Mikkel Brandt

Effect of workplace- versus home-based physical exercise on musculoskeletal pain among healthcare workers: a cluster randomized controlled trial.

OBJECTIVE Numerous studies has shown that regular physical exercise can reduce musculoskeletal pain, but the optimal setting to achieve high adherence and effectiveness remains unknown. This study investigated the effect of workplace versus home-based physical exercise on musculoskeletal pain among healthcare workers. METHODS The randomized controlled trial (RCT) comprised 200 female healthcare workers from 18 departments at 3 hospitals. Participants were randomly allocated at the cluster level to ten weeks of: (i) workplace physical exercise (WORK) performed during working hours for 5×10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed during leisure time for 5×10 minutes per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. Average pain intensity (0-10 scale) in the low back and neck/shoulder was the primary outcome. RESULTS Per week, 2.2 (SD 1.1) and 1.0 (SD 1.2) training sessions were performed in WORK and HOME groups, respectively. Pain intensity, back muscle strength and use of analgesics improved more following WORK than HOME (P<0.05). Between-group differences at follow-up (WORK versus HOME) was -0.7 points for pain intensity [95% confidence interval (95% CI) -1.0- -0.3], 5.5 Nm for back muscle strength (95% CI 2.0-9.0), and -0.4 days per week for use of analgesics (95% CI -0.7- -0.2). The effect size for between-group differences in pain intensity was small (Cohens d=0.31). CONCLUSIONS Workplace physical exercise is more effective than home-based exercise in reducing musculoskeletal pain, increasing muscle strength and reducing the use of analgesics among healthcare workers.

Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial.

Background Adolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries. Aim This study evaluated the effects of evidence-based lower extremity injury prevention training on neuromuscular and biomechanical risk factors for non-contact ACL injury. Methods 40 adolescent female football and handball players (15–16 years) were randomly allocated to a control group (CON, n=20) or neuromuscular training group (NMT, n=20). The NMT group performed an injury prevention programme as a warm-up before their usual training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated: (1) EMG amplitude from vastus lateralis (VL), semitendinosus (ST) and biceps femoris 10 ms prior to initial contact (IC) normalised to peak EMG amplitude recorded during maximal voluntary isometric contraction and (2) VL-ST EMG preactivity difference during the 10 ms prior to foot contact (primary outcome). We measured maximal knee joint valgus moment and knee valgus angle at IC. Results There was a difference between groups at follow-up in VL-ST preactivity (43% between-group difference; 95% CI 32% to 55%). No between-group differences were observed for kinematic and kinetic variables. Conclusions A 12-week injury prevention programme in addition to training and match play in adolescent females altered the pattern of agonist-antagonist muscle preactivity during side cutting. This may represent a more ACL-protective motor strategy.

Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial

OBJECTIVE Imbalance between work demands and individual resources can lead to musculoskeletal disorders and reduced work ability. The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability. METHODS Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were randomly allocated to 10 weeks of either strength training for the shoulder, arm, and hand muscles (3 times per week, 10 minutes per session) or ergonomic training (usual care control group) from September to December 2012. The outcome measure was the change from baseline to 10-week follow-up in the work ability index (WAI). RESULTS A priori hypothesis testing showed a group×time interaction for WAI (P<0.05). Compared with the ergonomic training group, WAI increased 2.3 [95% confidence interval (95% CI) 0.9-3.7] in the strength training group corresponding to a moderate effect size (Cohens d 0.52). Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group. Of the 7 items of WAI, item 2 (work ability in relation to the demands of the job) and item 7 (mental resources) increased following strength training compared with ergonomic training (P<0.05). CONCLUSIONS Implementation of strength training at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks. Thus, strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se.

High Intensity Physical Exercise and Pain in the Neck and Upper Limb among Slaughterhouse Workers: Cross-Sectional Study

Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand/wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49–0.997), whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present study can be used as general reference of pain in the neck and upper extremity among slaughterhouse workers. Future studies should investigate the effect of high intensity physical exercise on neck and upper limb pain in slaughterhouse workers.

Association between Neck/Shoulder Pain and Trapezius Muscle Tenderness in Office Workers

Background. Neck/shoulder pain is a common musculoskeletal disorder among adults. The pain is often assumed to be related to muscular tenderness rather than serious chronic disease. Aim. To determine the association between neck/shoulder pain intensity and trapezius muscle tenderness in office workers. Methods. 653 employees from two large office workplaces in Copenhagen, Denmark, replied to a questionnaire on health and working conditions (mean: age 43 years, body mass index 24 kg·m−2, computer use 90% of work time, 73% women). Respondents rated intensity of neck/shoulder pain during the previous three months on a scale of 0–10 and palpable tenderness of the upper trapezius muscle on a scale of “no tenderness,” “some tenderness,” or “severe tenderness.” Odds ratios for tenderness as a function of neck/shoulder pain intensity were determined using cumulative logistic regression controlled for age, gender, and chronic disease. Results. The prevalence of “no,” “some,” and “severe” tenderness of the trapezius muscle was 18%, 59%, and 23% in women and 51%, 42%, and 7% in men, respectively (chi-square, P < 0.0001). Participants with “no,” “some,” and “severe” tenderness of the trapezius muscle, respectively, rated their neck/shoulder pain intensity to 1.5 (SD 1.6), 3.8 (SD 2.0), and 5.7 (SD 1.9) for women and 1.4 (SD 1.4), 3.1 (SD 2.2), and 5.1 (SD 1.7) for men. For every unit increase in neck/shoulder pain intensity, the OR for one unit increase in trapezius tenderness was 1.86 (95% confidence interval 1.70 to 2.04). Conclusion. In office workers, a strong association between perceived neck/shoulder pain intensity and trapezius muscle tenderness exists. The present study provides reference values of pain intensity among office workers with no, some, and severe tenderness of the trapezius muscle.

Effect of physical exercise on workplace social capital: Cluster randomized controlled trial

Aims: While workplace health promotion with group-based physical exercise can improve workers’ physical health, less is known about potential carry-over effects to psychosocial factors. This study investigates the effect of physical exercise on social capital at work. Methods: Altogether, 200 female healthcare workers (nurses and nurse’s aides) from 18 departments at three hospitals were randomly allocated at the department level to 10 weeks of (1) group-based physical exercise at work during working hours or (2) physical exercise at home during leisure time. At baseline and follow-up, participants replied to a questionnaire concerning workplace social capital: (1) within teams (bonding); (2) between teams (bridging); (3) between teams and nearest leaders (linking A); (4) between teams and distant leaders (linking B). Results: At baseline, bonding, bridging, linking A and linking B social capital were 74 (SD 17), 61 (SD 19), 72 (SD 22) and 70 (SD 18), respectively, on a scale of 0–100 (where 100 is best). A group by time interaction was found for bonding social capital (P=0.02), where physical exercise at work compared with physical exercise during leisure time increased 5.3 (95% confidence interval 2.3– 8.2)(effect size, Cohen’s d = 0.31) from baseline to follow-up. For physical exercise at home during leisure time and exercise at work combined, a time effect (P=0.001) was found for linking A social capital, with a decrease of 4.8 (95% confidence interval 1.9–7.6). Conclusions: Group-based physical exercise at work contributed to building social capital within teams at the workplace. However, the general decrease of social capital between teams and nearest leaders during the intervention period warrants further research.

Physical exercise at the workplace prevents deterioration of work ability among healthcare workers: cluster randomized controlled trial

BackgroundImbalance between individual resources and work demands can lead to musculoskeletal disorders and reduced work ability. The purpose of this study was to investigate the effect of workplace- versus home-based physical exercise on work ability among healthcare workers.MethodsTwo hundred female healthcare workers (Age: 42.0, BMI: 24.1, work ability index [WAI]: 43.1) from 18 departments at three Danish hospitals participated (Copenhagen, Denmark, Aug 2013—Jan 2014). Participants were randomly allocated at the cluster level to 10 weeks of: 1) workplace physical exercise (WORK) performed during working hours for 5x10 min per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or 2) home-based physical exercise (HOME) performed during leisure time for 5x10 min per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. The main outcome measure was the change from baseline to 10-week follow-up in WAI.ResultsSignificant group by time interaction was observed for WAI (p < 0.05). WAI at follow-up was 1.1 (0.3 to 1.8) higher in WORK compared with HOME corresponding to a small effect size (Cohens’d = 0.24). Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in HOME. Of the seven items of WAI, item 2 (work ability in relation to the demands of the job) and item 5 (sickness absence during the past year) were improved in WORK compared with HOME (P < 0.05).ConclusionsPerforming physical exercise together with colleagues at the workplace prevents deterioration of work ability among female healthcare workers.Trial registration numberClinicalTrials.gov NCT01921764. Registered 10 August 2013.

Physical exercise at the workplace reduces perceived physical exertion during healthcare work: cluster randomized controlled trial:

Background: High physical exertion during work is a risk factor for musculoskeletal pain and long-term sickness absence. Physical exertion (RPE) reflects the balance between physical work demands and physical capacity of the individual. Thus, increasing the physical capacity through physical exercise may decrease physical exertion during work. This study investigates the effect of workplace-based versus home-based physical exercise on physical exertion during work (WRPE) among healthcare workers. Methods: 200 female healthcare workers (age: 42.0, body mass index: 24.1, average pain intensity: 3.1 on a scale of 0 to 10, average WRPE: 3.6 on a scale of 0 to 10) from 18 departments at three participating hospitals. Participants were randomly allocated at the cluster level to 10 weeks of: (1) workplace physical exercise (WORK) performed in groups during working hours for 5×10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (2) home-based physical exercise (HOME) performed during leisure time for 5×10 minutes per week. Physical exertion was assessed at baseline and at 10-week follow-up. Results: 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. Physical exertion was reduced more in WORK than HOME (p<0.01). Between-group differences in physical exertion at follow-up (WORK vs. HOME) was −0.5 points (95% CI −0.8 to −0.2). Within-group effect size (Cohen’s d) in WORK and HOME was 0.43 and 0.13, respectively. Conclusions: Physical exercise performed at the workplace appears more effective than home-based exercise in reducing physical exertion during daily work tasks in healthcare workers.

Participatory intervention with objectively measured physical risk factors for musculoskeletal disorders in the construction industry: study protocol for a cluster randomized controlled trial

BackgroundThere is high prevalence of back pain and neck-shoulder pain among blue collar workers in Denmark. Excessive physical exposures such as heavy lifting or working with bended or twisted back are risk factors for back pain among workers in the construction industry. Technical evaluation of awkward postures and kinematics of upper/ lower extremities (accelerometry) during work combined with the level of muscular activity (EMG) and video recordings can improve quantification of physical exposure and thereby can facilitate designing preventive strategies. Participatory ergonomics potentially increase the success of interventions aimed at reducing excessive physical exposures. The objectives of this study are to; 1) determine which work-tasks in selected job-groups involve excessive physical load of the back and shoulders during a normal working day (measured with accelerometers, EMG and video recordings). And 2) investigate whether a participatory intervention can reduce the excessive physical workloads, drawing on measurements from phase 1.Methods/DesignA two-armed parallel-group, single-blind, cluster randomized controlled trial with allocation concealment will be conducted in the Danish construction industry. Approximately 20 construction gangs (≈80 subjects) will be recruited and randomized at the cluster level (gang). We will record in situ physical workload using technical measurements (EMG, accelerometers and video recordings) during a working day before and after the intervention. Based on these measurements a physical load matrix for each worker will be developed.The participatory intervention consist of three workshops: 1) One at baseline, involving presentation of video clips of the work-tasks with excessive physical load customized for each gang, followed by a participatory development of solutions on how to reduce excessive workloads, leading to development of an action plan on how to implement these solutions at the workplace. 2) A second workshop where the implemented solutions will be further developed and qualitatively evaluated during group discussions. 3) A final workshop at follow-up to enhance long-time organizational sustainability of the implemented solutions.DiscussionThe results will provide knowledge about the level of physical exposure of the back and shoulders during specific work tasks in the construction industry, and will provide information on options to implement participatory interventions aiming at reducing excessive physical workload.Trial registrationClinicalTrials.gov (NCT02498197), registered 29 June 2015.

Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain, stress and work ability among laboratory technicians: randomized controlled trial protocol

BackgroundAmong laboratory technicians, the prevalence of neck and shoulder pain is widespread possibly due to typical daily work tasks such as pipetting, preparing vial samples for analysis, and data processing on a computer including mouse work - all tasks that require precision in motor control and may result in extended periods of time spent in static positions.In populations characterized by intense chronic musculoskeletal pain and diagnosed conditions in conjunction with psycho-physiological symptoms such as stress-related pain and soreness and other disabling conditions, multifactorial approaches applying a combination of individually tailored physical and cognitive strategies targeting the areas most needed, may be an effective solution to the physical and mental health challenges.The aim of this study is therefore to investigate the effect of an individually tailored biopsychosocial intervention strategy on musculoskeletal pain, stress and work disability in lab technicians with a history of musculoskeletal pain at a single worksite in Denmark.Methods/designIn this single-blind two-armed parallel-group randomized controlled trial with allocation concealment, participants receive either an individualized multifactorial intervention or “usual care” for 10 weeks at the worksite. Inclusion criteria: 1) female laboratory technician (18-67 years of age) and 2) Pain intensity ≥ 3 (0-10 Visual Analogue Scale) lasting ≥3 months with a frequency of ≥ 3 days per week in one or more of the following regions: i) upper back i) low back iii) neck, iv) shoulder, v) elbow and/or vi) hand. Exclusion criteria: 1) life-threatening disease and 2) pregnancy. Stress, as measured by Cohen´s perceived stress questionnaire is not an inclusion criteria, thus participants can participate regardless of their stress level.We will implement an individualized intervention addressing biopsychosocial elements of musculoskeletal pain with the following components; i) increasing physical capacity through strength- and motor control training; ii) lowering or preventing development of stress through mindfulness practice and learning de-catastrophizing pain management strategies through cognitive training.The primary outcome at 10-week follow-up is the between-group difference in intensity of perceived musculoskeletal pain during the last week (average value of back, neck, shoulder, elbow and hand) assessed by questionnaire (modified visual analogue scale 0-10).DiscussionThis study will provide experimental evidence to guide workplace initiatives designed towards reducing chronic musculoskeletal pain and stress.Trial registration numberClinicalTrials.gov NCT02047669.