BACKGROUND:Neck pain remains a persistent challenge in modern society and is frequently encountered across a wide range of occupations, particularly those involving repetitive and monotonous tasks. It might be expected that patterns of trapezius muscle activity at work, characterized by few breaks and prolonged periods of sustained muscle activity, are linked to neck pain. However, previous cross-sectional studies have generally failed to establish a definitive association. While some longitudinal studies have suggested that extended periods of heightened muscle activity could be a risk factor for neck pain, these findings often relied on limited participant numbers or specific professional groups. This study aimed to investigate the relationship between trapezius muscle activity and neck pain by pooling data from seven Scandinavian research institutes encompassing a diverse range of occupational backgrounds. METHODS:Electromyographic (EMG) data for the upper trapezius muscle, collected during working hours, were coupled with questionnaire responses pertaining to neck pain, individual characteristics, and potential confounding variables for a total of 731 subjects. Additionally, longitudinal data from 258 subjects were available. The various EMG datasets were consolidated into a standardized format, and efforts were made to harmonize inquiries about neck pain. Regression analyses, adjusting for sex and height, were conducted to explore the associations between muscle activity variables and neck pain. An exposure index was devised to quantify the cumulative neck load experienced during working hours and to differentiate between various occupational categories. RESULTS:The cross-sectional data displayed a distinct pattern characterized by positive associations for brief periods of sustained muscle activity (SUMA) and negative associations for prolonged SUMA-periods and neck pain. The longitudinal data exhibited a contrasting trend, although it was not as pronounced as the cross-sectional findings. When employing the exposure index, notable differences in cumulative muscle load emerged among occupational groups, and positive associations with longitudinal neck pain were identified. DISCUSSION:The results suggest that individuals with neck pain experience higher cumulative workloads and extended periods of muscle activity over the long term. In the short term, they appear to compensate by taking frequent short breaks, resulting in a lower cumulative workload. Regardless of their occupation, it is crucial to distribute work breaks throughout the workday to ensure that the cumulative load remains manageable.

Repetitive and monotonous work is often associated with neck pain, potentially resulting in sick leave and reduced productivity. Establishing appropriate muscle activity patterns, including duration and frequency of breaks that can prevent development of neck pain is important for providing workplace guidance. While several smaller studies of monotonous neck-loading work have indicated that such breaks can reduce the risk of neck pain, studies with a higher number of participants are necessary to confirm an association, and if so, to improve the precision of a possible association. The purpose of this protocol is to describe and discuss the background, methods and challenges of a study pooling several datasets with measurements of upper trapezius muscle activity during work and associated measurements of neck pain. Methods: Seven Scandinavian research institutes provided surface electromyographic (EMG) data of upper trapezius muscle activity recorded during working hours along with questionnaire data with information about neck pain and other health-related factors, from a total of 750 participants. The different data sets of the EMG data will be merged into a common format. Various questions on neck pain will be harmonized. Associations between EMG variables and neck pain will be examined with linear mixed model regressions controlled for various confounders. Discussion: Aiming to provide further insight into the possible association between trapezius muscle activity pattern and neck pain, this study protocol highlights the challenges that arise when creating a pooled data set. Solving these challenges may help to increase the knowledge about appropriate muscle activity patterns during work.

Musculoskeletal and psychological/mental disorders are major causes of sick leave, threatening the welfare of individuals and the economics of companies and societies. The prevailing research and development (R&D) of ergonomic interventions show minimal long-term effects on health and wellbeing while interventions to improve production seem to have a dominant negative effect, particularly in the health-care sector. Scientific evidence suggests that improved partnership is needed between stakeholders with different and often opposing aims, i.e., organizational productivity vs. worker wellbeing. In 2006 a Nordic R&D network, the NOVO Network, was established highlighting the need for a new approach, integrating work environment and production needs in intervention R&D. Our hypothesis is that such an integration is more readily established in the Nordic countries, largely due to their leading positions in the world in terms of social capital. Through annual symposia and other activities, the NOVO Network brings together scholars and practitioners to share knowledge and experience and to suggest and develop new areas of collaboration towards increased organizational sustainability in health care. A multicenter study conducted within the framework of the NOVO network resulted in a new, practical tool. This tool aims to facilitate partnership instead of the prevalent domination orientation, thereby combining consideration of work environment and production needs. Based on our experiences so far, this article highlights some key future challenges. As a result, we hope to see development of a stronger Nordic R&D tradition towards increased organizational sustainability in health care.

Ergonomic interventions have generally been unsuccessful in improving workers’ health, with concurrent rationalization efforts negating potentially successful intervention initiatives. We propose the two aims are considered simultaneously, aiming at the joint consideration of competitive performance and work environment in a long-term perspective (“organizational sustainability”). A prerequisite is a high level of dialogue between the different groups of stakeholders, and we argue that the Nordic countries, through high levels of trust and justice (social capital), have unique opportunity to carry out such research. The present authors bring forth the vision of “a Nordic Model for development of more sustainable production systems”.

The application of electromyography (EMG) in ergonomics is motivated by the problem of musculoskeletal complaints in the work-place. It is commonly assumed that such complaints are mediated through biomechanical forces acting in the body, since awkward postures and repetitive movement are identified as risk factors in epidemiological studies (Winkel and Westgaard, 1992). However, biomechanical forces may also result in improved health (Åstrand, 1988) and a key issue is then to distinguish forces that are health promoting from those that cause impaired health. The chain of events postulated to result in health effects is summarized in Figure 8.1. Work demands (external exposure, i.e. physical demands quantified independently of the worker) exert their effects through muscle activity patterns generated to meet these demands (internal exposure). The muscle activity causes short-term responses, e.g. increased circulation, fatigue, and a variety of metabolic responses, that on a longer time scale may result in health effects. Factors independent of muscle activity influence the outcome and thus modulate the assumed relationship. Later in this paper evidence to suggest that muscle pain may arise independently of muscle activity is discussed, a mechanism not considered in Figure 8.1. In this model, a surface EMG recording may be used to estimate muscle activity (internal exposure) and thereby, hopefully, provide an estimate of the risk of a future development of a health problem. This scheme depends on the existence of a physical exposure-health effect relationship and an important research objective within ergonomics is to provide information about this relationship, if existing.

This study of home care workers in a Norwegian municipality aimed to examine the effect of two measures involving organizational (job checklists) and technological (personal digital assistants) job aids on perceived work demands and musculoskeletal health. Questionnaire data was collected in 2009 (n = 138, response rate 76.2%) and 2011 (n = 80, response rate 54%). Forty-six home care workers responded at both waves. Respondents were assigned into ‘high’, ‘moderate’ and ‘low’ strain groups based on their responses to open and closed survey questions regarding impact of the two measures. One-way ANOVA with post-hoc t-tests and regression analyses investigated group differences and examined development in variables. Perceived work demands and health effects over the two-year study period were unchanged overall, yet significant differences between subgroups were highlighted. Work demands and shoulder-neck pain remained high for high-strain workers, but were reduced for low and moderate strain workers. Management should be aware of diversity in worker responses to rationalizations and give priority to supplementary, targeted measures to counteract adverse effects.

BACKGROUND:The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers' working conditions.METHODS:The study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders' appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels).RESULTS:Employees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular.CONCLUSIONS:It is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.

Adapted from: Lømo T, Westgaard RH, Hennig R, Gundersen K. The response of denervated muscle to long-term electrical stimulation, In: Carraro U, Angelini C, eds. Proceedings of the First Abano Terme Meeting on Rehabilitation, 1985 August 28-30, Abano Terme, Padova, Italy, An International Symposium, Satellite Meeting of the XIII World Congress of Neurology, Hamburg 1985. Cleup Padova 1985. pp 81-90.

BACKGROUND: Home care workers are at risk of various harmful occupational exposures, health complaints and sick leave.OBJECTIVE: Identifying occupational exposures related to shoulder-neck and low back pain, and assessing the comparative importance of such exposures, for home care workers.METHODS: One hundred and thirty-eight home care workers in a large municipality in Norway participated in the study (response rate 76.2%). Questionnaire comprised a combination of standardized items and context-specific VAS scales on mental, social, emotional and physical work demands, perceived general tension and pain in shoulder-neck and low back.RESULTS: Severe pain scores for both shoulder-neck and low back regions were common, with individual variations. All VAS measures on occupational exposures were significantly correlated with shoulder-neck pain and all except social demands were significantly correlated with low back pain. However, stronger associations were found with perceived general tension, which proved to be the strongest predictor of shoulder-neck and low back pain, indicating a mediating effect in the relationship between occupational exposures and musculoskeletal pain.CONCLUSIONS: Identifying and alleviating occupational exposures is important to ensure a healthy and sustainable work environment. Special attention should be drawn to early signs of symptoms, such as general tension, preventing further development of musculoskeletal pain.

OBJECTIVES:To investigate heart rate variability (HRV) in fibromyalgia (FM) patients and healthy controls (HCs) during different sleep stages, and to examine the association of HRV with pain and sleep quality. METHOD:Polysomnography was recorded from 23 female FM patients and 22 age- and sex-matched HCs. HRV was recorded from bedtime until awakening including the standard deviation of normal-to-normal intervals (SDNN), the root mean square successive difference (RMSSD), and the low (LF; 0.04-0.15 Hz) and high (HF; 0.15-0.4 Hz) frequency power. Subjective scores of neck/shoulder pain and sleep quality were obtained at bedtime and awakening. RESULTS:Both patients and HCs showed high incidence of arousals per hour (FM: 16 ± 9.7; HCs: 17 ± 11). RMSSD was lower in patients than HCs during non-rapid eye movement (non-REM) stage 2 (N2) sleep (mean ± SD; 30 ± 12 ms vs. 42 ± 13 ms, p < 0.002) and during REM sleep (23 ± 11 ms vs. 37 ± 16 ms, p < 0.003). HRV did not differ between groups during N3 sleep (p > 0.19 for all comparisons). In patients, SDNN, RMSSD, and HF power showed modest positive correlations with sleep quality (HF power during N3 sleep showed the highest correlation; Spearman's ρ = 0.54) and modest negative correlations with neck/shoulder pain (RMSSD during N3 sleep showed the highest correlation with pain at bedtime; Spearman's ρ = -0.51). CONCLUSIONS:RMSSD, indicative of parasympathetic predominance, is attenuated in FM patients compared to HCs during N2 sleep and REM sleep. This difference was not present for the HF component. HRV during sleep in FM patients is moderately and positively associated with sleep quality and moderately and negatively associated with neck/shoulder pain.

Background: Ergonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention.Methods: The study, using a historic prospectivemixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses.Results: The work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers.Conclusions: Establishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures.

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome (“modifiers” in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.

The aim of this project was to identify and systematically evaluate observational methods to assess workload on the musculoskeletal system. Searches in the electronic databases and other sources identified 29 observational methods. The methods were evaluated for the aspects related to their reliability and usability for different purposes. The results of evaluation will be found in internet with a tool that helps the user to search for most suitable method by sorting the methods according to the several items evaluated.

Research to assess ergonomic interventions that aim to improve the musculoskeletal health of workers is, for good reason, criticised as being of poor quality. Study design can be inadequate with poor or missing control groups, risk of bias and confounders potentially influencing the outcome. Many ergonomic intervention reviews have made this point, from the early review of Westgaard and Winkel1 to the review by Driessen et al 2 published in this issue of OEM ( see page 277 ). Researchers have responded to this criticism by upgrading study design, and in some studies aiming for the gold standard of randomised controlled trials (RCTs). Secondary to this development, recent reviews of ergonomic intervention have performed an extensive pruning of studies on the basis of flawed design (eg, Brewer et al 3, Burton et al 4, Boocock et al 5), culminating in the review by Driessen et al 2 who only included RCT studies. Inclusion and exclusion criteria follow the Cochrane mould (Higgins and Green6). Literature searches for reviews have typically identified several thousands of potentially relevant studies, but with only …