Standardised 25-Step Traditional Thai Massage (TTM) Protocol for Treating Office Syndrome (OS).

Traditional Thai massage (TTM) is a unique form of whole body massage practiced to promote health and well-being in Thailand since ancient times. The goal of the present study was to create a standardised TTM protocol to treat office syndrome (OS) diagnosed based on the identification of the palpation of at least one so-called myofascial trigger point (MTrP) in the upper trapezius muscle. The new 90 min TTM protocol, which was developed following appropriate review of the literature and in consultation with relevant experts, has 25 distinct steps (20 pressing steps, 2 artery occlusion steps, and 3 stretching steps). Eleven TTM therapists treated three patients each using the new 90 min TTM protocol. All of the therapists reported scores greater than 80% in respect to their satisfaction and confidence to deliver the protocol, and all of the patients gave the treatment a satisfaction score of greater than 80%. The treatment produced a significant reduction in pain intensity measured on a Visual Analogue Scale (VAS), with minimum and maximum values of 0 and 10 cm, of 2.33 cm (95% CI (1.76, 2.89 cm), p < 0.001) and significant increase in pain pressure threshold (PPT) of 0.37 kg/cm2 (95% CI (0.10, 0.64 kg/cm2), p < 0.05). The protocol was revised based on the feedback and the results obtained, and the new standardised TTM protocol will be applied in a randomised control trial (RCT) to compare the efficacy of TTM and conventional physical therapy (PT) for treating OS.

Ecology of musical performance as a model for evaluation and treatment of a musician with a playing related musculoskeletal disorder: A case report.

STUDY DESIGN: Case report BACKGROUND: Musicians with playing related musculoskeletal disorders (PRMD) require complex decision making to interpret examination findings and develop a holistic treatment approach that considers the unique interaction with their instrument. The Ecology of Musical Performance (EMP) model is a novel comprehensive clinical model designed to provide guidance for musician-centered evaluation, goal setting, and intervention planning for musicians with PRMD. PURPOSE OF THE STUDY: To describe the application of EMP in the evaluation and treatment of a pianist with PRMD. METHODS: Clinical documentation and the patient's symptom logs provided data for this study. Special considerations unique to musicians in the initial evaluation as well as a timeline of interventions are presented to illustrate the application of the EMP model for a holistic approach to treatment. RESULTS AND DISCUSSION: The pianist showed an increase in grip strength and self-reported hand function both in daily activities and in piano performance and training. Pain free practice tolerance increased and the patient successfully returned to participation in piano training and performance. CONCLUSION: This case demonstrates how a treatment program can be customized to benefit musicians taking into consideration the complexity introduced by their relationship with music making as a primary meaningful occupation. EMP may support a person-centered approach to musicians with PRMD by aligning with the phenomenology of musical performance and facilitating collaborative goal setting and problem solving.

Nutritional Factors in Occupational Lung Disease.

PURPOSE OF REVIEW: Lung diseases such as asthma and COPD are major public health issues and related to occupational exposures. While therapies to limit the development and progression of these diseases are limited, nutrition interventions could offer potential alternatives to mediate the inflammation associated with these diseases. This is a narrative review of the current state of relevant nutrients on inflammation and respiratory outcomes associated with occupational exposures. RECENT FINDINGS: Relevant nutrients that have been investigated in recent years include omega-3 polyunsaturated fatty acids, zinc, vitamin D, dairy products, and antioxidants. These nutrients have demonstrated the potential to prevent or modify the adverse outcomes associated with occupational exposures, primarily in preclinical studies. Current therapies for respiratory consequences associated with occupational exposures are limited; therefore, addressing strategies for reducing inflammation is important in improving quality of life and limiting health care costs. More human studies are warranted to determine the effectiveness of nutrition as an intervention.

On-site Clinical Care for Professional Dance Companies.

Thirty years ago the introduction of on-site health care for professional dance companies was a novel concept and dance medicine clinicians often had limited on-site hours, restricted treatment space, and small budgets. Companies are now developing fully staffed on-site clinics and backstage care that provide a multidisciplinary approach to dancer health and wellness. On-site dance medicine programs focus on holistic dancer health and preventive care rather than just triage and rehabilitation. Best practice recommendations for care of professional dancer patients allow for streamlined patient care within a network of medical professionals who understand the demands of a professional dance career.

Home-based fundamental approach to alleviate low back pain using myofascial release, stretching, and spinal musculature strengthening during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has caused global adoption of stay-at-home mandates in an effort to curb viral spread. This lockdown has had the unintended consequence of decreasing physical activity, and incidence of low back pain (LBP) is likely to rise as sedentary behavior increases. OBJECTIVE: In this article, we aim to provide a fundamental, novel approach to alleviate LBP including desk worker associated LBP exacerbated during the COVID-19 pandemic. METHODS: Individuals can alleviate their LBP through a simplistic, self-therapeutic approach: myofascial release and stretching of key musculature involved in LBP following a simple technique and associated time domain, as well as a 360-degree strengthening of the muscles surrounding the lower back. Additional muscular strength will support the lower back and lend resilience to aid in the mitigation of pain caused by poor work-related postural positions. RESULTS: We demonstrate several exercises and movements aimed at alleviating LBP. Additionally, we provide a summary graphic which facilitates ease of use of the exercise plan and represents a novel methodology for simple distribution of evidence-based pain reduction strategies. CONCLUSIOS: Through mitigation of sedentary behavior and adoption of the techniques described herein, LBP can be decreased and, in some cases, cured.

Psychological interventions to foster resilience in healthcare professionals.

BACKGROUND: Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes. OBJECTIVES: To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results. SELECTION CRITERIA: Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only). MAIN RESULTS: We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence). AUTHORS' CONCLUSIONS: For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Occupational Lead Poisoning in a Patient with Acute Abdomen and Normocytic Anemia.

We herein report a 24-year-old male construction worker with occupational lead poisoning who presented with acute abdomen and normocytic anemia. The levels of urinary delta-aminolevulinic acid and free erythrocyte protoporphyrin were elevated without any increase in the level of urine porphobilinogen. Detection of an elevated blood lead level of 100 µg/dL confirmed a diagnosis of lead poisoning. Chelation therapy with calcium disodium ethylenediaminetetraacetate resulted in prompt improvement of the clinical symptoms and the blood lead level. Clinicians should be aware that lead poisoning caused by occupational exposure can still occur sporadically in construction workers in Japan.

Branch-like gas in a commercial diver's liver: a case report.

We report the case of a 42-year-old commercial diver who presented with palpitations, arthralgia, tachypnea and vomiting after three hours of repetitive dives to 25-30 meters below sea level (msw). He was diagnosed with severe decompression sickness (Type II DCS) based on his dive history, his abrupt ascent to the surface within minutes, and systemic symptoms with mild hypovolemic shock. Besides remarkable cutis marmorata on the torso, the patient was also found positive for diffuse branch-like pneumatosis in the liver, mesentery and intestines on an abdominal computed tomography (CT). His vitals were relatively stable, with a soft distended abdomen and mild tenderness over the right upper quadrant. He was treated with hyperbaric oxygen (HBO2) treatment in addition to essential crystalloid resuscitation. The abdominal pneumatosis resolved completely after two HBO2 sessions. Post-diving intra-abdominal pneumatosis is a rare complication of DCS. In our case it was difficult for dive doctors to diagnose promptly because an emergency abdominal CT was not a routine for potential DCS cases. We propose that a contrast-enhanced abdominal CT, which usually involves a intravenous injection of imaging agent, should be considered in emergency management of these patients, especially when they present with gastrointestinal symptoms.

Vocal Fatigue-Do Young Speech-Language Pathologists Practice What They Preach?

PURPOSE: Speech-Language Pathologists can be categorized as Level II professional voice users who play the roles of voice therapist or vocal coach to treat voice problems. SLPs may be at the risk of experiencing vocal fatigue due to vocal loading and other contributing factors. The present study was undertaken to find the percentage of SLPs reporting vocal fatigue, the probable factors resulting in vocal fatigue, the measures that are taken to avoid/reduce the occurrence of vocal fatigue, its effect on their professional and personal life and the measures taken to tackle it. RESULTS: The results of this study are based on data collected from 142 SLPs and 50 controls using a questionnaire. 71.13% SLPs reported that they experience vocal fatigue. Some of the contributing factors that are mainly reported are long durations of voice use, voice use for recreational purposes, speaking loudly, frequent throat clearing, lack of adequate hydration and working in noisy or air-conditioned environments. The major symptoms reported were dryness in throat, tightness in neck and shoulder, choking sensation, effortful speech and pain in the throat. 59% SLPs reported that vocal fatigue affected their professional life while 44% SLPs reported that it affects their personal life also to varying degrees. Measures taken to avoid/ reduce the occurrence of vocal fatigue included vocal warm up, break in between sessions, and play activities. Only a few SLPs took intervention measures like ENT consultation, voice therapy, and home remedies. CONCLUSION: SLPs are inevitably at high risk of experiencing vocal fatigue which, if left untreated, will lead to organic voice problems. However, many young SLPs who experience vocal fatigue reported vocal abuse, do not follow vocal hygiene program and do not follow evidence-based preventive or intervention practices to treat vocal fatigue.

The effect of acupressure on quality of life among female nurses with chronic back pain.

BACKGROUND: Chronic back pain is one of the most common work-related diseases and most important of musculoskeletal disorders in nursing professionals and because of the physical and psychological effects, has a significant impact on quality of life (QOL). Acupressure is a holistic form of complementary medicine. This study aimed to investigate the effect of acupressure on QOL among female nurses with chronic back pain. MATERIALS AND METHODS: This randomized single-blind clinical trial was conducted on 50 nurses with chronic back pain working at the selected hospitals in Isfahan, Iran. After convenient sampling, the subjects were randomly allocated, through lottery, to the two groups of experimental (n = 25) and sham (n = 25). In the experimental group, acupressure techniques were performed during 9 sessions, 3 times a week for 14 min for each patient. In the sham group, points within 1 cm of the main points were only touched. Data were collected using the SF36 questioner, before, and immediately, 2 weeks, and 4 weeks after the intervention. Data analysis was performed using SPSS software. RESULTS: Independent t-test showed that the mean total score of QOL before the intervention was not significantly different between the two groups before the intervention (P = .68). However, it was significantly higher in the experimental group compared to the Sham group, immediately, 2 weeks, and 1 month after the intervention (P < .001). CONCLUSIONS: Acupressure on specific points of the foot and back improves back pain and as a result, increases QOL. Therefore, acupressure can be used as a drug-free and low-cost approach without side effects to improve QOL in nurses with chronic back pain.

Musculoskeletal disorders and complaints in professional musicians: a systematic review of prevalence, risk factors, and clinical treatment effects.

PURPOSE: Musicians' practice and performance routines reportedly lead to musculoskeletal complaints and disorders (MCD) that impact their wellbeing and performance abilities. This systematic review aims to assess the prevalence, risk factors, prevention and effectiveness of treatments for MCD in professional musicians and consider the methodological quality of the included studies. METHODS: A systematic literature search was performed in December 2017 using electronic databases and supplemented by a hand search. Case-control studies, cohort studies, cross-sectional studies, interventional studies and case reports investigating the prevalence, risk factors, prevention or treatment effects of MCD in professional musicians or music students (age ≥ 16 years) were included. Quality assessments of the included studies were performed using an adapted version of the "Study Quality Assessment Tools" from the National Heart, Lung, and Blood Institute. RESULTS: One case-control study, 6 cohort studies, 62 cross-sectional studies, 12 interventional studies and 28 case reports were included and assessed for methodological quality. The study designs, terminology, and outcomes were heterogeneous, as the analyses mostly did not control for major confounders, and the definition of exposure was often vague. Therefore, evidence that being a professional musician is a risk factor for MCD as well as the causal relationship between these factors remains low despite the fact that a large number of studies have been performed. CONCLUSIONS: Studies with high internal and external validity regarding the prevalence, risk factors and effectiveness of the prevention or treatment of MCD in professional musicians are still missing. Further high-quality observational and interventional studies are required.

Can Mindfulness Help to Predict Veterans' Mental Health Service Utilization?

Post-9/11 era military veterans are at high risk for posttraumatic stress disorder (PTSD) and depression, but less than half of veterans who screen positive for these disorders seek mental health treatment. Self-stigma of mental illness has emerged as a core barrier to mental health service use (MHSU) in this population. Mindfulness is associated with attention control, nonjudgment, and reduced self-stigma in civilians, but associations between PTSD and depression, mindfulness, self-stigma, and MHSU have never been investigated in military veterans. The present study used a logistic regression modeling strategy to investigate main and interaction effects for PTSD, depression, mindfulness, and self-stigma on MHSU. Study findings demonstrated a positive main effect for PTSD and negative main effects for mindfulness and self-stigma on MHSU, and a positive interaction effect for mindfulness and PTSD on MHSU. Findings suggest that more mindful individuals with PTSD symptoms are more likely to seek mental health services, whereas less mindful individuals with PTSD symptoms are less likely to seek treatment. More research into the potential for mindfulness to enhance MHSU outcomes for military veterans appears warranted.

Exertional Heat Stroke: Pathophysiology, Epidemiology, Diagnosis, Treatment, and Prevention.

Temperature increases due to climate changes and operations expected to be conducted in hot environments make heat-related injuries a major medical concern for the military. The most serious of heat-related injuries is exertional heat stroke (EHS). EHS generally occurs when health individual perform physical activity in hot environments and the balance between body heat production and heat dissipation is upset resulting in excessive body heat storage. Blood flow to the skin is increased to assist in dissipating heat while gut blood flow is considerably reduced, and this increases the permeability of the gastrointestinal mucosa. Toxic materials from gut bacteria leak through the gastrointestinal mucosa into the central circulation triggering an inflammatory response, disseminated intravascular coagulation (DIC), multiorgan failure, and vascular collapse. In addition, high heat directly damages cellular proteins resulting in cellular death. In the United States military, the overall incidence of clinically diagnosed heat stroke from 1998 to 2017 was (mean ± standard deviation) 2.7 ± 0.5 cases/10,000 Soldier-years and outpatient rates rose over this period. The cornerstone of EHS diagnosis is recognition of central nervous dysfunction (ataxia, loss of balance, convulsions, irrational behavior, unusual behavior, inappropriate comments, collapse, and loss of consciousness) and a body core temperature (obtained with a rectal thermometer) usually >40.5°C (105°F). The gold standard treatment is whole body cold water immersion. In the field where water immersion is not available it may be necessary to use ice packs or very cold, wet towels placed over as much of the body as possible before transportation of the victim to higher levels of medical care. The key to prevention of EHS and other heat-related injuries is proper heat acclimation, understanding work/rest cycles, proper hydration during activity, and assuring that physical activity is matched to the Soldiers' fitness levels. Also, certain dietary supplements (DSs) may have effects on energy expenditure, gastrointestinal function, and thermoregulation that should be considered and understood. In many cases over-motivation is a major risk factor. Commanders and trainers should be alert to any change in the Soldier's behavior. Proper attention to these factors should considerably reduce the incidence of EHS.

[The role of transcranial electrostimulation in the treatment of psychosomatic disorders in industrial workers]. / Transkranial'naia élektrostimuliatsiia v lechenii psikhosomaticheskikh rasstroistv u rabotnikov promyshlennogo predpriiatiia.

BACKGROUND: The prevalence of psychosomatic disorders (PD) is steadily increasing from year to year. Suffice it to mention that the appealability for the primary health care during the recent period increased from 20% to 40-49%. Various psychological, pharmacological and physical methods for the treatment of somatoform disorders have been developed. However, the physiotherapeutic methods for the management of psychosomatic disorders remain virtually unexplored. At the same time, the stress-limiting effects of transcranial electrical stimulation (TES) have been convincingly demonstrated. AIM: The objective of the present study was to determine the effectiveness of the treatment of psychosomatic disorders based on the application of transcranial electrostimulation. MATERIAL AND METHODS: We evaluated during 4 months the general functional state (GFS) as well as the psychosomatic and vegetative status (VS) of the employees of the Scientific development and production enterprise 'Splav' including 14 women and 14 men who complained of deterioration of health. All the participants of the study were divided into groups depending on their functional disorders. The patients in one of the groups underwent transcranial electrostimulation. The age of the patients ranged from 36 to 66 years. The mean age of the men and women was 56±1.4 and 48±2.2 years respectively. The study was designed to estimate GFS and VS based on the integral characteristics obtained with the use of the 'Simona 111' hardware-software complex. The complaints of stressful conditions, deteriorated GFS, and psycho-somatic disorders were revealed in the relevant questionnaire studies. The participants of the study were divided into two groups: the main study group and the control group matched for the age and sex of their members. Those of the former group underwent relaxation procedures in the combination with transcranial electrostimulation whereas the control subjects were managed with the use of the relaxation procedures alone. RESULTS: The workers comprising the group with the impaired functional indices and psychosomatic disorders were initially characterized by the moderate or high stress level with the poor general functional state. These parameters as well as the indicators of the vegetative status were significantly improved after the course of transcranial electrical stimulation. Specifically, the activity of the parasympathetic nervous system increased in comparison with the baseline level, the activity of the sympathetic nervous system decreased, and the manifestations of psychosomatic disorders became less pronounced. The authors maintain that these effects were due to the selective activation of the stress-limiting mechanisms operating in the brain that caused normalization of the activity of the vegetative nervous system and the psycho-emotional state of the patients together with the improvement of their general functional condition. CONCLUSION: This study has demonstrated that psychosomatic disorders are especially common among the industrial workers with the poor general functional state of the organism. The clinical data give evidence of the effectiveness of transcranial electrical stimulation for the correction of the functional state and psychosomatic disorders.

Brief mindfulness-based stress management program for a better mental state in working populations - Happy Nurse Project: A randomized controlled trial✰✰.

BACKGROUND: The efficacy of the mindfulness-based stress management program for maintaining a better mental state has not been examined among working populations. We aimed to explore the effectiveness of the brief mindfulness-based stress management program for hospital nurses. METHODS: In a multi-center randomized trial, 80 junior nurses working in hospitals were randomly allocated either to the brief mindfulness-based stress management program or psychoeducation using a leaflet. The program consisted of four 30 min individual sessions conducted by trained senior nurses using a detailed manual. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) at week 26. Secondary outcomes included presence of a major depressive episode; severity of depression, anxiety, insomnia, burnout, and presenteeism; utility scores; and adverse events up to 52 weeks. RESULTS: The mean HADS score of all the participants at baseline was 7.2. At 26 weeks, adjusted mean scores on the HADS score were 7.2 (95% confidence intervals: 5.9, 8. 5) in the program group and 6.0 (4.8, 7.2) in the leaflet group, respectively. The coefficient of the group by time interaction was not statistically significant at -1.41 (-3.35, 0.54; P = 0.156). No significant superiority or inferiority was observed on the other outcomes. LIMITATIONS: We did not manage to recruit the number of participants we initially set out, although our post-hoc analyses showed that this did not lead to changes in our conclusions. CONCLUSIONS: The additive value of the brief mindfulness-based stress management program was not confirmed in mental state and self-evaluated work efficiency.

Interventions in occupational health psychology.

The set of studies in this issue focus on applied interventions in occupational health psychology (OHP), that is, interventions that are intended to treat employee health and well-being problems or prevent these problems from occurring in the first place. An issue regarding many past evaluations of the effectiveness of these treatments was the relatively weak research methods, especially in regard to obtaining comparable groups to study so that internal validity is enhanced. Many of the studies presented here used the classically recommended approach of random assignment to alleviate this potential problem. We can see that there are a variety of types of potential treatments in OHP, including interventions focusing on changing the employee, other people in the employee's workplace (supervisors or coworkers), the employee's job characteristics, or the organization's climate. Although the ultimate criterion variables in OHP are indicators of employee wellness, some studies focused on improving what might theoretically be mediating variables between the interventions and employees' actual health or well-being. These outcomes include reductions of work-nonwork conflict and stigma of mental illness potentially present in the organization, its supervisors, or employees' coworkers. We note that there are probably moderators of the effectiveness of the interventions, so that a treatment may work better in some people, some situations, and some times than others. Finally, it is interesting to note that the interventions and their studies may be geographically concentrated rather than distributed equally around the globe. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Managing sickness absence of patients with musculoskeletal pain - a cross-sectional survey of Scandinavian chiropractors.

Background: Musculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners' practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours. Methods: As part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics. Results: Out of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden (p = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively (p < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work. Conclusions: Whilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a 'return-to-work' rather than a 'stay-at-home' approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.