High physical and psychosocial load at work and sickness absence due to neck pain. The Contribution of Previous Episodes of Pain, Pain Intensity, Physical Impairment, and Pain-Related Fear to Disability in Patients with Chronic Mechanical Neck Pain Reduction of Pain-Related Disability in Working Populations: A Randomized Intervention Study of the Effects of an Educational Booklet Addressing Psychosocial Risk Factors and Screening Workplaces for Physical Health Hazards The Saskatchewan Health and Back Pain Survey: The Prevalence of Neck Pain and Related Disability in Saskatchewan Adults The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders: A Randomized Controlled Trial Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China The impact of psychosocial factors on neck pain and disability outcomes among primary care patients: Results from the UCLA Neck Pain Study Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Work Disability After Whiplash: A Prospective Cohort Study Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care. Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial Prognostic Factors for Intervention Effect on Neck/Shoulder Symptom Intensity and Disability among Female Computer Workers A workplace exercise versus health promotion intervention to prevent and reduce the economic and personal burden of non-specific neck pain in office personnel: protocol of a cluster-randomised controlled trial. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial Chronic neck pain and treatment of cognitive and behavioural factors: results of a randomised controlled clinical trial
OBJECTIVES This study investigates the relationship between physical and psychosocial load at work and sickness absence due to  neck pain . METHODS A prospect i ve cohort study with a follow-up period of 3 years ( 1994 - 1998 ) was performed among a working population . At the beginning of the study , physical load at work was quantified by means of video recordings .  Work-related psychosocial variables were measured by means of the Job Content Question naire . The frequency of sickness absence due to neck pain with a minimal duration of 3 days was assessed on the basis of company registration s during the follow-up period . Altogether 758 workers were included in the analyses . Possible confounding by individual characteristics , physical load , and psychosocial load was studied . RESULTS Work-related neck flexion and neck rotation , low decision authority , and medium skill discretion showed statistically significant increased risks for sickness absence due to neck pain ( adjusted rate ratios ranging from 1.6 to 4.2 ) . High quantitative job dem and s , low skill discretion , and low job security showed nonsignificant increased risks for sickness absence due to neck pain ( adjusted rate ratios of 2.0 , 1.6 and 1.7 , respectively ) . Work-related sitting , conflicting job dem and s , supervisor support , and co-worker support did not increase sickness absence due to neck pain . CONCLUSION Work-related neck flexion , neck rotation , low decision authority , and medium skill discretion are risk factors for sickness absence due to neck pain . There are indications that high job dem and s , low skill discretion , and low job security are also risk factors for sickness absence due to neck pain Objective The influence of physical and psychosocial variables on self-rated disability in patients with chronic mechanical neck pain has not been fully determined . This study examined the relationship of pain , physical impairment , and pain-related fear to disability in individuals with chronic mechanical neck pain . Design A cross-sectional study was conducted . Ninety-seven ( n = 97 ) subjects ( 28 men , 69 women ; mean age , 39.3 yrs ) with chronic mechanical neck pain were prospect ively recruited .  Demographic information , duration of pain symptoms , pain intensity , pain-related fear , and cervical range of motion  were collected on all subjects . Self-reported disability was measured with the Neck Disability Index . Correlation and regression analyses were performed to determine the association among the variables and to determine the proportions of explained variance in disability . Results Significant positive correlations existed between disability and previous history of neck pain ( r = 0.45 ; P < 0.001 ) , disability and pain intensity ( r = 0.32 , P = 0.01 ) , and disability and kinesiophobia ( r = 0.23 , P = 0.02 ) . In addition , a significant negative correlation existed between disability and cervical extension range of motion ( r = −0.18 , P = 0.04 ) . Stepwise regression analyses revealed that previous neck pain episodes , intensity of neck pain , kinesiophobia , and cervical extension range of motion were significant predictors of disability ( r 2 = 0.400 ; r 2 adjusted = 0.372 ; F = 14.64 ; P < 0.001 ) . Conclusions This study found that previous episodes of neck pain , pain intensity , pain-related fear , and cervical extension range of motion explained 37.2 % of the variability of self-report disability . Future longitudinal studies will help to determine the clinical implication s of these findings Study Design . Cluster r and omized controlled trial with 6 and 8 quarters of follow-up . Objective . To test the effects of giving evidence -based information addressing psychosocial risk factors for pain-related disability and of screening workplaces for physical health hazards at work on reducing new episodes and duration of pain-related and general absence taking . Summary of Background Data . The “ flag strategy ” for h and ling low back pain problems is recommended in many Western countries but , so far , r and omized intervention studies addressing psychosocial risk factors for disability related to low back pain show mixed results . Methods . We followed employees from 39 different work sites in western Denmark , who had received interventions consisting of either a carefully prepared booklet providing evidence -based information on common musculoskeletal pain problems alone or in combination with systematic workplace screening for physical work hazards .  Absence due to pain for at least 7 days and the cumulative numbers of absence days were the main outcome measures . General absence taking was analyzed , too . Company registration s of sickness absence in combination with self-report on the cause of a given absence spell was used to inform absence spells . Results . A total of 3808 of 4006 eligible employees provided information . Among 1063 participants in the control arm , 1458 in the information arm , and 1287 in the  information and workplace screening  arm , 4.6 % , 6.9 % , and 4.6 % , respectively , experienced pain-related absence , and 27.8 % , 27.2 % , and 24.0 % , respectively , experienced general absence taking during follow-up . No positive effect on the risk of the 2 measures of absence or on the cumulative duration of absence among cases was seen . Conclusion . Results did not support population -based interventions addressing psychosocial risk factors for pain-related disability alone or in combination with workplace screening as effective in reducing the risk of pain-related absence taking or the duration of absence Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases with age . More women experience high‐disability neck pain than men . Wave analysis suggests that the point prevalence and 6‐month prevalence of high‐intensity and low‐disability neck pain are overestimated in this survey . Conclusion . This cross‐sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) of the adult population STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use . Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists . The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments . Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area . Our study investigates the effect of the latter approach . Methods / Design A r and omized controlled trial of 10 weeks duration is currently being conducted . Employed office workers with severe neck-shoulder pain are r and omized to  3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active . Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius . An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work . The first 100 positive replies entered the study . Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0 - 9 scale . Exclusion criteria were cardiovascular disease , trauma , hypertension , or serious chronic disease . Before and after the intervention period the participants replied to a question naire about musculoskeletal disorders and work disability , and underwent a st and ardized clinical examination of the neck and shoulder girdle . Further , on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week . The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination . Secondary outcomes are strength and work disability . Trial Registration Clinical Trials ( NCT ) : Objective : The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain . Methods : Sixty female subjects were r and omly assigned to an intervention group or a control group . The IG was administered of a 6-month , twice-a-week , tailored exercise program , whereas the CG received no intervention . Results : The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures . In addition , reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength . Conclusions : This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders , showing clinical ly meaningful reductions of pain symptoms and disability on upper limb and neck regions Objectives Studies from western countries show that dentists are vulnerable to work-related musculoskeletal disorders ( WMSDs ) of the neck and upper extremities , but little is known about their epidemiology among members of this rapidly growing profession in China . This study aims to investigate the prevalence of WMSDs and identify potential risk factors associated with their occurrence in the dental profession in China . Setting and participants A cross-sectional survey was carried out in 52 different hospitals in a large metropolitan city in China . A total of 304 question naires were distributed to respondents identified via stratified r and om sampling and 272 dentists ( 121 females and 151 males ) completed the survey . The response rate was 89.5 % . Outcomes Visual analogue score was used to record neck and upper limb musculoskeletal symptoms on a body chart . Work-related risk factors , including physical and psychosocial factors , were accounted for in the regression analysis . Results 88 % of the dentists reported at least one musculoskeletal disorder and 83.8 % suffered from neck pain . In the multivariate analyses , working hours per day were associated with neck pain ( OR=1.43 ; 95 % CI 1.03 to 1.98 ) . Inability to select the appropriate size of dental instrument was associated with shoulder ( OR=2.07 ; 95 % CI 1.00 to 4.32 ) and wrist/h and ( OR=2.47 ; 95 % CI 1.15 to 5.32 ) pain . As for psychosocial factors , high job dem and was associated with symptoms in the shoulder ( OR=1.09 ; 95 % CI 1.00 to 1.18 ) , elbow ( OR=1.11 ; 95 % CI 1.03 to 1.19 ) and wrist/h and ( OR=1.09 ; 95 % CI 1.02 to 1.17 ) . Regular physical exercise was associated with decreased neck pain ( OR=0.37 ; 95 % CI 0.14 to 1.00 ) . Conclusions The prevalence of WMSDs among Chinese dentists is high . Specifically , long working hours , inability to select the appropriate size of dental instrument and high job dem and are the most significant risk factors Purpose . The purpose of this study is to estimate the associations of psychosocial factors with pain and disability outcomes among neck-pain patients enrolled in a r and omized clinical trial of chiropractic treatments .  Methods . Neck-pain patients were r and omized to one of 8 modes of chiropractic treatment .  Health status and psychosocial variables were measured at baseline . Changes in neck pain severity and disability from baseline to 6 months were the primary outcome variables . Multivariable regression models were used to estimate effects of psychosocial variables adjusted for potential confounders . Results . Of 960 eligible patients , 336 were enrolled and 80 % were followed up through 6 months . Coping strategies involving self-assurance result ed in better disability outcomes , whereas getting angry or frustrated result ed in worse pain and disability outcomes . Participants with high levels of social support from individuals were more likely to experience clinical ly meaningful reductions in pain and disability . No consistent relations of internal health locus of control , and physical and psychological job dem and s with improvements in pain and disability were detected . Conclusions . We found some evidence that certain coping strategies and types of social support are associated with pain and disability outcomes in this population of largely subacute and chronic neck-pain patients Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Study Design . Prospect i ve cohort study . Objective . To investigate the consequences of neck pain after motor vehicle accidents in terms of disability for work and the relationship this has with symptom and work-related factors . Summary of Background Data . Previous studies on work disability related to whiplash are very heterogeneous , are often limited in sample size and show a wide variability in terms of results . A relationship has been suggested between poor recovery from or persistent work disability after whiplash and female gender , older age , marital status , heavy manual work , self-employment , prior psychological problems , subjective complaints of poor concentration , pain catastrophizing , and kinesiophobia . Methods . Individuals with neck complaints after involvement in traffic accidents , who initiated compensation cl aim procedures with a Dutch insurance company ( n = 879 ) , were sent question naires ( Q1 ) concerning the accident , the injuries that they had sustained , their complaints at that time , and questions regarding work and disability . The course of complaints and work disability was monitored at 6 ( Q2 ) and 12 months ( Q3 ) after the accident . Results . A total of 58.8 % of the population with neck complaints studied was work-disabled after the accident . Age and impaired concentration complaints after 1 month were found to be related to work disability at 1 year , independent of physical complaints and work characteristics . Conclusion . Age and concentration complaints were important independent predictors of long-lasting work disability , whereas no evidence emerged to indicate that the degree of manual labor ( blue or white collar work ) or educational level was involved in persistent work disability in postwhiplash syndrome . The current results suggest that work disability could benefit most from interventions related to recovery from cognitive complaints and less from physically related interventions UNLABELLED Studies regarding self-management of persistent neck pain are infrequent . OBJECTIVE to compare treatment effects of ( a ) a multi-component pain and stress self-management group intervention ( PASS ) and ( b ) individually administered physical therapy ( IAPT ) for patients with persistent musculoskeletal tension-type neck pain . METHODS Persons seeking physical therapy treatment due to persistent tension-type neck pain at nine primary health care centers in Sweden were r and omly assigned to either PASS or IAPT . Before treatment ( baseline ) and at 10- and 20-weeks the participants completed a self- assessment question naire comprising : the Self-Efficacy Scale , the Neck Disability Index , the Coping Strategies Question naire , the Hospital Anxiety and Depression Scale , the Fear-Avoidance Beliefs Question naire and questions regarding neck pain , analgesics and utilization of health care . Intention-to-treat analyses were performed using repeated measures analysis of variance between baseline , 10-week and 20-week follow-up . RESULTS One hundred and fifty six participants were included ( PASS n=77 , IAPT n=79 ) . On average participants receiving PASS attended seven treatment sessions and participants receiving IAPT 11 sessions over the 20-week follow-up period . Repeated measures ANCOVA showed significant time x group interaction effects for ability to control pain ( p<0.001 ) , self-efficacy regarding pain-interfering activities ( p=0.005 ) , disability due to neck pain ( p=0.001 ) and levels of catastrophic thinking ( p<0.001 ) in favour of PASS . CONCLUSION PASS had a better effect than IAPT in the treatment of persistent musculoskeletal tension-type neck pain regarding coping with pain , in terms of patients ' self-reported pain control , self-efficacy , disability and catastrophizing , over the 20-week follow-up Objective The aim of this study was to determine the effectiveness of a multimodal treatment in the short and medium term for disability in nonspecific chronic neck pain . Design The design of this study is a single-blinded r and omized controlled trial carried out in a university research laboratory . Forty-five patients between 18 and 65 yrs with nonspecific chronic neck pain were included in this study . Each patient was treated eight times over a 4-wk period . The sample was divided into three groups : control group , subjected to a protocol of manual therapy ; experimental group 1 , subjected to a protocol of manual therapy and therapeutic patient education ; and experimental group 2 , subjected to manual therapy , therapeutic patient education , and a therapeutic exercise protocol . Assessment s were performed at baseline and at 4 , 8 , and 16 wks using the following measurements : the Neck Disability Index , the 11-item Tampa Scale of Kinesiophobia , the Fear Avoidance Beliefs Question naire , the Neck Flexor Muscle Endurance Test , and the Visual Analog Fatigue Scale . Results The nonparametric Kruskal-Wallis test for the Neck Disability Index showed statistically significant differences between baseline outcomes and all follow-up periods ( P < 0.01 ) . In the Kruskal-Wallis test , differences were found for the Visual Analog Fatigue Scale and the Neck Flexor Muscle Endurance Test in the follow-ups at 8 and 16 wks ( P < 0.05 ) . Analysis of variance for group × time interaction showed statistically significant changes ( Tampa Scale of Kinesiophobia , F = 3.613 , P = 0.005 ; Fear Avoidance Beliefs Question naire , F = 2.803 , P = 0.022 ) . Minimal detectable changes were obtained in both experimental groups for the 11-item Tampa Scale of Kinesiophobia but not in the control group . Conclusion Differences between experimental groups and the control group were found in the short and medium term . A multimodal treatment is a good method for reducing disability in patients with nonspecific chronic neck pain in the short and medium term Introduction It has been suggested that treatments may be more effective when they are matched to patient characteristics . This study aim ed at investigating potential prognostic factors for clinical ly relevant improvement in symptom intensity and symptom-related disability among employees with symptoms in the neck/shoulder area , receiving either ergonomics counseling or such counseling in combination with myofeedback training .  Methods A r and omized controlled study was performed among female computer users aged 45 or older ( n = 36 ) . A clinical examination and a question naire survey were performed before inclusion in the study . Symptom intensity and disability was assessed using question naires before the start of the interventions ( baseline ) and at follow-ups directly after the end of the interventions ( T0 ) and after 3 ( T3 ) and 6 ( T6 ) months . Logistic regression analyses were performed in order to assess prognostic factors for clinical ly relevant improvement in symptom intensity and disability . Results Improvement in symptom intensity was consistently predicted by symptom intensity at baseline . Diagnosis and stress-induced lack of muscular rest were prognostic factors for improvement in symptom intensity at short term follow-up . Baseline disability and passive coping consistently served as prognostic factors for outcome in disability . Few substantial differences were found between the interventions in terms of prognostic factors . Conclusions Myofeedback training in combination with ergonomics counseling seem to be an especially beneficial tool for secondary prevention among employees with moderate levels of symptom intensity and symptom-related disability , who respond to work-related stress by increased/sustained muscle activation , and who tend to employ passive coping to deal with their neck/shoulder symptoms INTRODUCTION Non-specific neck pain is a major burden to industry , yet the impact of introducing a workplace ergonomics and exercise intervention on work productivity and severity of neck pain  in a population of office personnel is unknown . RESEARCH QUESTION Does a combined workplace-based best practice ergonomic and neck exercise program reduce productivity losses and risk of developing neck pain in asymptomatic workers , or decrease severity of neck pain  in symptomatic workers , compared to a best practice ergonomic and general health promotion program ? DESIGN Prospect i ve cluster r and omised controlled trial . PARTICIPANTS AND SETTING Office personnel aged over 18 years , and who work>30 hours/week .  INTERVENTION Individualised best practice ergonomic intervention plus 3 × 20 minute weekly , progressive neck/shoulder girdle exercise group sessions for 12 weeks . CONTROL Individualised best practice ergonomic intervention plus 1-hour weekly health information sessions for 12 weeks . MEASUREMENTS Primary ( productivity loss ) and secondary ( neck pain and disability , muscle performance , and quality of life ) outcome measures will be collected using vali date d scales at baseline , immediate post-intervention and 12 months after commencement . PROCEDURE 640 volunteering office personnel will be r and omly allocated to either an intervention or control arm in work group clusters . ANALYSIS Analysis will be on an ' intent-to-treat ' basis and per protocol . Multilevel , generalised linear models will be used to examine the effect of the intervention on reducing the productivity loss in dollar units ( AUD ) , and severity of neck pain and disability . DISCUSSION The findings of this study will have a direct impact on policies that underpin the prevention and management of neck pain in office personnel Background Many patients suffer from chronic neck pain following a whiplash injury . A combination of cognitive , behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders . The objective is to present the design of a r and omised controlled trial ( RCT ) aim ed at evaluating the effectiveness of a combined individual physical and cognitive behavioural- grade d activity program on self-reported general physical function , in addition to neck function , pain , disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline . Methods / Design The design is a two-centre , RCT - study with a parallel group design . Included are whiplash patients with chronic neck pain for more than 6 months , recruited from physiotherapy clinics and an out-patient hospital department in Denmark . Patients will be r and omised to either a pain management ( control ) group or a combined pain management and training (intervention)group . The control group will receive four educational sessions on pain management , whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months , including guidance in specific neck exercises and an aerobic training programme . Patients and physiotherapists are aware of the allocation and the treatment , while outcome assessors and data analysts are blinded . The primary outcome measures will be Medical Outcomes Study Short Form 36 ( SF36 ) , Physical Component Summary ( PCS ) . Secondary outcomes will be Global Perceived Effect ( -5 to + 5 ) , Neck Disability Index ( 0 - 50 ) , Patient Specific Functioning Scale ( 0 - 10 ) , numeric rating scale for pain bothersomeness ( 0 - 10 ) , SF-36 Mental Component Summary ( MCS ) , TAMPA scale of Kinesiophobia ( 17 - 68 ) , Impact of Event Scale ( 0 - 45 ) , EuroQol ( 0 - 1 ) , craniocervical flexion test ( 22 mmHg - 30 mmHg ) , joint position error test and cervical range of movement . The SF36 scales are scored using norm-based methods with PCS and MCS having a mean score of 50 with a st and ard deviation of 10 . Discussion The perspectives of this study are discussed , in addition to the strengths and weaknesses . Trial registration The study is registered in http://www . Clinical Trials.gov identifier NCT01431261 Purpose Although there is growing evidence in favour of the bio-psychosocial approach to the treatment of  persistent neck pain  , it is question ed whether treating psychological factors can improve patient perceptions of disability , pain and quality of life . This r and omised , controlled study with 12 months ’ follow-up was conducted to evaluate the efficacy of adding cognitive-behavioural principles to exercises for chronic neck pain . Methods Eighty patients were r and omly assigned to the usual neck exercises plus cognitive-behavioural treatment ( PTcb group , 40 subjects ) or to treatment based on neck exercises alone ( PT group , 40 subjects ) . Before treatment ( T1 ) , at the end of treatment ( T2 ) and 12 months later ( T3 ) , all of the patients completed a booklet including the Neck Pain and Disability Scale , a numerical rating scale , and the Short-Form Health Survey Question naire ( SF-36 ) . Results The present trial failed to demonstrate its primary end point : the pre- and post-treatment difference in total NPDS scores was not statistically different between groups . Disability improved similarly in both groups over time , remaining stable until T3 in the PTcb group and slightly increasing at the same time in the PT group . Pain trends were comparable , with both groups showing an improvement between T1 and T2 , and a slight worsening between T2 and T3 . There were significant increases in all of the SF-36 domains except for health in general , and vitality in both groups by the end of treatment . SF-36 showed a between-group difference only for the physical activity domain ( 10.4 ; 95 % CI 2.4–18.5 ) . Conclusion Disability , pain and quality of life improved at the end of treatment in both groups , without differences between them
Thus , WIs were seldom design ed to improve return-to-work .
Overall , there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity .
If present , significant results in favour of WIs were not sustained across follow-up times .
Overall , this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term , which was not sustained over time .
BACKGROUND Musculoskeletal disorders are the most common cause of disability in many industrial countries .
Recurrent and chronic pain accounts for a substantial portion of workers ' absenteeism .
Neck pain seems to be more prominent in the general population than previously known .
OBJECTIVES To determine the effectiveness of workplace interventions ( WIs ) in adult workers with neck pain .