Sense of coherence and health in women: a 25-year follow-up study.

BACKGROUND: Health and Sense of Coherence (SOC) has been shown to be intertwined and argued to have a reciprocal relationship. The theory of SOC implies relatively stable scores during adulthood, however there are few longitudinal studies on the association between SOC and mental and somatic health. The main aim of the present study was to examine how SOC and self-rated health (SRH) are related during 25 years of follow-up. METHODS: Using paper questionnaires distributed by postal services, 415 mothers were followed from childbirth and 25 years prospectively. SOC was measured at three, 12 and 25 years after inclusion. Self-reports on health status were obtained at the 25-year follow-up. The association between SOC and self-reported health as well as the effect of sociodemographic factors and experience of stressful life events was assessed through regression models. RESULTS: SOC scores increased between three and 12 years after inclusion, and slightly decreased at the 25-year follow-up. Women of good health had a higher SOC-score at all three measurements compared to women of poor health. Multiple logistic regression showed that the likelihood of reporting good health increased with the number of times the women had reported SOC-scores above the 75th percentile. Moreover, women who had not been through a divorce were close to 60% more likely to report good health compared to women who had been through a divorce, whereas women not reporting stressful life events during the past two years were more than twice as likely to report good health. Symptoms below cut-off for postpartum depression and not having been through a divorce were associated with SOC scores above the 75th percentile. CONCLUSION: This 25-year follow-up study of a cohort of women reports good stability of SOC assessments in the vast majority of women. There was a stronger and more stable SOC in women with better health. The findings are in line with other studies on the predictive value of SOC and self-perceived health.

Exposure to different lengths of sick leave and subsequent work absence among young adults.

BACKGROUND: Sweden has a public and easily accessible sickness insurance. Research shows, however, downsides to taking sick leave. Both short and longer periods of sick leave have been seen to increase the risk for subsequent work absence. The aim of this study was to investigate whether there was an association between sick leave claimed in 1993 and work absence in the subsequent 15 years, i.e. up to 2008. A further aim was to explore differences in this relation with regard to gender, origin and educational level at baseline. METHODS: Our cohort consisted of all immigrants aged 21-25 years in Sweden in 1993 and a control group of native Swedes in the same age group. RESULTS: Subsequent work absence increased from 313 days among persons with no days of claimed sick leave in 1993 to 567 days among persons with 1-7 days of claimed sick leave in 1993. Thereafter there was a lower, but steady increase in days of future work absence, to 611 days among persons with 8-14 days of sick leave claimed in 1993. There was an interaction between sick leave and gender, education and origin respectively regarding later work absence. CONCLUSION: Periods of sick leave claimed were associated with subsequent work absence. Immigrants, women and persons with low education had the most risk of future work absence after a period of sick leave.

A systematic review of studies in the contributions of the work environment to ischaemic heart disease development.

BACKGROUND: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. INCLUSION CRITERIA: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. RESULTS: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. CONCLUSIONS: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

The impact of work related physical activity and leisure physical activity on the risk and prognosis of neck pain - a population based cohort study on workers.

BACKGROUND: The effect of physical activity on risk and prognosis for neck pain has been studied earlier with inconclusive results. There is a need for large prospective studies on the subject. The aim of this study was to investigate if work related physical activity and physical activity during leisure time are of importance for the risk and prognosis of neck pain in men and women. METHODS: We used the Stockholm Public Health Cohort and formed two sub-cohorts of the working population based on data from 2002. Cohort I (risk cohort) included persons without neck pain (n = 4681), and cohort II (prognostic cohort) included persons with occasional neck pain (n = 6820) during the previous six months. Both cohorts were assessed for the outcome long duration troublesome neck pain (LDNP) in 2007. The exposures and potential confounders were assessed through a questionnaire in 2002. The question regarding work related physical activity over the past 12 months had five answering categories ranging from "sedentary" to"heavy". The question regarding leisure physical activity for the past 12 months had five answering categories ranging from "sedentary" to "regular physical activity". LDNP in 2007 was defined as having had troublesome neck pain lasting ≥ 3 consecutive months during the previous five years. Associations between work related physical activity and LDNP, as well as leisure physical activity and LDNP, were investigated by multivariable logistic regression, considering potential confounding factors. RESULTS: In cohort I (risk cohort) we found an association between leisure physical activity and LDNP. In cohort II (prognostic cohort) we found no association between the exposures and the outcome. CONCLUSION: The results suggest that leisure physical activity has a protective effect on the risk of developing LDNP in a population free from neck pain. It did not, however, affect the prognosis of occasional neck pain. Neither the risk nor the prognosis of neck pain was affected by work related physical activity in this study.

Sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income in native Swedes and immigrants.

BACKGROUND: Sickness absence with cash benefits from the sickness insurance gives an opportunity to be relieved from work without losing financial security. There are, however, downsides to taking sickness absence. Periods of sickness absence, even short ones, can increase the risk for future spells of sickness absence and unemployment. The sickness period may in itself have a detrimental effect on health. The aim of the study was to investigate if there is an association between exposure to sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income from work. METHODS: Our cohort consisted of all immigrants aged 21-25 years in Sweden in 1993 (N = 38 207) and a control group of native Swedes in the same age group (N = 225 977). We measured exposure to sickness absence in 1993 with a follow-up period of 15 years. We conducted separate analyses for men and women, and for immigrants and native Swedes. RESULTS: Exposure to ≥60 days of sickness absence in 1993 increased the risk of sickness absence [hazard ratio (HR) 1.6-11.4], unemployment (HR 1.1-1.2), disability pension (HR 1.2-5.3) and death (HR 1.2-3.5). The income from work, during the follow-up period, among individuals with spells of sick leave for ≥60 days in 1993 was around two-thirds of that of the working population who did not take sick leave. CONCLUSIONS: Individuals on sickness absence had an increased risk for work absence, death and lower future income.

Measuring psychosocial exposures: validation of the Persian of the copenhagen psychosocial questionnaire (COPSOQ).

BACKGROUND: The effect of psychosocial work environment on personal and organizational aspects of employees is well-known; and it is of fundamental importance to have valid tools to evaluate them. This study aims to evaluate the reliability and validity of the Persian version of Copenhagen Psychosocial Questionnaire (COPSOQ). METHODS: The questionnaire was translated into Persian and then back translated into English by two translators separately. The wording of the final Persian version was established by comparing the translated versions with the original questionnaire. One hundred three health care workers completed the questionnaire. Chronbach's alpha was calculated, and factor analysis was performed. RESULTS: Factor analysis revealed acceptable validity for the five contexts of the questionnaire. Cronbach's alpha ranged from 0.73 to 0.82 in different contexts. CONCLUSION: This study revealed that the Persian version of COPSOQ is a reliable and valid instrument for measuring psychosocial factors at work.

The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women: a population-based cohort study.

BACKGROUND: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population. METHODS: The study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods ≥ 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups. RESULTS: Compared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women. CONCLUSIONS: Regular leisure time physical activity seems to improve recovery from persistent back pain among women.

Unemployment at a young age and later sickness absence, disability pension and death in native Swedes and immigrants.

BACKGROUND: Youth unemployment is an increasing problem for societies around the world. Research has revealed negative health effects of unemployment, and this longitudinal register-based cohort study examined the relationship between unemployment and later sickness absence, disability pension and death among youth in Sweden. METHOD: The study group of 199,623 individuals comprised all immigrants born between 1968 and 1972 who immigrated before 1990 (25,607) and a random sample of native Swedes in the same age-range (174,016). The baseline year was 1992, and the follow-up period was from 1993 to 2007. Subjects with unemployment benefit in 1990-91, disability pension in 1990-92, severe disorders leading to hospitalization in 1990-92 and subjects who emigrated during follow-up were excluded. RESULTS: Those who were unemployed in 1992 had elevated risk of ≥60 days of sickness absence (OR 1.02-1.49), disability pension (HR 1.08-1.62) and all except native Swedish women had elevated risk of death (HR 1.01-1.65) during follow-up compared with non-unemployed individuals. The risk of future sickness absence increased with the length of unemployment in 1992 (OR 1.06-1.54), and the risk of sickness absence increased over time. A larger part of the immigrant cohort was unemployed at baseline than native Swedes. Selection to unemployment by less healthy subjects may explain part of the association between unemployment and the studied outcomes. CONCLUSION: Unemployment at an early age may influence the future health of the individual. To a society it may lead to increased burdens on the welfare system and productivity loss for many years.

Work and health among immigrants and native Swedes 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality.

BACKGROUND: There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. METHODS: This study included migrants to Sweden since 1960 who were 28-47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. RESULTS: Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. CONCLUSIONS: Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

The long-term effects of naprapathic manual therapy on back and neck pain - results from a pragmatic randomized controlled trial.

BACKGROUND: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the long-term effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system. METHODS: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires. RESULTS: 89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p < or = 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group. CONCLUSIONS: Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain. TRIAL REGISTRATION: Current Controlled Trials ISRCTN56954776.

Excessive body weight and smoking associates with a high risk of onset of plaque psoriasis.

Accumulating evidence indicates that body weight, alcohol and smoking are associated with psoriasis. However, these factors have scarcely been investigated in relation to onset and disease activity at onset of psoriasis. A population-based case-control study was performed including 373 cases with onset of first-time plaque psoriasis within 12 months and matched healthy controls. Psoriasis activity was measured using the Psoriasis Area and Severity Index (PASI). Analyses were performed using conditional logistic regression. In multivariable analyses for each unit increment in body mass index, there was statistically significant 9% increased risk for psoriasis onset and 7% higher risk for increased PASI. Obesity (body mass index > or =30) compared with normal body weight was associated with a two-fold increased risk for psoriasis onset. Smoking was associated with a 70% increased risk for onset, but was not related to PASI. A positive association with alcohol drinking was observed among men, but not among women. No associations were observed for weight gain and use of smokeless tobacco. Our results indicate that excessive body weight and smoking are risk factors for onset of psoriasis and that higher body mass index increases the PASI of plaque psoriasis at onset.

Comparisons between five self-administered instruments predicting sick leaves in a 4-year follow-up.

OBJECTIVES: This study aimed to explore and compare the ability of five instruments for self-rating to predict future sick leave rates. METHODS: In three Swedish municipalities 2,252 employees completed a baseline questionnaire and were followed up for 4 years. Five health-oriented instruments for self-rating were used as potential predictors of the two outcome measures no sick leave at all, and one or more spells of long-term sick leave >or=28 days. Positive and negative predictive values as well as Cox proportional hazard ratios (denoted as RRs) adjusted for age and work type were calculated. RESULTS: The instruments showed no statistical difference in predicting future sick leave for either of the sexes. For no sick leave RRs ranged between 1.27 and 1.52 (women), 1.35 and 1.61 (men); for long-term sick leave RRs ranged between 1.78 and 2.39 (women), 2.87 and 5.53 (men). However, the best prediction of long-term sick leave for men, RR 5.53, 95% confidence interval (CI) 3.37-9.08, was significantly higher than the best prediction for women, RR 2.39, 95% CI 1.97-2.90. CONCLUSION: Prediction of long-term sick leave was better than that of no sick leave, and better among men than among women. There was a tendency for somewhat better prediction of future sick leave by multiple-question instruments, but single-question instruments can very well be used in predicting future sick leaves, and crude analyses stratified by sex can be used for screening purposes.

Healthy migrant effect in the Swedish context: a register-based, longitudinal cohort study.

OBJECTIVES: Studies have found a 'healthy-migrant effect' (HME) among arriving migrants, that is, a better health status compared with others in the home country, but also in comparison with the population in the host country. The aims were to investigate whether the HME hypothesis is applicable to the Swedish context, that is, if health outcomes differed between a group of mainly labour migrants (Western migrants) and a group of mainly refugee/family reunion migrants (non-Western migrants) compared with the native Swedish population, and if there were any correlations between labour market attachment (LMA) and these health outcomes. DESIGN: Register-based, longitudinal cohort study. PARTICIPANTS: The cohort was defined on 31 December 1990 and consisted of all migrants aged 18-47 years who arrived in Sweden in 1985-1990 (n=74 954) and a reference population of native Swedes (n=1 405 047) in the same age span. They were followed for three consecutive 6-year periods (1991-1996, 1997-2002 and 2003-2008) and were assessed for five measures of health: hospitalisation for cardiovascular and psychiatric disorders, mortality, disability pension, and sick leave. RESULTS: Western migrants had, compared with native Swedes, lower or equal HRs for all health measures during all time periods, while non-Western migrants displayed higher or equal HRs for all health measures, except for mortality, during all time periods. Age, educational level, occupation and LMA explained part of the difference between migrants and native Swedes. High LMA was associated with higher HRs for cardiovascular disorders among Western migrants, higher HRs of psychiatric disorders among non-Western migrants and higher HRs of mortality among both migrant groups compared with native Swedes. CONCLUSIONS: There were indications of a HME among Western migrants, while less proof of a HME among non-Western migrants. Stratification for LMA and different migrant categories showed some interesting differences, and measurements of the HME may be inconclusive if not stratified by migrant category or other relevant variables.

Influence of self-reported work conditions and health on full, partial and no return to work after long-term sickness absence.

OBJECTIVES: This study aimed at describing the frequency of full, partial, and no return to work after long-term sick leave and at ascertaining the influence of psychosocial work conditions, work ability and health, reported before the onset of sick leave, on full and partial return to work. METHODS: Altogether 853 public-sector employees in Sweden, mainly women, with at least one sick leave lasting > or = 28 days, were studied. The outcome was the level of sick leave 2 years after the sick leave began. Potential predictors were self-rated health, work ability, and psychosocial work conditions assessed by questionnaire before the sick leave. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by multinomial regression analyses. RESULTS: Altogether 41% of the participants went directly from full sick leave to full return to work; 21% had periods of partial return to work, but, at the 2-year follow-up, were fully back to work; 15% had partial return to work; and 23% were still not working. A relaxed work situation, a combination of low demands and high decision latitude, increased the odds for full (OR 2.72, 95% CI 1.60-4.62) and partial (OR 2.42, 95% CI 1.21-4.85) return to work. Negative consequences of organizational changes were associated with decreased odds for full return to work (OR 0.54, 95% CI 0.38-0.77). Good self-rated health and work ability were associated with full return to work. CONCLUSIONS: Partial return to work often precedes full return to work, but also operates as a long-term solution for remaining occupationally active. Promoting relatively low demands and high decision latitude at work may support both full and partial return to work after long sick leaves.

The same factors influence job turnover and long spells of sick leave--a 3-year follow-up of Swedish nurses.

BACKGROUND: In many countries, a general shortage of nurses is a public health problem, and retention of nurses in active work is a challenge. The aim of this study was to ascertain whether the same individual factors, working conditions and health problems had led to increased probability of both leaving jobs and prolonged sickness absence in a cohort of Swedish nurses over a period of 3 years. METHODS: A baseline questionnaire was answered by 2293 nurses, representing a response rate of 86%. Exposed and unexposed nurses were compared with regard to two outcomes. During the 3-year follow-up, exposed and unexposed nurses were compared with regard to two outcomes: resigning and having at least one sick leave spell that lasted 28 days or longer. RESULTS: We found that 18% of the nurses left their employment, and 16% had sick leave spells > or =28 days. Work in geriatric care, being socially excluded by superiors and/or workmates, negative effects of organizational changes and poor self-rated general health were factors that increased the likelihood of both leaving jobs and long-term sick leave. CONCLUSIONS: The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

Occupational neck and shoulder pain among automobile manufacturing workers in Iran.

BACKGROUND: Work-related musculoskeletal disorders (MSDs) of the upper extremities are a major problem globally, though most relevant studies have been reported from high income countries. AIMS AND METHODS: The prevalence of neck and shoulder pain and its association with work-related physical and psychosocial factors and life style was determined by a cross-sectional survey using the Nordic Musculoskeletal Questionnaire (NMQ) in the largest Iranian car manufacturing company, with more than 18,000 employees. RESULTS: A total of 14,384 (79.8%) of all employees completed the questionnaire. Depending on the questions used to measure neck and shoulder symptoms, the prevalence varied widely (from 20.5% to 3.9%). In the multiple logistic regression model, limited to employees with at least 1 year of work experience, risk indicators for disabling pain of the neck and/or shoulder that remained for male were: duration of employment, high visual demands, repetitive work, sitting position at work, awkward working position, no regular exercise, monotonous work, lack of encouraging organizational culture, and anxiety concerning change. For female repetitive work, sitting position at work and no support if there is trouble at work were the only remaining factors. CONCLUSIONS: The study confirms the effects of physical and psychosocial factors on neck and shoulder symptoms among automobile manufacturing workers in a low to middle income country in spite of the relative youth and job insecurity of the population.

Effect of psychosocial factors on low back pain in industrial workers.

AIM: To test the hypothesis that workplace psychosocial factors such as demand, control, support, job satisfaction and job appreciation can predict the future onset of disabling low back pain (LBP). METHODS: The present study involved a prospective cohort of 4500 Iranian industrial workers. Data were gathered by means of a self-reported questionnaire about LBP, as well as working life exposure, lifestyle factors, social exposures, co-morbidity, life events and psychosomatic complaints in 2004. All new episodes of disabling LBP resulting in medically certified sick leave during the 1-year follow-up registered by occupational health clinic inside the factory. RESULTS: The participation rate was good (85%). A total of 744 subjects reported current LBP (point prevalence cases). A total of 52 (<2%) new episodes of disabling LBP were observed during the 1-year follow-up (incident cases). Male employees reported higher demands, lower control and lower support than female employees. Employees with high demands, low control, job strain, low job satisfaction and low job appreciation showed increased odds ratios, and these results were statistically significant. CONCLUSIONS: Few prospective studies in this field have been published, but all of them are related to industrialized countries. This prospective study suggests the aetiological role of job strain for LBP. The findings of this study indicate a substantial potential for disease prevention and health promotion at the workplace.

Life events and the risk of low back and neck/shoulder pain of the kind people are seeking care for: results from the MUSIC-Norrtalje case-control study.

OBJECTIVE: To expand the knowledge about the occurrence of life events, and how they affect the risk of low back and neck/shoulder pain. DESIGN: A population-based case-control study. SETTING: Men and women 20-59-years old, living in and not working outside the municipality of Norrtälje, Sweden, from November 1993 to November 1997. PARTICIPANTS: Cases (n = 1,148) were defined as all subjects from the study base who sought healthcare for a new episode of low back and/or neck/shoulder pain by any of the care givers in the municipality. Controls (n = 1,700) were selected as a stratified random sample from the study base, considering sex and age. Study subjects were interviewed about life events and critical life changes. Critical life changes were defined as events that brought about a marked psychosocial change. Odds ratios (ORs) associated with different numbers of life events or critical life changes were calculated. RESULTS: Having experienced at least two life events during the preceding 5 years was associated with an increased risk of neck/shoulder pain (OR = 1.6, 95% CI 1.1 to 2.4). At least two critical life changes were associated with an increased risk of neck/shoulder pain (OR = 1.9, 95% CI 1.3 to 2.7). In general, no associations were observed in relation to risk of low back pain. CONCLUSION: Life events and critical life changes are of importance for the risk of neck/shoulder pain of the kind that people are seeking care for. The study provides useful information for clinical practice and for future aetiological research on neck/shoulder pain.

Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial.

OBJECTIVES: To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system. METHODS: Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks. RESULTS: At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD)=27%, 95% confidence interval (CI): 17-37], disability (RD=18%, 95% CI: 7-28), and perceived recovery (RD=44%, 95% CI: 35-53). Separate analysis of neck pain and back pain patients showed similar results. DISCUSSION: This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.