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      Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

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          Abstract

          Background

          Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers.

          Methods

          Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9).

          Results

          85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders.

          Conclusion

          High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain.

          Trial registration

          NCT01071980.

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          Most cited references27

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          Work-related musculoskeletal disorders: the epidemiologic evidence and the debate.

          The debate about work-relatedness of musculoskeletal disorders (MSDs) reflects both confusion about epidemiologic principles and gaps in the scientific literature. The physical ergonomic features of work frequently cited as risk factors for MSDs include rapid work pace and repetitive motion, forceful exertions, non-neutral body postures, and vibration. However, some still dispute the importance of these factors, especially relative to non-occupational causes. This paper addresses the controversy with reference to a major report recently commissioned by the US Congress from the National Research Council (NRC) and Institute of Medicine (IOM) (2001). The available epidemiologic evidence is substantial, but will benefit from more longitudinal data to better evaluate gaps in knowledge concerning latency of effect, natural history, prognosis, and potential for selection bias in the form of the healthy worker effect. While objective measures may be especially useful in establishing a more secure diagnosis, subjective measures better capture patient impact. Examination techniques still do not exist that can serve as a "gold standard" for many of the symptoms that are commonly reported in workplace studies. Finally, exposure assessment has too often been limited to crude indicators, such as job title. Worker self-report, investigator observation, and direct measurement each add to understanding but the lack of standardized exposure metrics limits ability to compare findings among studies. Despite these challenges, the epidemiologic literature on work-related MSDs-in combination with extensive laboratory evidence of pathomechanisms related to work stressors-is convincing to most. The NRC/IOM report concluded, and other reviewers internationally have concurred, that the etiologic importance of occupational ergonomic stressors for the occurrence of MSDs of the low back and upper extremities has been demonstrated.
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            Fundamentals of resistance training: progression and exercise prescription.

            Progression in resistance training is a dynamic process that requires an exercise prescription process, evaluation of training progress, and careful development of target goals. The process starts with the determination of individual needs and training goals. This involves decisions regarding questions as to what muscles must be trained, injury prevention sites, metabolic demands of target training goals, etc. The single workout must then be designed reflecting these targeted program goals including the choice of exercises, order of exercise, amount of rest used between sets and exercises, number of repetitions and sets used for each exercise, and the intensity of each exercise. For progression, these variables must then be varied over time and the exercise prescription altered to maintain or advance specific training goals and to avoid overtraining. A careful system of goal targeting, exercise testing, proper exercise technique, supervision, and optimal exercise prescription all contribute to the successful implementation of a resistance training program.
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              Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations.

              An essential component of the interpretation of results of randomized clinical trials of treatments for chronic pain involves the determination of their clinical importance or meaningfulness. This involves two distinct processes--interpreting the clinical importance of individual patient improvements and the clinical importance of group differences--which are frequently misunderstood. In this article, we first describe the essential differences between the interpretation of the clinical importance of patient improvements and of group differences. We then discuss the factors to consider when evaluating the clinical importance of group differences, which include the results of responder analyses of the primary outcome measure, the treatment effect size compared to available therapies, analyses of secondary efficacy endpoints, the safety and tolerability of treatment, the rapidity of onset and durability of the treatment benefit, convenience, cost, limitations of existing treatments, and other factors. The clinical importance of individual patient improvements can be determined by assessing what patients themselves consider meaningful improvement using well-described methods. In contrast, the clinical meaningfulness of group differences must be determined by a multi-factorial evaluation of the benefits and risks of the treatment and of other available treatments for the condition in light of the primary goals of therapy. Such determinations must be conducted on a case-by-case basis, and are ideally informed by patients and their significant others, clinicians, researchers, statisticians, and representatives of society at large.
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                Author and article information

                Journal
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central
                1471-2474
                2011
                21 September 2011
                : 12
                : 205
                Affiliations
                [1 ]Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5320 Odense M, Denmark
                [2 ]National Research Centre for the Working Environment, Lersø Parkallè 105, 2100 Copenhagen Ø, Denmark
                [3 ]Department of Exercise and Sport Sciences, Faculty of Science, University of Copenhagen, 2200 Copenhagen N. Denmark
                [4 ]Department of Occupational Health, Bispebjerg University Hospital, 2400 Copenhagen NV, Denmark
                Article
                1471-2474-12-205
                10.1186/1471-2474-12-205
                3188479
                21936939
                50992ca0-9d73-4e52-9bcb-d728b839ad60
                Copyright ©2011 Zebis et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 January 2011
                : 21 September 2011
                Categories
                Research Article

                Orthopedics
                Orthopedics

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