The economic burden of knee and hip osteoarthritis: absenteeism and costs in the Dutch workforce.

BACKGROUND: This study aimed to quantify the absenteeism costs of knee and hip osteoarthritis in the Netherlands for the Dutch workforce and specific groups of workers. METHODS: We used a longitudinal, dynamic database from a large occupational health service in which occupational physicians register information about personal information and sick leave of workers with the diagnosis of knee- and/or hip osteoarthritis. We included all employees aged 15 to 75 years performing paid work and diagnosed with knee and/or hip osteoarthritis. Costs were calculated annually and per episode for different subgroups from an employer's perspective using the Human Capital Approach. In the Netherlands, the employer has to pay 70% of the employee's wage out of pocket for the first two years of sick leave and also for the occupational health care. In this way, employers receive information about the costs of workers on sick leave due to knee or hip osteoarthritis. This might stimulate investments in targeted prevention and work-directed care. RESULTS: For the period 2015-2017, 1399 workers fulfilled the inclusion criteria. An average sick leave episode of knee osteoarthritis had a duration of 186 calendar days and was associated with €15,550 in costs. For hip osteoarthritis these data were 159 calendar days and €12,482 in costs. These costs are particularly high among male workers and workers with a higher number of weekly working hours. The average annual costs for the Dutch workforce due to sick leave for knee and hip osteoarthritis were €26.9 million and €13.8 million, respectively. Sick leave costs decreased for hip and not for knee osteoarthritis during 2015-2017. CONCLUSIONS: Annual sick leave costs due to knee and hip osteoarthritis are about €40 million for the Dutch workforce and approximately twice as high for knee compared to hip osteoarthritis. Average costs per sick leave episode are particularly high among male workers and workers with a higher number of weekly working hours.

The Dynamic Work study: study protocol of a cluster randomized controlled trial of an occupational health intervention aimed at reducing sitting time in office workers.

BACKGROUND: Large volumes of sitting time have been associated with multiple health risks. To reduce sitting time of office workers working for a Dutch insurance company, the Dynamic Work intervention was developed. The primary objective of this paper is to describe the study protocol of the Dynamic Work study, which aims to evaluate if this multicomponent intervention is (cost-)effective in reducing total sitting time on the short-term (≈3 months) and longer-term (≈12 months) compared to usual practice. METHODS/DESIGN: This two-arm cluster randomized controlled trial will recruit 250 desk-based office workers working at different locations of an insurance company in the Netherlands. After baseline measurements, departments will be matched in pairs and each pair will be randomly assigned to the control or intervention condition. The multicomponent intervention contains organizational (i.e. face to face session with the head of the department), work environmental (i.e. the introduction of sit-stand desks and cycling workstations), and individual elements (i.e. counselling and activity/sitting tracker with a self-help program booklet). The counselling involves two group intervention sessions and four on-site department consultations with an occupational physiotherapist. Sitting time (primary outcome), upright time and step counts will be assessed objectively using the activPAL activity monitor at baseline, short-term (approximately 3 months) and longer-term (12 months). Other outcomes will include: self-reported lifestyle behaviours, anthropometrics, work-related outcomes (i.e. absenteeism, presenteeism, work performance, work-related stress), health-related outcomes (i.e. vitality, musculoskeletal symptoms, need for recovery, quality of life), and costs from both company and societal perspective. The study will include economic and process evaluations. DISCUSSION: This study will assess the longer-term (cost-) effectiveness of a multicomponent workplace intervention aimed at reducing sitting time in comparison with usual practice. Furthermore, the process evaluation will provide insights in factors associated with successful implementation of this intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03115645 ; Registered 13 April 2017. Retrospectively registered.

'The End of Sitting' in a public space: observations of spontaneous visitors.

BACKGROUND: Sitting too much has been associated with negative health outcomes. 'The End of Sitting' is a newly developed office landscape that moves away from the traditional chair-desk setup. The landscape aims to reduce sitting time by offering a variety of (supported) standing positions. The aim of this study was to determine the usage of the landscape after being placed in the main entrance hall of the VU University in Amsterdam. METHODS: We observed the number of spontaneous visitors as well as the duration of visits, changes to another location within the landscape, and adopted postures. Using questionnaires reasons (not) to visit the landscape, perceived affordances of the landscape and associations with long-term use were determined. RESULTS: Observed numbers of visitors were relatively low and duration of visits were short, which seemed to indicate visitors were trying out the landscape. The majority of visitors were in an upright position, reflecting the designers' intentions. Visitors indicated that long-term use would be pleasant to them. CONCLUSION: 'The End of Sitting' landscape received positive reactions but number of visits were limited in the few months that it was placed in the university main entrance hall. The landscape might be better suited for designated working or study spaces, for which it was originally intended. It might also be worth to explore the landscapes suitability for short stay environments, such as waiting rooms.

The influence of psychosocial work characteristics on the need for recovery from work: a prospective study among computer workers.

PURPOSE: To investigate the influence of high job demands, low job control, and high social support on need for recovery (NFR) among computer workers. METHODS: Data was obtained from a longitudinal cohort study, including 5 consecutive measurements, with an in-between period of 6 months. General estimating equations analyses were performed to assess the risk for high NFR 6 months later. Odds ratios (ORs) for high NFR were calculated for high job demands, low job control and low social support, separately. Likewise, ORs were calculated for combinations of job demands and job control, as well as for combinations of job demands, job control and social support. RESULTS: High job demands resulted in an increased risk for high NFR 6 months later, particularly in older workers. Low social support showed also an increased risk for future high NFR, but this was not the case for low job control. Furthermore, a combination of high job demands and low job control, as well as a combination of high job demands, low job control and low social support demonstrated an increased risk for future high NFR where older workers showed higher risks. CONCLUSION: This study demonstrated that adverse psychosocial work characteristics predicted future NFR among computer workers.

Effect of two dynamic seat cushions on postural shift, trunk muscle activation and spinal discomfort in office workers.

We investigated the effect of two dynamic seat cushions on postural shift, trunk muscle activation and spinal discomfort. In this repeated-measures study, 30 healthy office workers were randomly assigned to a sequence of three conditions: sitting on a dynamic seat cushion-A, cushion-B and control (no seat cushion). The two dynamic seat cushions had different inflation levels. Participants typed a standard text for an hour and were monitored for postural shift by using a seat pressure mat, transversus abdominis/internal oblique and lumbar multifidus muscles activity by using surface EMG, spinal discomfort by using Borg's CR-10 scale. Two-way repeated ANOVAs showed no statistically significant interaction effects between condition and time on postural shift and muscle activation. Post hoc Bonferroni tests showed that postural shifts and lumbar multifidus activation during sitting on cushion-A were significantly higher (p < 0.01) than in the control and cushion-B conditions. Both cushions reduced spinal discomfort, compared to the control condition (p < 0.05).

Concurrent validity of questions on arm, shoulder and neck symptoms of the RSI QuickScan.

PURPOSE: The objective was to determine the concurrent validity of questions on arm, shoulder and neck symptoms of an Internet-based questionnaire. In addition, the inter-observer reliability of physical examinations by occupational physicians was investigated. METHODS: A total of 160 employees of a Dutch occupational health service were approached, of which 106 participated. Right after the assessment of arm, shoulder and neck symptoms using a self-administered questionnaire, each participant was examined by two occupational physicians. The presence of symptoms in the past 7 days was compared to the physical examinations. The participation of two occupational physicians allowed us to study also the inter-observer reliability. RESULTS: Overall, the concurrent validity of the symptom questions of the questionnaire can be defined as poor to moderate with κ values between 0.16 and 0.53. Detecting the presence of symptoms (p(pos)) could be considered as moderately valid with values below 0.60, but the p(neg) shows that the concurrent validity for detecting the absence of arm, shoulder or neck symptoms can be considered sufficient with values above 0.69. The agreement between occupational physicians can, with a few exceptions, be considered as moderate with κ values below 0.60. The agreement was sufficient for detecting the absence of symptoms (p(neg) > 0.7). CONCLUSIONS: The agreement between the symptom questions of the questionnaire and physical examinations of occupational physicians can be considered as poor to moderate. The results are comparable to what is generally reported in the literature. Future studies should be aimed at gaining more fundamental knowledge about the possible conceptual differences between self-reported symptoms and symptoms assessed using physical examinations. Moreover, it is advisable to improve the inter-observer reliability of physical examinations as applied in the present study.

The predictive validity of the RSI QuickScan questionnaire with respect to arm, shoulder and neck symptoms in computer workers.

The aim of this study was to determine whether results from the RSI QuickScan questionnaire on risk factors for arm, shoulder and neck symptoms can predict future arm, neck and shoulder symptoms in a population of computer workers. For this prospective cohort study, with a follow-up of 24 months, 3383 workers who regularly worked with a computer were approached. Generalised estimating equations (GEE) with 6, 12, 18 and 24 months time lags were used to determine whether high exposure was related to symptoms at follow-up. The results showed that high scores on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up. These results provide support for the predictive validity of the RSI QuickScan questionnaire. PRACTITIONER SUMMARY: The results showed that high scores on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up. The RSI QuickScan questionnaire may be recommended as a tool in the identification of computer workers who should be targeted with interventions aimed at prevention of future symptoms.

Predicting long-term sickness absence among retail workers after four days of sick-listing.

OBJECTIVE: This study tested and validated an existing tool for its ability to predict the risk of long-term (ie, ≥6 weeks) sickness absence (LTSA) after four days of sick-listing. METHODS: A 9-item tool is completed online on the fourth day of sick-listing. The tool was tested in a sample (N=13 597) of food retail workers who reported sick between March and May 2017. It was validated in a new sample (N=104 698) of workers (83% retail) who reported sick between January 2020 and April 2021. LTSA risk predictions were calibrated with the Hosmer-Lemeshow (H-L) test; non-significant H-L P-values indicated adequate calibration. Discrimination between workers with and without LTSA was investigated with the area (AUC) under the receiver operating characteristic (ROC) curve. RESULTS: The data of 2203 (16%) workers in the test sample and 14 226 (13%) workers in the validation sample was available for analysis. In the test sample, the tool together with age and sex predicted LTSA (H-L test P=0.59) and discriminated between workers with and without LTSA [AUC 0.85, 95% confidence interval (CI) 0.83-0.87]. In the validation sample, LTSA risk predictions were adequate (H-L test P=0.13) and discrimination was excellent (AUC 0.91, 95% CI 0.90-0.92). The ROC curve had an optimal cut-off at a predicted 36% LTSA risk, with sensitivity 0.85 and specificity 0.83. CONCLUSION: The existing 9-item tool can be used to invite sick-listed retail workers with a ≥36% LTSA risk for expedited consultations. Further studies are needed to determine LTSA cut-off risks for other economic sectors.

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.

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 NUMBER: NTR1117.

Natural Patterns of Sitting, Standing and Stepping During and Outside Work-Differences between Habitual Users and Non-Users of Sit-Stand Workstations.

Sit-stand workstations have shown to reduce sitting time in office workers on a group level. However, movement behaviour patterns might differ between subgroups of workers. Therefore, the objective of this study was to examine sitting, standing and stepping outcomes between habitual users and non-users of sit-stand workstations. From an international office population based in the Netherlands, 24 users and 25 non-users of sit-stand workstations were included (all had long-term access to these workstations). Using the ActivPAL, sitting, standing and stepping were objectively measured during and outside working hours. Differences in outcomes between users and non-users were analysed using linear regression. During working hours, users sat less (-1.64; 95% IC= -2.27--1.01 hour/8 hour workday) and stood more (1.51; 95% IC= 0.92-2.10 hour/8 hour workday) than non-users. Attenuated but similar differences were also found for total sitting time over the whole week. Furthermore, time in static standing bouts was relatively high for users during working hours (median= 0.56; IQR = 0.19-1.08 hour/8 hour workday). During non-working hours on workdays and during non-working days, no differences were found between users and non-users. During working hours, habitual users of their sit-stand workstation sat substantially less and stood proportionally more than non-users. No differences were observed outside working hours, leading to attenuated but similar differences in total sitting and standing time between users and non-users for total days. This indicated that the users of sit-stand workstations reduced their sitting time at work, but this seemed not to be accompanied by major carry-over or compensatory effects outside working hours.

The user and non-user perspective: Experiences of office workers with long-term access to sit-stand workstations.

OBJECTIVE: Sit-stand workstations have been shown to be effective in reducing sitting time in office workers. The aim of this study was to explore reasons for use and non-use of sit-stand workstations and strategies to decrease sitting and increase physical activity in the workplace from perspectives of users and non-users, as well as from managers and ergo-coaches. METHODS: Six group interviews with employees who have had access to sit-stand workstations for several years were conducted in a large semi-governmental organisation in the Netherlands. Verbatim transcripts were analysed using thematic analysis. Open coding was conducted by three researchers and codes and themes were discussed within the research team. RESULTS: Thematic analysis resulted in two major themes: 1) Reasons for use and non-use and 2) Strategies to increase standing and physical activity in the workplace. Shared and distinct reasons for use and non-use were identified between users and non-users of the sit-stand workstations. The most important reasons for use indicated by users were that they had experiencing immediate benefits, including staying alert and increasing focus; these benefits were not acknowledged by non-users. Non-users indicated that sitting was comfortable for them and that they were therefore not motivated to use the standing option. Strategies to increase the use of the standing option included an introductory phase to become familiar with working while standing and to experience the immediate benefits that come from using the standing option. Furthermore, providing reminders to use the standing option was suggested as a strategy to increase and sustain the use of sit-stand workstations. Increased use may lead to a change in the sitting culture within the organisation, as more employees would adopt active movement behaviours. CONCLUSION: Immediate benefits of the use of the standing option-only mentioned by the users-was the most distinct reason to use sit-stand workstations. Future research should explore how to motivate potential users to adhere to an introductory phase in order to experience these immediate benefits, whether it is linked to the use of sit-stand workstations or other interventions to reduce sitting time.

Effectiveness of the multi-component dynamic work intervention to reduce sitting time in office workers - Results from a pragmatic cluster randomised controlled trial.

OBJECTIVE: Prolonged sitting, which is highly prevalent in office workers, has been associated with several health risks. The aim of this study was to evaluate the Dynamic Work intervention by determining its effect on total sitting time at the 8-month follow-up in comparison to the control. METHODS: This two-arm pragmatic cluster randomised controlled trial included 244 office workers from 14 different departments of a large, Dutch insurance company. The Dynamic Work intervention was a real-life, worksite intervention that included environmental components (i.e. sit-stand workstations), organisational components (i.e. group sessions), and individual components (e.g. activity/sitting trackers). Outcomes were assessed at baseline, 4-month follow-up, and 8-month follow-up. The primary outcome was total sitting time per day, objectively assessed using the activPAL activity monitor at 8-month follow-up. Secondary outcomes included other total and occupational movement behaviour outcomes, health-related outcomes, and work-related outcomes. Data analyses were performed using linear and logistic mixed models. RESULTS: Total sitting time did not differ between the intervention and control group at the 8-month follow-up. Secondary outcomes also showed no difference between the intervention and control group at either the 4-month or at 8-month follow-up, with the exception of number of occupational steps, which showed a statistically significant effect at 4-month follow-up (but not at 8-month follow-up) of 913 (95% CI = 381-1445) steps/8-h working day. CONCLUSIONS: This study evaluated the effectiveness of a real-life worksite intervention to reduce sitting time and showed little to no effect. This may be due to the relatively low intensity of the intervention, i.e. that it only involved the replacement of 25% of sitting workstations with sit-stand workstations. Future research should focus on the evaluation of more intensive real-life worksite interventions that are still feasible for implementation in daily practice. CLINICALTRIALS. GOV, REGISTRATION NUMBER: NCT03115645.

Long-Term Access to Sit-Stand Workstations in a Large Office Population: User Profiles Reveal Differences in Sitting Time and Perceptions.

Background: To decrease the detrimental health effects of prolonged sitting, the implementation of sit-stand workstations is a commonly used intervention for office workers. Most studies on this topic evaluated the effects of newly introduced sit-stand workstations. The objective of this study was to determine how often and how long the standing option is used and how the use of sit-stand workstations is perceived in office workers with long-term access to these workstations. Methods: Using an online survey, 1098 office employees responded to questions about frequency of usage of the sit-stand workstation, sitting time, physical activity, and positive and negative perceptions of the use of the sit-stand workstations. Results: Based on the frequency of use, three user groups were identified: non-users (32.1%), monthly/weekly users (37.5%) and daily users (30.4%). Non-users reported to sit more, stand less and have longer bouts of sitting, compared to monthly/weekly users, and these differences were even larger compared to daily users. A higher proportion of daily users perceived the use of the sit-stand workstation as being more healthy and appealing and making them more productive and energetic compared to the non-users. A higher proportion of the non-users perceived it as being uncomfortable, distracting, and unpractical, compared to the other user groups. Conclusions: The differences between the three identified user groups with respect to sitting, standing and perceptions of sit-stand workstations, might be helpful in tailoring future interventions to reduce occupational sitting time, to increase the reach, effectiveness and sustainability.