Cost and statistical efficiency of posture assessment by inclinometry and observation, exemplified by paper mill work.

Postures at work are paramount in ergonomics. They can be determined using observation and inclinometry in a variety of measurement scenarios that may differ both in costs associated with collecting and processing data, and in efficiency, i.e. the precision of the eventual outcome. The trade-off between cost and efficiency has rarely been addressed in research despite the obvious interest of obtaining precise data at low costs. Median trunk and upper arm inclination were determined for full shifts in 28 paper mill workers using both observation and inclinometry. Costs were estimated using comprehensive cost equations; and efficiency, i.e. the inverted standard deviation of the group mean, was assessed on basis of exposure variance components. Cost and efficiency were estimated in simulations of six sampling scenarios: two for inclinometry (sampling from one or three shifts) and four for observation (one or three observers rating one or three shifts). Each of the six scenarios was evaluated for 1 through 50 workers. Cost-efficiency relationships between the scenarios were intricate. As an example, inclinometry was always more cost-efficient than observation for trunk inclination, except for observation strategies involving only few workers; while for arm inclination, observation by three observers of one shift per worker outperformed inclinometry on three shifts up to a budget of €20000, after which inclinometry prevailed. At a budget of €10000, the best sampling scenario for arm inclination was 2.5 times more efficient than the worst. Arm inclination could be determined with better cost-efficiency than trunk inclination. Our study illustrates that the cost-efficiency of different posture measurement strategies can be assessed and compared using easily accessible diagrams. While the numeric examples in our study are specific to the investigated occupation, exposure variables, and sampling logistics, we believe that inclinometry will, in general, outperform observation. In any specific case, we recommend a thorough analysis, using the comparison procedure proposed in the present study, of feasible strategies for obtaining data, in order to arrive at an informed decision support.

Hybrid office work in women and men: do directly measured physical behaviors differ between days working from home and days working at the office?

OBJECTIVE: We investigated and compared temporal sitting patterns among male and female hybrid office workers when working at the office (WAO), working from home (WFH), and for non-working days (NWD). METHODS: We analyzed data collected in 2020 among 165 hybrid office workers, carrying thigh-worn accelerometers for 938 days in total. Day type (WAO, WFH, or NWD) and time in bed were identified using diaries. Time awake was exhaustively classified as non-sitting time and time sitting in short, moderate, and long bouts. Effects of day type and gender on the 24-h compositions of physical behaviors were analyzed using multilevel linear mixed models. RESULTS: During workdays (both WAO and WFH), workers spent less time in bed and more time sitting, particularly in moderate and long bouts, than during NWD. Time in bed was longer when working from home than when working at the office, and more of the awake time was spent sitting. Differences between WAO and WFH in ratios between short, moderate, and long bouts of sitting were small and inconsistent. Men spent more time sitting than women, and more time in moderate and long sitting bouts relative to short bouts. CONCLUSIONS: When working from home, hybrid office workers sat more during their hours awake compared to when working at the office. Sitting time was larger during working days than during non-working days and was higher in men than in women. These results may contribute to support organizational policies for hybrid work.

Mismatch between actual and preferred extent of telework: cross-sectional and prospective associations with well-being and burnout.

BACKGROUND: This study aimed to determine whether telework mismatch, i.e., lack of fit between actual and preferred extent of telework, is cross-sectionally and prospectively associated with well-being and burnout. METHODS: A questionnaire was sent to employees in a Swedish manufacturing company in November 2020 (baseline) and September 2021 (follow-up). It contained questions about well-being (WHO-5 Well-Being Index) and burnout (Copenhagen Psychosocial Questionnaire III), as well as the preferred extent of telework and extent of telework performed. Telework mismatch was calculated as the difference between the actual and preferred extent of telework. Change in mismatch over time was categorized as 1) less mismatch at follow-up than at baseline, 2) more mismatch at follow-up, and 3) identical levels of mismatch at baseline and follow-up. Multivariate and univariate analyses of variance were used to determine the effects of mismatch and change in mismatch over time on baseline ratings and changes in ratings of well-being and burnout. All analyses were performed with and without adjustment for age, sex, marital status, children, type of employment, commuting time and extent of telework performed. RESULTS: The response rate was 39% at baseline (n = 928, 67% men, mean(SD) age: 45(11) years) and 60% at follow-up (n = 556, 64% men, mean(SD) age: 46(11) years). A cross-sectional association was found between telework mismatch and well-being, showing that employees who teleworked more than they would like reported worse well-being than those who teleworked less than they would like. No statistically significant association was found between telework mismatch and burnout. The ability of telework mismatch at baseline to predict changes in well-being or burnout over 10 months was small and non-significant. No association was found between change in telework mismatch over the 10-month period and corresponding changes in well-being or burnout. CONCLUSION: Our results suggest that telework should be thoughtfully practiced in companies/organizations to avoid negative consequences for employees who already telework more than they prefer. Studies are needed to determine how long-term changes in match between preferred and actual extent of telework is associated with employee well-being, including how the association is modified by the nature of the job and the work environment.

Associations Between Telework Experience and Psychosocial Working Conditions During the COVID-19 Pandemic: A Cross-sectional Analysis Among White-Collar Workers in Sweden.

OBJECTIVES: The aim of the study are to determine to what extent pre-COVID-19 experience of telework was associated with perceived psychosocial working conditions (PWCs; job demands, social support, and influence at work) during the COVID-19 pandemic among white-collar workers in Sweden and to determine to what extent the association depends on demographic factors, organizational tenure, and amount of computer use. METHODS: Cross-sectional questionnaire data from 603 white-collar workers were collected October to December 2020 in an industrial company. RESULTS: In general, telework experience was not significantly associated with PWCs. Women who began teleworking because of COVID-19 reported more job demands than women not teleworking. For those who began teleworking because of COVID-19, managerial support increased with age. CONCLUSIONS: In general, telework experience was not associated with PWCs, but telework due to COVID-19 may have influenced PWCs differently depending on gender and age.

Sedentary behaviour, physical activity, and sleep among office workers during the COVID-19 pandemic: a comparison of Brazil and Sweden.

BACKGROUND: The COVID-19 pandemic has affected the physical behaviours of office workers worldwide, but studies comparing physical behaviours between countries with similar restrictions policies are rare. This study aimed to document and compare the 24-hour time-use compositions of physical behaviours among Brazilian and Swedish office workers on working and non-working days during the pandemic. METHODS: Physical behaviours were monitored over 7 days using thigh-worn accelerometers in 73 Brazilian and 202 Swedish workers. Daily time-use compositions were exhaustively described in terms of sedentary behaviour (SED) in short (< 30 min) and long (≥30 min) bouts, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and time-in-bed. We examined differences between countries using MANOVA on data processed according to compositional data analysis. As Swedish workers had the possibility to do hybrid work, we conducted a set of sensitivity analyses including only data from days when Swedish workers worked from home. RESULTS: During working days, Brazilian office workers spent more time SED in short (294 min) and long (478 min) bouts and less time in LPA (156 min) and MVPA (50 min) than Swedish workers (274, 367, 256 and 85 min, respectively). Time spent in bed was similar in both groups. Similar differences between Brazilians and Swedes were observed on non-working days, while workers were, in general, less sedentary, more active and spent more time-in-bed than during working days. The MANOVA showed that Brazilians and Swedes differed significantly in behaviours during working (p <  0.001, ηp2 = 0.36) and non-working days (p <  0.001, ηp2 = 0.20). Brazilian workers spent significantly more time in SED relative to being active, less time in short relative to long bouts in SED, and more time in LPA relative to MVPA, both during workdays and non-workdays. Sensitivity analyses only on data from days when participants worked from home showed similar results. CONCLUSIONS: During the COVID-19 pandemic Brazilian office workers were more sedentary and less active than Swedish workers, both during working and non-working days. Whether this relates to the perception or interpretation of restrictions being different or to differences present even before the pandemic is not clear, and we encourage further research to resolve this important issue.

Flexible Work: Opportunity and Challenge (FLOC) for individual, social and economic sustainability. Protocol for a prospective cohort study of non-standard employment and flexible work arrangements in Sweden.

INTRODUCTION: Flexibility in working life, including non-standard employment (NSE) and flexible work arrangements (FWAs), offers the organisation a better ability to adapt to changing conditions while also posing considerable challenges for organisations as well as workers. The aim of the Flexible Work: Opportunity and Challenge (FLOC) study is to investigate associations between NSE and FWA on the one hand, and individual, social and economic sustainability on the other. METHODS AND ANALYSIS: This prospective open cohort study targets approximately 8000 workers 18-65 years old in 8-10 public and private organisations in Sweden. We will use a comprehensive battery of measurement methods addressing financial performance, physical and psychosocial exposures, and physical and mental health, both at the organisational and the individual level. Methods include valid survey questionnaires and register data, and, in subpopulations, technical measurements, interviews and diaries. Main exposures are type of employment and type of work arrangement. Main outcomes are indicators of social and economic sustainability and, at the individual level, health and well-being. Data, collected over 54 months at approximately 18-month intervals, will be analysed using multivariate methods considering main effects as well as potential effect modifiers. The analyses will take into account that respondents are nested in organisations, divisions and/or have specific managers. ETHICS AND DISSEMINATION: FLOC is approved by the Swedish Ethical Review Authority (decision numbers 2019-06220, 2020-06094 and 2021-02725). Data will be published in peer-reviewed journals and presented at international conferences, and researchers will assist the organisations in improving policies and routines for employment and organisation of work.

A systematic review of the research on telework and organizational economic performance indicators.

Introduction: A systematic review is conducted in the study to investigate the relationship between telework and organizational economic performance indicators such as self-reported employee performance, organizational performance, actual employee turnover rates, or intentions. Methods: The databases Scopus, Business Source Premier, and Web of Science were used to conduct a literature search. Original articles published from 2000 and up to May 2021 were selected. Studies were screened for inclusion independently by review pairs and data were extracted. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the quality of the studies included. Results: Forty-three studies were included with some addressing multiple outcomes. Self-reported performance was higher for teleworking employees compared to those working in the ordinary workplace. The extent of the change in performance was dependent on individual characteristics and the extent of the teleworking practice in the organization. Telework was also associated with increased organizational performance, particularly in homogenous samples with unique work tasks. When telework is voluntary, it appears that both actual employee turnover rates and intentions to leave the organization are lower. Discussion: Further research with high-quality prospective designs is necessary to properly understand the contribution of telework to organizational economic performance indicators.

Psychophysiological Reactivity, Postures and Movements among Academic Staff: A Comparison between Teleworking Days and Office Days.

The aim of this study was to determine if psychophysiological activity, postures and movements differ during telework (i.e., work performed at home) and work performed at the conventional office. We performed twenty-four-hour pulse recordings and accelerometry measurements on 23 academic teaching and research staff during five consecutive workdays, with at least one day of telework. Additionally, we conducted salivary sampling during one day of telework, and one day of office work. Heart rate and heart rate variability indices, postural exposure and cortisol concentration were analyzed using repeated measures analysis of variance with Workplace and Time (i.e., before, during and after workhours) as within-subject effects. We found a significant interaction effect of Workplace and Time in heart rate variability indices and in the number of transitions between seated and standing postures. This shows more parasympathetic activity among academic teleworkers during telework than office work, which may indicate more relaxation during telework. They had an overall sedentary behavior at both workplaces but switched between sitting and standing more often during telework, which may be beneficial for their health.

Do work ability and life satisfaction matter for return to work? Predictive ability of the work ability index and life satisfaction questionnaire among women with long-term musculoskeletal pain.

BACKGROUND: Impaired work ability and reduced life satisfaction due to long-term musculoskeletal pain, particularly in neck, shoulders and back, are considered occupational health problems that can result in workers taking sick leave. The aim of the study was to determine whether work ability and life satisfaction predict return to work (RTW) among women with long-term neck/shoulder and/or back pain, and to assess the ability of the Work Ability Index (WAI) and the Life Satisfaction Questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW (NRTW). METHODS: This is a cohort study with 1-year follow-up. A survey was sent to 600 women receiving sick leave benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and life satisfaction predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and the LiSat-11 for women who did RTW and those who did NRTW, receiver operating characteristic curves were fitted. RESULTS: Work ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04-1.22). Life satisfaction was not significant. The WAI at baseline adequately discriminated between RTW and NRTW after 1 year (Area under curve 0.78, 95% CI: 0.70-0.86), but the LiSat-11 did not. CONCLUSIONS: This study supports a relationship between work ability and RTW among women on sick leave for long-term neck/shoulder and/or back pain. The results indicate that the WAI, but not the LiSat-11, can discriminate between RTW and NRTW in the population under study. Although the discriminative ability of the WAI needs to be verified in new samples before it can be recommended for use in rehabilitation settings, we suggest that healthcare professionals consider how women perceive their work ability in order to better support them in their RTW.

Working from home during the COVID-19 outbreak in Sweden: effects on 24-h time-use in office workers.

BACKGROUND: The COVID-19 pandemic has triggered national recommendations encouraging people to work from home (WFH), but the possible impact of WFH on physical behaviors is unknown. This study aimed to determine the extent to which the 24-h allocation of time to different physical behaviors changes between days working at the office (WAO) and days WFH in office workers during the pandemic. METHODS: Data were collected on 27 office workers with full-time employment at a Swedish municipal division during the COVID-19 outbreak in May-July 2020. A thigh-worn accelerometer (Axivity) was used to assess physical behavior (sedentary, stand, move) during seven consecutive days. A diary was used to identify periods of work, leisure and sleep. 24-h compositions of sedentary, standing and moving behaviors during work and non-work time were examined using Compositional data analysis (CoDA), and differences between days WAO and days WFH were determined using repeated measures ANOVA. RESULTS: Days WFH were associated with more time spent sleeping relative to awake, and the effect size was large (F = 7.4; p = 0.01; ηp2 = 0.22). The increase (34 min) in sleep time during WFH occurred at the expense of a reduction in work and leisure time by 26 min and 7 min, respectively. Sedentary, standing and moving behaviors did not change markedly during days WFH compared to days WAO. CONCLUSION: Days working from home during the COVID-19 pandemic in Sweden were associated with longer duration of sleep than days working at the office. This behavioral change may be beneficial to health.

Content and psychometric evaluations of questionnaires for assessing physical function in people with low back disorders. A systematic review of the literature.

Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders in the low back. Specifically:Which questionnaires are used to assess physical function in people with musculoskeletal disorders in the low back?What aspects of physical function do those questionnaires measure?What are the measurement properties of the questionnaires?Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations of them. The content of the questionnaires was categorised according to the International Classification of Function, Disability and Health, and the psychometric evaluations were categorised using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist.Results: The questionnaires measured disability or ability to cope in everyday life, rather than physical function as such. Different aspects of a person's mobility and ability to attend to one's personal care were most often included regarding activity and participation. For body functions, items about sleep and pain were most often included. The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.Conclusions: The extent of psychometric evaluations differed substantially, as did the items included. Focus of measurement was predominantly on activities in daily life.Implications for rehabilitationValid and reliable instruments that measure relevant aspects of low back disorders are needed to provide early diagnostics and effective treatment.Most questionnaires need more psychometric evaluations to establish the quality.The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.The results may be useful when making decisions about which measurement instruments to use when evaluating low back disorders.

Trunk and upper arm postures in paper mill work.

The aim of this study was to assess postures and movements of the trunk and upper arm during paper mill work, and to determine the extent to which they differ depending on method of assessment. For each of 28 paper mill workers, postures and movements were assessed during three full shifts using inclinometer registration and observation from video. Summary metrics for each shift, e.g., 10th, 50th, and 90th posture percentile, were averaged across shifts and across workers. In addition, the standard deviation between workers, and the standard deviation between shifts within worker were computed. The results showed that trunk and arm postures during paper mill work were similar to other occupations involving manual materials handling, but the velocities of arm movements were lower. While postures determined by inclinometry and observation were similar on a group level, substantial differences were found between results obtained by the two methods for individual workers, particularly for extreme postures. Thus, measurements by either method on individuals or small groups should be interpreted with caution.

A comparison of standard and compositional data analysis in studies addressing group differences in sedentary behavior and physical activity.

BACKGROUND: Data on time spent in physical activity, sedentary behavior and sleep during a day is compositional in nature, i.e. they add up to a constant value. Compositional data have fundamentally different properties from unconstrained data in real space, and require other analytical procedures, referred to as compositional data analysis (CoDA). Most physical activity and sedentary behavior studies, however, still apply analytical procedures adapted to data in real space, which can lead to misleading results. The present study describes a comparison of time spent sedentary and in physical activity between age groups and sexes, and investigates the extent to which results obtained by CoDA differ from those obtained using standard analytical procedures. METHODS: Time spent sedentary, standing, and in physical activity (walking/running/stair climbing/cycling) during work and leisure was determined for 1-4 days among 677 blue-collar workers using accelerometry. Differences between sexes and age groups were tested using MANOVA, using both a standard and a CoDA approach based on isometric log-ratio transformed data. RESULTS: When determining differences between sexes for different activities time at work, the effect size using standard analysis (η2 = 0.045, p < 0.001) was 15% smaller than that obtained with CoDA (η2 = 0.052, p < 0.001), although both approaches suggested a statistically significant difference. When determining corresponding differences between age groups, CoDA resulted in a 60% larger, and significant, effect size (η2 = 0.012, p = 0.02) than that obtained with the standard approach (η2 = 0.008, p = 0.07). During leisure, results based on standard (age; η2 = 0.007, p = 0.09; sex; η2 = 0.052, p < 0.001) and CoDA (age; η2 = 0.007, p = 0.09; sex; η2 = 0.051, p < 0.001) analyses were similar. CONCLUSION: Results and, hence, inferences concerning age and sex-based differences in time spent sedentary and in physical activity at work differed between CoDA and standard analysis. We encourage researchers to use CoDA in similar studies, to adequately account for the compositional nature of data on physical activity and sedentary behavior.

Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study.

BACKGROUND: Musculoskeletal pain is one of the leading causes of sick leave, especially among women, in Western countries. The aim of the present study was to identify factors associated with work ability and well-being, respectively, among women on sick leave due to long-term pain in the neck/shoulders and/or back. METHODS: A cross-sectional study with a correlational design was conducted on women who were sick-listed due to long-term pain in the neck/shoulders and/or back. A total of 208 participants responded to a survey comprising eight instruments: Multidimensional Pain Inventory scale, General Self-Efficacy scale, Sense of Coherence scale, Coping Strategies Questionnaire, Demand-Control-Support Questionnaire, Hospital Anxiety and Depression Scale, Work Ability Index and Life Satisfaction questionnaire. Multiple linear regression analyses were performed to identify factors associated with work ability and well-being, respectively. RESULTS: Women who more strongly believed they would return to the same work had greater work ability (ß = 0.39, p < 0.001), whereas women with higher pain intensity (ß = - 0.30, p < 0.001) and higher job strain (ß = - 0.12, p < 0.05) had lower work ability. Women with higher self-efficacy rated greater well-being (ß = 0.14, p < 0.05). As the women's scores for depression increased, their well-being decreased by 48%, which was statistically significant (p < 0.001). The regression models for work ability and well-being were significant (p < 0.001), and their adjusted R- square values were 48% and 59%, respectively. CONCLUSIONS: The study suggests that the factors beliefs to be back at the same work, pain intensity and job strain are predictive of work ability. Moreover, the factors self-efficacy and depression seem to be predictive of well-being. The findings highlight factors that should be considered by health care professionals and policy-makers to guide attempts to reduce sick leave.

Uncertainty in monetary cost estimates for assessing working postures using inclinometry, observation or self-report.

OBJECTIVE: To assess uncertainty in cost estimates for collecting posture data by inclinometry, observations and self-report. METHOD: In a study addressing physical workloads at a paper mill, costs were calculated for measuring postures of twenty-eight workers during three shifts. Uncertainty in costs was assessed for all three methods as the range between an assumed best case (lowest cost) and worst case (highest cost) using scenario analysis. RESULTS: The cost for observation was larger, but also more uncertain (€16506 and €89552 in the best and worst case, respectively) than that of inclinometry (€7613 - €45896). Self-report costs were both lower and less uncertain (€3743 - €23368). CONCLUSIONS: The extent of uncertainty in cost estimates implies that observation could be less expensive than inclinometry, e.g., in a scenario where experienced observers could use existing software, while inclinometers would have to be purchased. We propose adding uncertainty assessments to cost estimates when selecting a method for measuring working postures, and offer guidance in how to proceed in a specific setting.

Content and psychometric evaluations of questionnaires for assessing physical function in people with neck disorders: a systematic review of the literature.

PURPOSE: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders (MSD) in the neck. Specifically, we aimed to determine: (1) Which questionnaires are used to assess physical function in people with MSD in the neck? (2) What do those questionnaires measure? (3) What are the measurement properties of the questionnaires? MATERIALS AND METHODS: A systematic review was performed to identify questionnaires and psychometric evaluations. The content of the questionnaires was categorized according to the International Classification of Function, Disability and Health, and the psychometric properties were quality-rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS: Ten questionnaires and 32 articles evaluating measurement properties were analyzed. Most questionnaires covered only the components body functions and activity and participation, more often activity participation than body function. Internal consistency was adequate in most questionnaires, whereas responsiveness was generally low. Neck Disability Index was most evaluated, but the evaluations of all questionnaires tended to cover most properties in the checklist. CONCLUSIONS: The questionnaires differed substantially in items and extent to which their psychometric properties had been evaluated. Focus of measurement was on activities in daily life rather than physical function as such. Implications for Rehabilitation To provide early diagnostics and effective treatment for patients with neck disorders, valid and reliable instruments that measure relevant aspects of the disorders are needed. This paper presents an overview of content and quality of questionnaires used to assess physical function in neck disorders, which may facilitate informed decisions about which measurement instruments to use when evaluating the course of neck disorders. Most of the questionnaires need more testing to judge the quality, however the NDI was the most frequently tested questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments checklist is a useful tool in relation to psychometric testing of questionnaires, but clear definitions of interpretation of the quality criteria in each study would enhance comparability of results.

Is self-reported time spent sedentary and in physical activity differentially biased by age, gender, body mass index, and low-back pain?

Objectives This study aimed to determine the extent to which age, gender, body mass index (BMI) and low-back pain (LBP) influence bias in self-reported sedentary behavior and moderate-to-vigorous physical activity (MVPA) among blue-collar workers. Methods For 2-4 consecutive working days, 147 workers wore an Actigraph accelerometer on the thigh. Proportional time spent sedentary and in MVPA was determined using the Acti4 software. The same variables were also self-reported in a questionnaire. The difference between self-reported and accelerometer-based sedentary time and MVPA was calculated and linearly regressed against age, gender, BMI, and self-reported LBP intensity as main effects, as well as interaction terms combining each of these factors with objectively measured exposure. Results Workers objectively spent 64% of their time sedentary and 9% in MVPA. On average, self-reports underestimated sedentary time by 1.5% and overestimated MVPA by 5.5%. Workers with mild/no LBP appeared to have the same size of self-report bias in MVPA regardless of how much MVPA they actually had, while workers with high LBP overestimated MVPA to an increasing extent with increasing exposure [interaction: B=0.29, 95% confidence interval (CI) 0.05-0.53]. Age was positively associated with self-report bias in sedentary time (B=0.31, 95% CI 0.09-0.54) regardless of actual sedentary time. Conclusions LBP and age, but not BMI and gender, introduced differential bias in self-reported information on sedentary behavior and MVPA among blue-collar workers. This result suggests that bias correction in future studies based on self-reports of sedentary time and MVPA should account for LBP and age.

Factors associated with return to work among people on work absence due to long-term neck or back pain: a narrative systematic review.

OBJECTIVE: The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain. METHODS: A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category. RESULTS: Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW. CONCLUSIONS: Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.

Predicting Directly Measured Trunk and Upper Arm Postures in Paper Mill Work From Administrative Data, Workers' Ratings and Posture Observations.

Objectives: A cost-efficient approach for assessing working postures could be to build statistical models for predicting results of direct measurements from cheaper data, and apply these models to samples in which only the latter data are available. The present study aimed to build and assess the performance of statistical models predicting inclinometer-assessed trunk and arm posture among paper mill workers. Separate models were built using administrative data, workers' ratings of their exposure, and observations of the work from video recordings as predictors. Methods: Trunk and upper arm postures were measured using inclinometry on 28 paper mill workers during three work shifts each. Simultaneously, the workers were video filmed, and their postures were assessed by observation of the videos afterwards. Workers' ratings of exposure, and administrative data on staff and production during the shifts were also collected. Linear mixed models were fitted for predicting inclinometer-assessed exposure variables (median trunk and upper arm angle, proportion of time with neutral trunk and upper arm posture, and frequency of periods in neutral trunk and upper arm inclination) from administrative data, workers' ratings, and observations, respectively. Performance was evaluated in terms of Akaike information criterion, proportion of variance explained (R2), and standard error (SE) of the model estimate. For models performing well, validity was assessed by bootstrap resampling. Results: Models based on administrative data performed poorly (R2 ≤ 15%) and would not be useful for assessing posture in this population. Models using workers' ratings of exposure performed slightly better (8% ≤ R2 ≤ 27% for trunk posture; 14% ≤ R2 ≤ 36% for arm posture). The best model was obtained when using observational data for predicting frequency of periods with neutral arm inclination. It explained 56% of the variance in the postural exposure, and its SE was 5.6. Bootstrap validation of this model showed similar expected performance in other samples (5th-95th percentile: R2 = 45-63%; SE = 5.1-6.2). Conclusions: Observational data had a better ability to predict inclinometer-assessed upper arm exposures than workers' ratings or administrative data. However, observational measurements are typically more expensive to obtain. The results encourage analyses of the cost-efficiency of modeling based on administrative data, workers' ratings, and observation, compared to the performance and cost of measuring exposure directly.