Mediators and moderators of a walking intervention to prevent neck pain among high-risk office workers: a secondary analysis of a randomized controlled trial.

OBJECTIVES: To test hypothesized mediators and moderators of the benefits of an app-provided walking intervention for preventing neck pain in high-risk office workers. METHODS: Ninety-one office workers at risk for developing neck pain participated in the primary clinical trial. Two hypothesized mediators (the total number of steps taken and the number of days that participants exceed the number of recommended steps) were tested using a smartphone application every month during a 6-month period. Four hypothesized moderators (number of working hours, level of work psychological demands, chair height adjustability, and body mass index) were assessed at baseline. Parallel mediation and moderation analyses were conducted using the Hayes PROCESS macro, model 4 and 1, respectively, with post-hoc Johnson-Neyman techniques. RESULTS: The number of days that participants exceeded the recommended steps ‒ the specific number was tailored to each participant, but averaged 7735 steps/day ‒ mediated the benefits of the walking intervention for reducing the risk for neck pain at each of six assessment points (B's range -0.63 to -0.89, all p's < 0.05) over 6-month period. None of the hypothesized moderators evidenced statistically significant moderator effects of the walking intervention. CONCLUSION: Workers should walk at rates greater than recommended levels on as many days as possible, rather than attempt to maximize walking within a limited number of days. Given that the walking program studied appeared to be similarly effective across multiple groups of workers, the findings suggest that regular walking can reduce the risk for developing neck pain among high-risk office workers.

Is the number of daily walking steps in sedentary workers affected by age, gender, body mass index, education, and overall energy expenditure?

BACKGROUND: Healthy adults should take 10,000 steps per day to gain the resulting health benefits. Knowledge regarding the individual characteristics associated with daily walking steps would enhance resource allocation to those most likely to benefit from the 10,000-steps-per-day campaign. OBJECTIVE: To determine the extent to which age, gender, body mass index (BMI), education, and energy expenditure influence daily walking steps in white-collar workers and to assess the correlation of daily walking steps among pedometer, wristband activity tracker, and smartphone application. METHODS: A cross-sectional study was conducted on 49 sedentary workers. Daily walking steps were simultaneously assessed by three activity trackers in free-living conditions for 7 consecutive days. Associations between daily walking steps and individual factors were examined using linear regression. Correlation tests were conducted to assess the association among the three devices. RESULTS: Multiple regression analyses showed that BMI was associated with daily walking steps. A moderate to good correlation in daily walking steps was found between the wristband activity tracker and pedometer, as well as between the smartphone application and pedometer. CONCLUSIONS: BMI influenced daily walking steps in white-collar workers. Daily walking steps assessed by the wristband activity tracker and smartphone application differed from those assessed by the pedometer.

The effects of walking intervention on preventing neck pain in office workers: A randomized controlled trial.

OBJECTIVE: This study aimed to evaluate the efficacy of increased daily walking steps on the 6-month incidence of neck pain among office workers. METHODS: Healthy office workers with high risk of neck pain were recruited into a 6-month prospective cluster-randomized controlled trial. Participants were randomly assigned at the cluster level, into either intervention (n = 50) or control (n = 41) groups. Participants in the intervention group were instructed to increase their daily walking steps to a designated level for a duration of 6 months. Participants in the control group received no intervention. The outcome measures included the 6-month incidence of neck pain as well as its pain intensity and disability level. Analyses were performed using multivariable logistic regression model. RESULTS: Of the participants in the intervention and control groups, 22% and 34% reported a 6-month incidence of neck pain, respectively. After adjusting for confounders, a significant preventive effect of walking intervention was found (adjusted odd ratio 0.22, 95% confidence interval 0.06-0.75). No significant difference in pain intensity and disability level was found between those in the intervention and control groups. CONCLUSION: An intervention to increase daily walking steps reduced onset neck pain in high-risk office workers. However, the walking interventions did not decrease pain intensity and disability in those increasing the number of daily walking steps compared to the control group.

A Path Analysis of the Effects of Biopsychosocial Factors on the Onset of Nonspecific Low Back Pain in Office Workers.

OBJECTIVE: The purpose of this study was to develop a conceptual model for the association between various biopsychosocial factors and nonspecific low back pain (LBP) in a sample of office workers. METHODS: A 1-year prospective cohort study of 669 healthy office workers was conducted. At baseline, a self-administered questionnaire and standardized physical examination were employed to gather biopsychosocial data. Follow-up data were collected every month for the incidence of LBP. A regression model was built to analyze factors predicting the onset of LBP. Path analysis was performed to examine direct and indirect associations between identified risk factors and LBP. RESULTS: The onset of LBP was predicted by history of LBP, frequency of rest breaks, and psychological demand, measured by the Job Content Questionnaire. All 3 factors directly related to LBP; history of LBP was the strongest effector on the onset of LBP. History of LBP and frequency of rest breaks had indirect effects on LBP that were mediated through psychological demand, and frequency of rest breaks was the most influential effector on psychological demand. CONCLUSIONS: Three risk factors were identified to predict onset LBP, including history of LBP, frequency of rest breaks, and psychological demand. Each factor had direct effects on the development of LBP. Also, history of LBP and frequency of rest breaks had indirect effects on LBP that were mediated through psychological demand.

The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this meta-analysis of randomized controlled trials was to gain insight into the effectiveness of walking intervention on pain, disability, and quality of life in patients with chronic low back pain (LBP) at post intervention and follow ups. METHOD: Six electronic databases (PubMed, Science Direct, Web of Science, Scopus, PEDro and The Cochrane library) were searched from 1980 to October 2017. The following keywords were used: Walk* or Pedometer* or Accelerometer* or Treadmill* paired with "Back pain", "Low back pain", "Chronic low back pain", "LBP", or "Backache". Randomized controlled trials in patients with chronic LBP were included if they compared the effects of walking intervention to non-pharmacological interventions. Pain, disability, and quality of life were the primary health outcomes. RESULTS: Nine studies were suitable for meta-analysis. Data was analyzed according to the duration of follow-up (short-term, < 3 months; intermediate-term, between 3 and 12 months; long-term, > 12 months). Low- to moderate-quality evidence suggests that walking intervention in patients with chronic LBP was as effective as other non-pharmacological interventions on pain and disability reduction in both short- and intermediate-term follow ups. CONCLUSIONS: Unless supplementary high-quality studies provide different evidence, walking, which is easy to perform and highly accessible, can be recommended in the management of chronic LBP to reduce pain and disability.

Effect of exercise type on smoking cessation: a meta-analysis of randomized controlled trials.

BACKGROUND: Exercise is one choice of additional treatment for smoking cessation by relieving nicotine withdrawal symptoms and smoking craving. The possible mechanism of the effect of exercise on relieving nicotine withdrawal symptoms and smoking craving is including affect, biological, and cognitive hypotheses. Evidence suggests that different types of exercise have different effects on these mechanisms. Therefore, type of exercise might have effect on smoking cessation. The purpose of this study is to systematically review randomized controlled trials to gain insight into which types of exercise are effective for smoking cessation. METHODS: Publications were systemically searched up to November 2016 in several databases (PubMed, ScienceDirect, PEDro, Web of Science, Scopus and Cochrane Library), using the following keywords: "physical activity", "exercise", "smoking", "tobacco" and "cigarette". The methodological quality was assessed independently by two authors. Meta-analysis was conducted to examine the effectiveness of the type of exercise on smoking cessation. The quality of the evidence was assessed and rated according to the GRADE approach. RESULTS: 20 articles on 19 studies were judged to meet the selection criteria (seven low-risk of bias RCTs and 12 high-risk of bias RCTs). The findings revealed low quality evidence for the effectiveness of yoga for smoking cessation at the end of the treatment. The evidence found for no effect of aerobic exercise, resisted exercise, and a combined aerobic and resisted exercise program on smoking cessation was of low to moderate quality. Furthermore, very low to low quality evidence was found for no effect of physical activity on smoking cessation. CONCLUSIONS: There was no effect of aerobic exercise, resisted exercise, physical activity and combined aerobic and resisted exercise on smoking cessation. There was a positive effect on smoking cessation at the end of treatment in the program where yoga plus cognitive-behavioral therapy (CBT) was used. However, which of the two work is still to be studied.

Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials.

BACKGROUND: Neck and low back pain are significant health problems due to their high prevalence among the general population. Educational intervention commonly aims to reduce the symptoms and risk for additional problems by increasing the participant's knowledge, which in turn will alter the person's behavior. The primary aim of this study was to review randomize controlled trials (RCTs) to gain insights into the effectiveness of education for the prevention and treatment of non-specific neck and low back pain. METHODS: Publications were systematically searched from 1982 to March 2015 in several databases. Relevant RCTs were retrieved and assessed for methodological quality. Meta-analysis was conducted to examine the effectiveness of education for the prevention and treatment of non-specific neck and low back pain. The overall quality of evidence was assessed using the GRADE system. RESULTS: Thirty-six RCTs (30 high-quality studies) were identified. A total of 15 RCTs, which compared education programs to no education program, were included for further analysis. All studies included investigated the effectiveness of education with intermediate- and long-term follow-ups. The results showed that education programs were not effective in preventing and treating neck pain as well as treating low back pain. Conflicting evidence was found for the effectiveness of education on prevention of low back pain. CONCLUSIONS: Evidence suggests that education programs are not recommended in preventing or treating neck pain as well as treating low back pain, unless supplementary high-quality studies provide evidence to the contrary.

Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study.

OBJECTIVE: All occupations expose workers to varied and unique conditions. The nature of work has been recognized as influencing the health of workers. Whether predictors for chronic neck and low back pain would be occupation-specific is unknown. This study aimed to identify predictors for chronic neck and low back pain in a cohort of office workers. METHODS: A prospective study was carried out among 669 healthy office workers. At baseline, risk factors were assessed using a questionnaire and standardized physical examination. A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS, and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months. Two regression models were built to analyze the risk factors for developing chronic neck and low back pain. RESULTS: Of the sample, 17 and 27% of office workers who reported a new onset of neck or low back pain developed chronicity, respectively. Predictors for chronic neck pain were high body mass index, frequent neck extension during the work day, high initial pain intensity, and high psychological job demands. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity. CONCLUSIONS: The findings suggest that predictors for chronic musculoskeletal pain in a subpopulation may be a subset of predictors identified in a general population or occupation specific. Successful management to prevent chronic musculoskeletal pain may also need to consider the patient's occupation.

A screening tool for non-specific low back pain with disability in office workers: a 1-year prospective cohort study.

BACKGROUND: Having a screening tool with reasonable predictive ability is essential in providing information about an individual's risk of developing a disease, allowing an examination to be conducted with limited personnel and time, and selecting the relevant individuals for therapeutic research. This study aimed to produce a screening tool to identify office workers at risk of developing non-specific low back pain (LBP) with disability, and to evaluate the tool's predictive power. METHODS: At baseline, 615 healthy office workers filled out a self-administered questionnaire and underwent physical examination to gather potential risk factors. The incidence of LBP was collected every month thereafter. Disability level was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The minimum RMDQ score for categorization as LBP was 3. Logistic regression was used to select significant factors to build a risk score. The coefficients from the logistic regression model were used to develop the components of a screening tool. RESULTS: Over the 1-year follow-up, 8.8 % of participants reported incident LBP with disability. The screening tool for non-specific low back pain with disability in office workers comprised two items that contributed to the total score: previous history of LBP and psychological demand (assessed by the Job Content Questionnaire). The score range of the screening tool was 12 to 69. With a cut-off score of 53, the sensitivity was 65 % and the specificity was 68 %. The positive and negative predictive values were 16 and 95 %, respectively. The area under the receiver-operating characteristic curve was 0.76. CONCLUSIONS: A screening tool for non-specific low back pain with disability in office workers was developed and appears to have reasonable sensitivity, specificity, positive predictive values, and negative predictive values. Further validation and impact studies of the screening tool in a new population of office workers are suggested.

The effect of daily walking steps on preventing neck and low back pain in sedentary workers: a 1-year prospective cohort study.

OBJECTIVE: This study aimed to investigate the causal relationship between daily walking steps and the 1-year incidence of neck and low back pain in workers with sedentary jobs. METHODS: A 1-year prospective study was carried out among 387 workers who reported no spinal symptoms in the previous 3 months with pain intensity greater than 30 mm on a 100-mm visual analog scale. Data were gathered using a self-administered questionnaire, physical examination, and pedometer. Follow-up data were collected every month for the incidence of musculoskeletal disorders and every 3 months for daily walking steps. Two regression models were built to analyze the effect of daily walking steps on the 1-year incidence of neck and low back pain. RESULTS: Among 367 (95 %) participants followed for 1 year, 16 and 14 % reported incident neck and low back pain, respectively. After adjusting for confounders, a negative association between daily walking steps and onset of neck pain was found. Increasing daily walking steps by 1,000 reduced the risk of neck pain by 14 %. No significant association between daily walking steps and the onset of low back pain was found. CONCLUSIONS: Increasing daily walking steps is a protective factor for onset of neck pain in those with sedentary jobs. Interventions to reduce neck pain should include attempts to increase daily walking steps.

Correlation between pedometer and the Global Physical Activity Questionnaire on physical activity measurement in office workers.

BACKGROUND: This study aimed to examine the correlation of physical activity levels assessed by pedometer and those by the Global Physical Activity Questionnaire (GPAQ) in a population of office workers. METHODS: A cross-sectional study was conducted on 320 office workers. A self-administered questionnaire was distributed to each office worker by hand. Physical activity level was objectively assessed by a pedometer for 7 consecutive days and subjectively assessed by the GPAQ. Based on the pedometer and GPAQ outcomes, participants were classified into 3 groups: inactive, moderately active, and highly active. RESULTS: No correlation in the physical activity level assessed by the pedometer and GPAQ was found (rs = .08, P = 0.15). When considering the pedometer as the criterion for comparison, 65.3% of participants had underestimated their physical activity level using the GPAQ, whereas 9.3% of participants overestimated their physical activity level. CONCLUSIONS: Physical activity level in office workers assessed by a subjective measure was greatly different from assessed by an objective tool. Consequently, research on physical activity level, especially in those with sedentary lifestyle, should consider using an objective measure to ensure that it closely reflects a person's physical activity level.

Risk factors for the onset of nonspecific low back pain in office workers: a systematic review of prospective cohort studies.

OBJECTIVE: The purpose of this study was to systematically review prospective cohort studies to identify risk factors for the onset of low back pain (LBP) in office workers. METHODS: Online searches were conducted on PubMed, CINAHL Plus with full text, ScienceDirect, PEDro, ProQuest, and Scopus databases from 1980 to November 2011 using the following keywords: low back pain paired with risk or prognostic factors and office or computer or visual display unit (VDU) or visual display terminal (VDT). The methodological quality of each study was assessed using a 21-item checklist, which was divided into 2 parts: the internal validity (11 items) and descriptive quality (10 items) of studies. Strength of evidence for risk factors associated with the development of nonspecific LBP was assessed by defining 5 levels of evidence based on the number of studies and the quality score of studies. RESULTS: Eighteen full-text articles were identified, and 15 were excluded. A total of 3 articles were judged to meet the selection criteria and were included in the methodological quality assessment. Risk factors were divided into 3 groups: individual, work-related physical, and work-related psychosocial risk factors. There was strong evidence that history of LBP is a predictor of the onset of LBP. Limited evidence was found that the combination of postural risk factors and job strain is associated with the onset of LBP. CONCLUSION: After review of 3 high-quality prospective studies on the association between risk factors and the onset of nonspecific LBP in office workers, few risk factors were found to predict the onset of LBP in office workers.

External validity in randomised controlled trials of acupuncture for osteoarthritis knee pain.

OBJECTIVES: To assess two aspects of the external validity of acupuncture research for osteoarthritis knee pain and determine the common acupoints and treatment parameters used. METHODS: The external validity of 16 randomised controlled trials (RCTs) was investigated using a scale consisting of two aspects: reporting and performance. The reporting aspect included acupuncturist's background, study location, treatment detailed, patient characteristics, positive trial results, adverse effects and between-group statistical differences, whereas treatment appropriateness, appropriate controls and outcomes were classified as the performance aspect. Acupuncture treatment in RCTs was compared with common practice according to the literature sources and survey of acupuncturists working in different parts of Thailand. RESULTS: The levels of external validity for the reporting and performance aspects were in the range of 31.3% to 100%. Statistic values such as mean difference and confidence interval were reported by the minority of trials (43.8%). Patient satisfaction and quality of life were seldom used (31.3%). There were minor differences between research and practice in terms of the points used (25.0%), number of treatment sessions (6.3%) and frequency (12.5%). The most frequently used points were ST34, ST35, ST36, SP6, SP9, SP10, GB34, Xiyan and ah shi points, and the commonly used treatment parameters were 20 minutes, 10-15 sessions and two treatments weekly. CONCLUSIONS: Reporting of the external validity of acupuncture RCTs for knee pain was notably inadequate in terms of trial setting, treatment provider and statistical reporting. The majority of studies involved appropriate controls and outcomes and applied acupuncture treatments in line with practice.

Exercise therapy for office workers with nonspecific neck pain: a systematic review.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers. METHODS: Publications between 1980 and April 2010 were systematically searched in various databases (PubMed, CINAHL Plus with full text, The Cochrane Library, Science Direct, PEDro, ProQuest, PsycNet, and Scopus). The following key words were used: neck pain, cervical pain, exercise, strengthening, stretching, endurance, office workers, visual display unit, visual display terminal, and computer users. A hand search of relevant journals was also carried out. Relevant randomized controlled trials were retrieved and assessed for methodological quality by 2 independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. RESULTS: Nine randomized controlled trials were included in this review, of which 6 were rated as high-quality studies. No exercise type was identified as being effective in the prevention of nonspecific neck pain in office workers. Strong evidence was found for the effectiveness of muscle strengthening and endurance exercises in treating neck pain. Moderate evidence supported the use of muscle endurance exercise in reducing disability attributed to neck pain. CONCLUSION: Literature investigating the efficacy of exercise in office workers with nonspecific neck pain was heterogeneous. Within the limitations, for treatment of neck pain, either muscle strengthening or endurance exercise is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested. Further research is needed before any firm conclusions regarding the most effective exercise programs for office workers can be reached.

The association between physical activity and neck and low back pain: a systematic review.

The effect of physical activity on neck and low back pain is still controversial. No systematic review has been conducted on the association between daily physical activity and neck and low back pain. The objective of this study was to evaluate the association between physical activity and the incidence/prevalence of neck and low back pain. Publications were systematically searched from 1980 to June 2009 in several databases. The following key words were used: neck pain, back pain, physical activity, leisure time activity, daily activity, everyday activity, lifestyle activity, sedentary, and physical inactivity. A hand search of relevant journals was also carried out. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Seventeen studies were included in this review, of which 13 were rated as high-quality studies. Of high-quality studies, there was limited evidence for no association between physical activity and neck pain in workers and strong evidence for no association in school children. Conflicting evidence was found for the association between physical activity and low back pain in both general population and school children. Literature with respect to the effect of physical activity on neck and low back pain was too heterogeneous and more research is needed before any final conclusion can be reached.