[A cross-sectional study of physical activity promotion projects and organizational factors in the workplace].

OBJECTIVE: The benefits of physical activity are well-recognized but physical activity promotion projects (PAPP) are not well implemented in workplaces, resulting in an evidence-practice gap. This study identified the organizational factors associated with PAPP in the workplace in Japan. METHODS: A self-administered questionnaire survey was postal mailed to 3,266 listed companies (with ≥ 50 employees) in Japan. The items surveyed included the presence or absence of PAPP and 29 organizational factors. Organizational factors were also extracted from interviews with corporate health managers. The Consolidated Framework for Implementation Research (CFIR) was applied. Multiple logistic regression analysis was conducted with the presence or absence of PAPP as the objective variable, each quartile group (Q1-Q4) of the total number of relevant organizational factors as the explanatory variable, and the basic workplace attributes as the covariate. RESULTS: The analysis covered 301 workplaces. Of these, 98 (32.6%) had implemented PAPP. The adjusted odds ratio for PAPP for each group based on Q1 was 1.88 (0.62-5.70) for Q2, 3.38 (1.21-9.43) for Q3, and 29.69 (9.95-88.59) for Q4. The association between each organizational factor and PAPP was high for the constructs in the 'inner setting' of the CFIR. The observed adjusted odds ratios for these items were: 'there is a precedent for PAPP' 12.50 (6.42-24.34), 'there is a budget for the health department' 10.36 (5.24-20.47), 'understanding of the health department manager' 8.41 (4.43-15.99), 'understanding of workplace management' 7.63 (4.16-14.02), 'employee 7.31 (3.42-15.64), and 'requests from employees' 7.31 (3.42-15.64). CONCLUSION: There was a quantity-response relationship between the number of applicable organizational factors and PAPP. It has been suggested that the expansion of organizational factors may lead to PAPP. In particular, the creation of an internal atmosphere and the promotion of understanding among the people concerned may be useful.

Validity and Reliability of the Japanese Version of the Örebro Musculoskeletal Pain Screening Questionnaire-Short Form for Chronic Low Back Pain.

BACKGROUND: Identifying patients at risk of developing persistent musculoskeletal pain problems with psychosocial aspects is crucial for targeted interventions. The Örebro Musculoskeletal Pain Screening Questionnaire-Short Form (ÖMPSQ-SF) is a valid screening instrument that is widely used for this purpose. OBJECTIVES: The aim of this study was to assess the validity and reliability of the Japanese version of the ÖMPSQ-SF. STUDY DESIGN: Cross-sectional study. SETTING: A Japanese population of voluntary patients in a web-based survey. METHODS: A sample of 262 individuals with chronic low back pain was included to assess the internal consistency and concurrent validity of the Japanese questionnaire. Internal consistency was evaluated by calculating Cronbach's alpha coefficients. Concurrent validity was assessed using the short form of the Short-Form McGill Pain Questionnaire, Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, Pain Disability Assessment Scale, and Patient Health Questionnaire 2 items. Forty-one patients were asked to complete the ÖMPSQ-SF twice, a week apart, to evaluate test-retest reliability. Reliability was evaluated by calculating the intraclass correlation coefficient (ICC). RESULTS: The Cronbach's alpha coefficient and ICC for the ÖMPSQ-SF total score were 0.71 and 0.77, respectively, indicating acceptable internal consistency and reliability. The concurrent validity results showed moderate-to-strong correlations between the ÖMPSQ-SF and other reference questionnaires (r = 0.38-0.65). The ÖMPSQ-SF domains on pain intensity, function, distress, fear-avoidance beliefs, and expectations showed the highest correlations with their counterpart standard questionnaires. LIMITATIONS: Our study included only individuals with chronic low back pain. CONCLUSIONS: The Japanese version of the ÖMPSQ-SF showed acceptable psychometric properties in Japanese adults with chronic low back pain, supporting its use in clinical and research settings.

Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial.

BACKGROUND: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. OBJECTIVE: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)-assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants' adherence to exercises. METHODS: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone's chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). RESULTS: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001). CONCLUSIONS: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. TRIAL REGISTRATION: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307.

Pain Status and Its Association with Physical Activity, Psychological Stress, and Telework among Japanese Workers with Pain during the COVID-19 Pandemic.

Changes in working styles and physical activities, and an increase in psychological stress during the coronavirus disease 2019 (COVID-19) pandemic, may have affected pain conditions among workers with pain; however, these associations are still poorly understood. Therefore, we conducted a web-based, cross-sectional study to investigate these changes among Japanese workers suffering from pain. A total of 1941 workers who were aged 20-64 years and suffered from body pain within 4 weeks prior to the study were included. Information was collected using a self-reported questionnaire between July and August 2020. Among the respondents, 15% reported that their pain worsened during the COVID-19 pandemic. Approximately half of the workers claimed to have decreased physical activity (47%) and increased psychological stress (47%) during the pandemic. Multivariable logistic regression analyses found that telework (odds ratio 2.27, 95% confidence interval 1.68-3.06), decreased physical activity (3.18, 2.38-4.27), and increased psychological stress (2.16, 1.64-2.84) were associated significantly with pain augmentation. The group of workers who participated in telework and had decreased physical activity comprised the highest proportion of those with augmented pain. Our findings suggest that measures, which consider physical activities, psychological aspects, and working styles, to alleviate pain may be required for the working population in the future.

The effects of a two-minute original exercise program supported by the workplace unit on the workers' work engagement: the "Bipoji" exercise.

[Purpose] This study examined whether workplace support of an exercise program would increase the workers' engagement. [Participants and Methods] Employees at two facilities of the Kyoto Industrial Health Association (the Uji branch and the headquarters) were recruited. A survey of 238 employees was conducted. A seminar was held, at the facilities, about the "Bipoji" exercise program and afterward the participants underwent different procedures. The Uji branch (the support group) supported the continuation of the program for two months. At the headquarters (the control group), the individual decided whether to continue the program. Data were collected at the time of the seminar (the baseline) and two months later. A questionnaire measured work engagement using the Utrecht Work Engagement Scale. [Results] At the follow-up, data were collected from 65 people (60.2%) from the support group and 97 people (74.6%) from the control group. The average change in the Utrecht Work Engagement Scale scores was 1.7 and -1.2, for the support group and the control group, respectively. When adjusted for background factors, the change was 1.6 and -1.2, for the support group and the control group, respectively. This indicates a significant increase in work engagement for the support group. [Conclusion] These results suggest that a workplace exercise program can improve work engagement.

Association between high fear-avoidance beliefs about physical activity and chronic disabling low back pain in nurses in Japan.

BACKGROUND: High prevalence of low back pain (LBP) in nurses has been reported globally. Ergonomic factors and work-related psychosocial factors have been focused on as risk factors. However, evidence on the role of fear-avoidance beliefs (FABs) concerning LBP in nurses is lacking. This study examined LBP prevalence and the association between FABs and chronic disabling LBP that interfered with work and lasted ≥ 3 months. METHODS: Female nurses (N = 3066; mean age = 35.8 ± 10.6 years) from 12 hospitals in Japan participated. A self-reported questionnaire was used to collect information on sociodemographics, LBP, work-related factors, and psychological distress. FABs about physical activity were assessed using a subscale from the FAB Questionnaire (score range = 0-24). The participants were asked to choose one of four statements regarding their LBP in the past 4 weeks: 1) I did not have LBP, 2) I had LBP without work difficulty, 3) I had LBP with work difficulty but without requiring absence from work, and 4) I had LBP requiring absence from work. If the participant had LBP in the past 4 weeks, it was also inquired if the LBP had lasted for ≥ 3 months. Chronic disabling LBP was defined as experiencing LBP with work difficulty in the past 4 weeks which had lasted for ≥ 3 months. In the nurses who had experienced any LBP in the past 4 weeks, we examined the association between FABs and experiencing chronic disabling LBP using multiple logistic regression models adjusting for pain intensity, age, body mass index, smoking status, psychological distress, hospital department, weekly work hours, night shift work, and the12 hospitals where the participants worked. RESULTS: Four-week and one-year LBP prevalence were 58.7 and 75.9%, respectively. High FABs (≥ 15) were associated with chronic disabling LBP (adjusted odds ratio = 1.76, 95% confidence interval [1.21-2.57], p = 0.003). CONCLUSIONS: LBP is common among nurses in Japan. FABs about physical activity might be a potential target for LBP management in nurses. TRIAL REGISTRATION: UMIN-CTR UMIN000018087. Registered: June 25, 2015.

Survey on chronic disabling low back pain among care workers at nursing care facilities: a multicenter collaborative cross-sectional study.

Purpose: Care workers at nursing care facilities have a high rate of low back pain (LBP). Although increasing evidence has revealed the important role of psychosocial factors in chronic LBP, factors associated with chronic LBP interfering with work have not been fully investigated in Japanese workers at nursing care facilities. The present study aimed to determine the prevalence of chronic LBP interfering with work and related factors of chronic LBP including psychosocial factors, among workers at nursing care facilities. Material and methods: Eligible participants in the present study were Japanese workers at 95 nursing care facilities in Ishikawa Prefecture (n=2,242). Of these, 1,345 participants completed a self-administered questionnaire that included the following items: individual characteristics, severity of LBP, sleep problem, fear-avoidance beliefs (Tampa Scale for Kinesiophobia: TSK), STarT Back Screening Tool (SBST), fatigue, somatizing tendency, and work-related stress such as job satisfaction, job demand, interpersonal stress at work, and social support. The logistic regression analysis was used to assess factors associated with chronic disabling LBP. Results: Of participants who completed the questionnaires, 159 (11.8%) reported chronic LBP that interfered with their work. The multivariable analysis of related-factors of chronic disabling LBP found statistically significant associations with the following: high score of psychological subscale in SBST (adjusted odds ratio [aOR]: 5.83, 95% confidence interval [CI]: 3.55-9.59), high score of TSK (aOR: 1.08, 95% CI: 1.05-1.13), and high somatizing tendency (aOR: 2.07, 95% CI: 1.31-3.23). Conclusion: Psychological factors, including fear-avoidance beliefs or somatizing tendency, showed significant association with chronic LBP that interfered with work, among workers at nursing care facilities. Our results suggest that these factors would need to be considered in addition to screening for the risk factors of LBP chronicity by SBST when evaluating workers with chronic disabling LBP.

A cooperative support model for cancer therapy and employment balance: from focus-group interviews of health and business professionals.

This study aimed to obtain a comprehensive collection of ideas and opinions from the perspective of various professionals and support providers for cancer treatment and employment balance. We performed a focus group interview, and a model diagram was created using categories created via classification of important items. The focus group interview revealed six strategies aligned with seven issues concerning the support needed to balance cancer treatment and employment. These strategies suggested the importance of not only the way of directly connecting among several specialists but also the presence and the role of the coordinators with their own specialties. Workers with cancer need supportive advices after their initial diagnosis, when returning to work, and after returning to work. After returning to work, a number of problems resulted from the lack of advice at the time of diagnosis or when returning to work. These results emphasized the necessity for the development of early comprehensive system for integrated collaboration between medical institutions, workplaces and other occupational health institutions. The results suggest that a multi-profession collaboration model is necessary to support cancer patients staying at work, which includes the cooperation between medical institutions and their counterparts from occupational health and the patients' employers.

The effect of the 'One Stretch' exercise on the improvement of low back pain in Japanese nurses: A large-scale, randomized, controlled trial.

Objectives: To evaluate the 'One Stretch' exercise's effect on improvements in low back pain (LBP), psychological factors, and fear avoidance in a large number of nurses. Methods: Between July 2015 and June 2016, we performed a prospective, randomized, parallel-group, multi-center study with central evaluations. Eligible patients were randomly assigned (1:1:1 ratio) to either the control group (Group A) or an intervention group (Group B: 30-min seminar about the 'One Stretch' exercise, Group C: B + physical and psychological approaches to LBP treatment). The primary outcome was subjective improvement from baseline to 6 months (improved/unchanged/worsened) and overall exercise habits (good/poor). Results: There were 4767 participants: 1799, 1430, and 1548 in Groups A, B, and C, respectively. We collected data on 3439 participants (949, 706, and 751 in Groups A, B, and C, respectively) at the 6-month follow-up. The improvement rates in Groups A, B, and C were 13.3%, 23.5%, and 22.6%, respectively. The worsened pain rates were 13.0%, 9.6%, and 8.1%, which decreased as the intervention degree increased (the Cochran-Armitage trend test: p < .0001). In Groups A, B, and C, 15.6%, 64.9%, 48.8% of the patients, respectively, exhibited exercise habits. Conclusion: The 'One Stretch' exercise is useful for improving LBP.

Estimated risk for chronic pain determined using the generic STarT Back 5-item screening tool.

OBJECTIVE: The generic STarT Back 5-item screening tool (STarT-G) is used to manage chronic pain in the lower back and elsewhere. This study evaluated the validity of the Japanese version of this generic screening tool. MATERIALS AND METHODS: Japanese participants between the ages of 20 and 64 years completed online surveys regarding pain. Survey reliability was assessed with internal consistency, as calculated using Cronbach's alpha coefficients. Spearman's correlation coefficients were used to evaluate concurrent validity between the STarT-G score and standard reference questionnaires. Associations between STarT-G scores and the presence of a disability due to chronic pain (DCP) were analyzed using receiver operator characteristic (ROC) curves. RESULTS: Analyses ultimately included data obtained from 52,842 Japanese participants (54.4% male) with a mean (standard deviation) age of 47.7 (9.4) years. Approximately 1.5% of participants had DCP, and the mean STarT-G score was 1.2 (1.4). The Cronbach's alpha coefficient was 0.71, indicating an acceptable reliability. The STarT-G score moderately correlated with the pain numerical rating scale (NRS) score (Spearman's correlation coefficient: r = 0.34). When the STarT-G threshold was set at 4, the sensitivity and specificity of the DCP predictive model were 65.8% and 82.4%, respectively, and the area under the ROC was 0.808. CONCLUSION: The STarT-G was internally consistent and was able to distinguish between subjects with and without a DCP. Therefore, the STarT-G can reliably be used in the Japanese population to identify patients with DCP.

[The association between the presence of occupational health nurses at Japanese worksites and health promotion activities].

OBJECTIVES: The purpose of this study was to determine the association between the presence of occupational health nurses and health promotion activities, relative to the number of employees, and the health promotion policies of the companies. METHODS: We investigated 3,266 companies with at least 50 employees listed on the Tokyo Stock Exchange. Questionnaires were sent by mail, and employees in charge of health management or promotion were asked about health promotion activities at their own worksites. Logistic regression analysis was performed with each type of health promotion activity (nutrition, exercise, sleep, mental health, smoking cessation, alcohol consumption reduction, and oral health) as dependent variables, and the presence of an occupational health nurse as the independent variable. The results were adjusted for the type of industry, total number of company employees, presence of company health promotion policies, and the presence of an occupational health physician. RESULTS: Responses were received from 415 companies (response rate: 12.7%). Occupational health nurses were present at 172 companies (41.4%). Health promotion activities such as (in order of frequency) mental health (295 companies, 71.1%), smoking cessation (133, 32.0%), exercise (99, 23.9%), nutrition (75, 18.1%), oral health (49, 11.8%), sleep (39, 9.4%), and alcohol consumption reduction (26, 6.3%) were being conducted. Setting worksites with no occupational health nurse as a reference, the odds ratios of each health promotion activity of a worksite with one or more occupational health nurses were calculated. The odds ratios of mental health (2.43, 95% confidence interval: 1.32-4.48), smoking cessation (3.70, 2.14-6.38), exercise (4.98, 2.65-9.35), nutrition (8.34, 3.86-18.03), oral health (4.25, 1.87-9.62), and alcohol consumption reduction (8.96, 2.24-35.92) were significant. Stratified analysis using the number of worksite employees, 499 or fewer and 500 or more, also showed significantly higher odds ratios of smoking cessation, exercise, and nutrition activities at worksites of both groups. However, the odds ratios were significant for mental health and oral health activities only at worksites with 499 or fewer employees. CONCLUSIONS: At worksites of listed companies around Japan, those with an occupational health nurse carried out more health promotion activities such as nutrition, exercise, mental health, smoking cessation, alcohol consumption reduction, and oral health than those without, even after adjusting for scale of the company and presence of health promotion policies. This result suggests that the posting of an occupational health nurse to a worksite is associated with the conduct of health promotion activities.