/s00586-007-0346-6
PMCID: PMC2223334  PMID: 17611784
Low back pain; Nurses; Sedentary work; Physical workplace factors
3.  Long-term effects of supervised physical training in secondary prevention of low back pain 
European Spine Journal  2005;14(6):599-611.
Background and objectives: In the last few years, several studies have focused on short-term treatment effects of exercise therapy. However, there is a lack of knowledge concerning the long-term treatment effects recorded after several years. Hence, this study was performed to investigate the short- and long-term effects of supervised physical training on functional ability, self-rated pain and disability in secondary prevention of low back pain. Methods: One hundred and eighty-three hospital employees with chronic low back pain were randomly assigned either to back school (comparison group), or three-months supervised physical training including a back school (exercise group). Various measurements of functional ability were performed and subjects completed questionnaires on self-rated pain, disability, and general well-being before treatment, immediately after intervention, and at six-months follow-up. At one-year and at ten-years follow-up participants evaluated treatment effectiveness. Results: Out of 183 employees, 148 completed the program. Participation at follow-ups ranged from 66 to 96%. Supervised physical training significantly improved muscular endurance and isokinetic strength during a six-months follow-up, and effectively decreased self-rated pain and disability during a one-year follow-up. At ten-years follow-up the subjects’ assessment of the effectiveness of treatment was significantly better in the exercise group. Conclusions: Supervised physical training effectively improved functional capacity and decreased LBP and disability up to one-year follow-up. The subjects’ positive evaluation of the treatment effect at ten-years follow-up suggests a long-term benefit of training.
doi:10.1007/s00586-004-0873-3
PMCID: PMC3489242  PMID: 15714351
Randomized clinical trial; Supervised physical training; Back school; Hospital employees; Low back pain

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