Need for recovery in relation to effort from work and health in four occupations.

OBJECTIVE: To examine three levels of need for recovery (NFR) after work in relation to effort from work demands, demand compensatory strategies, effort-moderating or -reversing resources, and health including health behaviors. A further purpose was to examine occupational characteristics determining NFR. METHODS: 5000 engineers, carpenters, nurses, and home care nurses were invited to participate. NFR k-means clusters were calculated from 1289 participants. The effect from three levels of NFR regarding demands, compensatory strategies, resources at work, health, and health behaviors was examined using analysis of variance (ANOVA) and post hoc analysis. Prevalence ratios (PRs) of suboptimal health for three levels of NFR were calculated using Poisson regression. Linear stepwise multiple regression predictors explaining NFR were examined also occupation wise. RESULTS: NFR centroids at 5.8/33, 13.1/33, and 21.0/33 points were identified. ANOVA showed corresponding effects from NFR levels on work demands and compensatory strategies. The inversed proportion concerned levels of resources at work. Only the low NFR cluster negated regular health effects. The other two cluster groups also repeatedly worked while ill and presented PRs concerning health effects from 1.9 to 3.9 when compared to the low NFR group. Making good quality work, recovery opportunities, and thinking of work when off work were the most important predictors of NFR among 1289 participants with also occupation-wise interpretable profiles. CONCLUSIONS: Three levels of NFR meant corresponding levels of work demands, work-demand compensatory strategies, and unfavorable health behaviors. An inversed proportion of resources related to the same levels of NFR. Low NFR meant no regular health effects which could guide limit values regarding salutary NFR. Important predictors of NFR were resources making a good quality work, recovery opportunities, and reversely effort from rumination when off work. Occupation-wise predictors could guide interventions.

The view and policy of management of occupational health services on the performance of workers' health surveillance: a qualitative exploration.

BACKGROUND: Although workers' health surveillance is an important preventive activity, it is not regularly performed. In addition to the occupational physician, the management of occupational health services can also be involved in the performance of workers' health surveillance. The present study investigated the view and policy of the managements of occupational health services on the performance of workers' health surveillance by occupational physicians. METHOD: Semi-structured face-to-face interviews about the mission, view, and policy of the occupational health services with respect to workers' health surveillance were conducted with eighteen randomly selected board members of occupational health services in the Netherlands. The results were transcribed verbatim and were analysed using MAXQDA software to form themes and categories. RESULTS: The first theme found was the view of the management of occupational health services. Categories found were mission statements of occupational health services and the attitude of the management of occupational health services towards workers' health surveillance. Three types of mission statements were mentioned by the board members: keeping workers at work, improving the health of workers, or helping the employer with sick-leave management. Both positive and negative attitudes towards workers' health surveillance appeared from the interviews. Some board members mentioned that workers' health surveillance can improve workers' health, and creates awareness about workers' health. Other board members mentioned that performing workers' health surveillance is eliciting problems, and that employers do not have a positive attitude towards workers' health surveillance. The second theme was the policy on performing workers' health surveillance. Categories found were the policy on performing workers' health surveillance towards companies, and the policy on performing workers' health surveillance towards professionals. Some occupational health services recommend workers' health surveillance to all companies. However, in general workers' health surveillance was only performed at request of companies, and no instructions or training programmes for occupational physicians were provided. CONCLUSION: Although some of the mentioned views on workers' health surveillance are positive, the policy of occupational health services on workers' health surveillance does, so far, in general, not stimulate occupational physicians or employers to perform or organize workers' health surveillance.

Physicians' Perspectives on Person-Related Factors Associated With Work Participation and Methods Used to Obtain Information About These Factors.

OBJECTIVE: Person-related factors influencing work participation of employees with health problems are important. However, the best method to obtain information about them, according to occupational physicians (OPs) and insurance physicians (IPs), is unknown. METHODS: Questionnaires in which OPs and IPs rated the importance of and described methods to obtain information about 10 person-related factors: expectations regarding recovery or return to work, optimism/pessimism, self-efficacy, motivation, feelings of control, perceived health, coping strategies, fear-avoidance beliefs, perceived work-relatedness, and catastrophizing. RESULTS: OPs and IPs perceived all person-related factors, except for optimism/pessimism and perceived health as important for work participation. Information about the factors could best be obtained with use of a topic list during consultations. CONCLUSIONS: OPs and IPs should take person-related factors into account during consultations and it is best to use a topic list when discussing them.

Flight Performance Aspects During Military Helicopter Flights.

INTRODUCTION: A flight is composed of many flight performance aspects. However, not all of these aspects are equally important for the success and safety of a flight. When investigating the influence of a stressor on flight performance, it is important to understand not only which flight performance aspects are important for the success and the safety of the flight, but also which of these aspects will most likely be affected by reduced alertness.METHOD: A total of 136 helicopter pilots of the Royal Netherlands Air Force (RNLAF) of all qualification levels were invited to participate in a three-round ranking Delphi study.RESULTS: A total of 41 (30%) helicopter pilots completed the first questionnaire round and 20 (77%) flight instructors completed the ranking round. The top ten skills elements comprised seven nontechnical skills (NTS), namely, awareness of the environment, decision making, workload management, stress management, planning and coordinating, general knowledge, and basic fitness; and three technical skills (TS), that is, advanced aircraft handling, flight maneuvers and procedures, and abnormal and emergency procedures. The top three ranked skill elements (awareness of environment, decision making, and workload management) were considered by the flight instructors to be highly influenced by reduced pilot alertness.CONCLUSION: NTS are considered more important and more affected by reduced pilot alertness during operational helicopter flight compared to TS.Steinman Y, van den Oord MHAH, Frings-Dresen MHW, Sluiter JK. Flight performance aspects during military helicopter flights. Aerosp Med Hum Perform. 2019; 90(4):389-395.

Education as important predictor for successful employment in adults with congenital heart disease worldwide.

BACKGROUND: Conflicting results have been reported regarding employment status and work ability in adults with congenital heart disease (CHD). Since this is an important determinant for quality of life, we assessed this in a large international adult CHD cohort. METHODS: Data from 4028 adults with CHD (53% women) from 15 different countries were collected by a uniform survey in the cross-sectional APPROACH International Study. Predictors for employment and work limitations were studied using general linear mixed models. RESULTS: Median age was 32 years (IQR 25-42) and 94% of patients had at least a high school degree. Overall employment rate was 69%, but varied substantially among countries. Higher education (OR 1.99-3.69) and having a partner (OR 1.72) were associated with more employment; female sex (OR 0.66, worse NYHA functional class (OR 0.67-0.13), and a history of congestive heart failure (OR 0.74) were associated with less employment. Limitations at work were reported in 34% and were associated with female sex (OR 1.36), increasing age (OR 1.03 per year), more severe CHD (OR 1.31-2.10), and a history of congestive heart failure (OR 1.57) or mental disorders (OR 2.26). Only a university degree was associated with fewer limitations at work (OR 0.62). CONCLUSIONS: There are genuine differences in the impact of CHD on employment status in different countries. Although the majority of adult CHD patients are employed, limitations at work are common. Education appears to be the main predictor for successful employment and should therefore be encouraged in patients with CHD.

Effectiveness of a skin care programme for the prevention of contact dermatitis in healthcare workers (the Healthy Hands Project): A single-centre, cluster randomized controlled trial.

BACKGROUND: Healthcare workers (HCWs) are at risk of developing hand dermatitis (HD). Guidelines recommend moisturizers to prevent HD, but in practice their effectiveness has been poorly investigated. OBJECTIVES: To assess whether an intervention aimed at improving skin care leads to a reduction in HD severity. METHODS: In this 1-year randomized controlled trial, 9 wards (285 HCWs) were allocated to an intervention group (IG), and 10 wards (216 HCWs) were allocated to the control group (CG). The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCWs. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (HECSI) score (ΔHECSI) and change in natural moisturizing factor (NMF) level (ΔNMF). RESULTS: At 12 months, the rates of loss to follow-up were 41% and 39% in the IG and the CG, respectively. The HECSI score was reduced in the IG by -6.2 points (95%CI: -7.7 to -4.7) and in the CG by -4.2 points (95%CI: -6.0 to -2.4). There was no significant difference in ΔHECSI or ΔNMF between the groups. Relative improvement in the HECSI score was significantly higher in the IG than in the CG (56% vs 44%). In a subgroup of HCWs with mild HD, the IG showed a larger HECSI score decrease than the CG (P < 0.001). CONCLUSION: Although there was no significant effect on the primary outcomes, the intervention showed overall positive effects on the HECSI score.

Evaluation of the effects of two alternative participatory ergonomics intervention strategies for construction companies.

To improve the use of ergonomics tools by construction workers, the effect of two guidance strategies - a face-to-face strategy (F2F) and an e-guidance strategy (EG) - of a participatory ergonomics intervention was studied. Twelve construction companies were randomly assigned to the F2F group or the EG group. The primary outcome measure, the percentage of workers using ergonomics tools, and secondary outcome measures - work ability, physical functioning and limitations due to physical problems - were assessed using surveys at baseline and after 6 months. Additionally, a cost-benefit analysis was performed on company level. No differences in primary and secondary outcomes were found with the exception of the use of ergonomics tools to adjust working height (F2F +1%; EG +10%; p = .001). Newly-implemented tools were used by 23% (F2F) and 42% (EG) of the workers (p = .271). Costs were mainly determined by guidance costs (F2F group) or purchase costs (EG group). Practitioner Summary: Participatory strategies aim to stimulate behavioural change of stakeholders to increase the use of ergonomics tools. Two guidance strategies - face-to-face or e-mail interventions - among construction companies were studied. Both guidance strategies led to an increase in the use of new ergonomics tools.

Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project.

BACKGROUND: Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend the use of emollients; however, in practice, adherence is poor. OBJECTIVE: To assess whether the provision of creams, electronic monitoring and feedback on cream consumption can improve skin care in HCWs. METHODS: A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. The intervention wards (n = 9; 285 HCWs) were provided with hand cream dispensers equipped with an electronic system to monitor use, which was regularly communicated to the HCWs by the use of posters. The process outcomes were self-reported cream consumption in both groups, and electronically measured consumption per ward in the intervention group (IG) vs the control group (CG). RESULTS: Self-reported cream use at follow-up was significantly higher in the IG than in the CG, before (odds ratio [OR] 2.27; 95%CI: 1.29-3.97; P = 0.004) and during (OR 3.30; 95%CI: 1.80-6.06, P < 0.001) the shift, whereas at baseline there was no difference between the groups. In the IG, electronically measured cream use was, on average, 0.4 events per shift per HCW. CONCLUSION: The intervention improved hand cream use, and may therefore be considered as a practical strategy to promote skin care in HCWs. Notwithstanding this, the application frequency remained lower than recommended in the present study and current guidelines.

Toward Effective Work Accommodations for Depression: Examining the Relationship Between Different Combinations of Depression Symptoms and Work Productivity Losses.

OBJECTIVE: Heterogeneity of depression experiences has led to suggestions that interventions focus on depression symptom combinations rather than depression severity alone. Our analyses explore the question, "What is the relationship between different combinations of depression symptoms and work productivity losses?" METHODS: These analyses use a population-based sample of 2219 working adults. Using the PHQ-8 items, cluster analysis methods were used to identify depression symptom clusters. The Work Limitations Questionnaire's four work productivity loss dimensions were regressed on the identified depression symptoms clusters. RESULTS: The symptoms clusters of workers with mild to moderate depression had significant but similar work productivity losses. However, the symptom combinations within these clusters of workers varied. CONCLUSION: To create effective work accommodations, attention should focus on the combinations of depression symptoms and specific job characteristics rather than severity alone.

Occupational Diseases among Workers in Lower and Higher Socioeconomic Positions.

Background: To determine differences between workers in lower and higher socioeconomic positions (SEP) in incidences of occupational disease (OD) and incapacity for work due to ODs. Methods: From a Dutch dynamic prospective cohort of occupational physicians (OPs), ODs assessed by OPs were retrieved for lower and higher SEP groups. Results: Among the lower SEP, musculoskeletal disorders, and noise-induced hearing loss (NIHL) comprised two-thirds of the OD diagnoses. Among the higher SEP, stress/burnout comprised 60% of the OD diagnoses. Temporary and permanent incapacity for work due to work-related lower back disorders and repetitive strain injuries differed significantly between workers in lower compared to higher SEP. Conclusions: Occupational diseases occur at a 2.7 higher incidence rate for workers in lower SEP compared with higher SEP. Incapacity for work varies between the type of OD and the level of SEP.

Statistical analysis plan for the Healthy Hands Project; single centre cluster-randomised clinical trial of a skin care program for the prevention of contact dermatitis in health care workers.

BACKGROUND: The Healthy Hands Project (HHP) is a randomised clinical trial aiming to determine the effectiveness of an intervention program in the prevention of hand dermatitis in healthcare workers (HCWs). The intervention is comprised of placing dispensers with hand creams on wards combined with continuous electronic monitoring of cream consumption and regular feedback to HCWs. The clinical severity (HECSI score) was used as the primary outcome and natural moisturising factor (NMF) levels as the secondary outcome. The study protocol for the cluster-randomised controlled trial of HHP was published in Trials in 2017. This article describes the detailed statistical analysis plan for the HHP trial. METHODS/DESIGN: The HHP is a single-centre, cluster-randomised controlled trial with two parallel groups and blinded outcome assessment. This update article presents (1) the descriptive statistics of the primary and secondary outcomes, (2) the statistical models used for the analysis of the main outcomes, (3) sensitivity analyses on the effect of observed exposure to wet work, (4) handling of missing data including sensitivity analysis and (5) an updated power calculation. This statistical analysis plan was written prior to unblinding of the study. DISCUSSION: This paper presents a comprehensive statistical analysis plan for the data resulting from the HHP trial. It supports transparency in reporting by clarifying differences between the previously published protocol and the proposed actual statistical analyses. TRIAL REGISTRATION: Netherlands Trial Register (NTR), identification number NTR5564 . Registered on 2 November 2015.

Specific barrier response profiles after experimentally induced skin irritation in vivo.

BACKGROUND: Recently, natural moisturizing factors (NMFs) and corneocyte surface topography were suggested as biomarkers for irritant dermatitis. OBJECTIVES: To investigate how exposure to different irritants influences corneocyte surface topography, NMF levels and the barrier function of human skin in vivo. METHODS: Eight healthy adult volunteers were exposed to aqueous solutions of 60% n-propanol, 0.5% sodium lauryl sulfate (SLS), 0.15% sodium hydroxide, and 2.0% acetic acid, and distilled water, in a repeated irritation test over a period of 96 hours. Erythema, transepidermal water loss (TEWL), skin hydration, the dermal texture index (DTI) and NMF levels were measured at baseline, and after 24 and 96 hours. RESULTS: SLS and sodium hydroxide had the most pronounced effects on erythema and TEWL. Although n-propanol caused only slight changes in TEWL and erythema, it showed pronounced effects on skin hydration, NMF levels, and the DTI. NMF was the only parameter that was significantly altered by all investigated irritants. The changes in the DTI were inversely associated with NMF levels and skin hydration. CONCLUSION: Skin barrier impairment and the inflammatory response are irritant-specific, emphasizing the need for a multiparametric approach to the study of skin irritation. NMF levels seem to be the most sensitive parameter in detecting irritant-induced skin barrier alterations.

The process evaluation of two alternative participatory ergonomics intervention strategies for construction companies.

To gain insight into the process of applying two guidance strategies - face-to-face (F2F) or e-guidance strategy (EC) - of a Participatory Ergonomics (PE) intervention and whether differences between these guidance strategies occur, 12 construction companies were randomly assigned to a strategy. The process evaluation contained reach, dose delivered, dose received, precision, competence, satisfaction and behavioural change of individual workers. Data were assessed by logbooks, and questionnaires and interviews at baseline and/or after six months. Reach was low (1%). Dose delivered (F2F: 63%; EC: 44%), received (F2F: 42%; EC: 16%) were not sufficient. The precision and competence were sufficient for both strategies and satisfaction was strongly affected by dose received. For behavioural change, knowledge (F2F) and culture (EC) changed positively within companies. Neither strategy was delivered as intended. Compliance to the intervention was low, especially for EC. Starting with a face-to-face meeting might lead to higher compliance, especially in the EC group. Practitioner Summary: This study showed that compliance to a face-to-face and an e-guidance strategy is low. To improve the compliance, it is advised to start with a face-to-face meeting to see which parts of the intervention are needed and which guidance strategy can be used for these parts. TRIAL REGISTRATION: ISRCTN73075751.

An intervention that reduces stress in people who combine work with informal care: randomized controlled trial results.

Background: The aim of the research was to examine whether a role-focused self-help course intervention would decrease caregiver stress and distress, and functioning problems, among people who suffer stress because they combine paid work with informal care. Methods: A pre-registered (NTR 5528) randomized controlled design was applied (intervention vs. wait list control). Participants (n = 128) were people who had paid work and were suffering stress due to their involvement in informal care activities. Participants allocated to the intervention group (n = 65) received the role-focused self-help course. Control group members (n = 63) received this intervention after all measurements. Prior to the random allocation (pre-test), and 1 month (post-test 1) and 2 months (post-test 2) after allocation, all participants completed a questionnaire that measured their caregiver stress (primary outcome), distress, work functioning, negative care-to-work interference and negative care-to-social and personal life interference. Mixed model ANOVAs were used to test the effectiveness of the intervention. Results: Two months after allocation, the intervention group participants had lower levels of caregiver stress and distress compared with the control group participants. The intervention did not directly resolve impaired work functioning or interference of care with work and social/personal life. Conclusion: The intervention decreases caregiver stress and distress in people who suffer stress because they combine paid work with informal caring. The intervention (Dutch version) can be downloaded at no cost from www.amc.nl/mantelzorgstress.

The influence of risk labeling on risk perception and willingness to seek help in an experimental simulation of preventive medical examinations.

OBJECTIVE: To study the influence of the presentation of results of a preventive medical examination on risk perception and willingness to seek help for work-related fatigue or being overweight. METHODS: A factorial design experiment was conducted, presenting workers (n = 82) with vignettes including eight scenarios of test results with and without an emphasis on the risk of a current or future health condition or a probe to seek help. Participants rated perceived risk and willingness to seek help (0-100 Visual Analogue Scale) as if these were their own results. Differences were tested with paired-sample t-tests. RESULTS: In scenarios emphasizing the risk of a current or future disorder, participants perceived higher risk and were more willing to seek help (p-values < .00). Slightly higher willingness to seek help scores was observed in all scenarios that included probes (p < .00). CONCLUSION: Risk perception and willingness to seek help of workers participating in a preventive medical examination were higher when they were told that the test results indicate a risk of a current or future disorder and after being advised to seek help. PRACTICE IMPLICATIONS: Healthcare providers should take the potential effects on risk perception and help-seeking into account in preventive settings.

Consequences of Traumatic Brain Injury in Professional American Football Players: A Systematic Review of the Literature.

OBJECTIVE: The purpose of this study was to systematically review the literature for the consequences Traumatic brain injury (TBI) has on cognitive, psychological, physical, and sports-related functioning in professional American Football players. DATA SOURCES: We performed a systematic search in 2 databases, PubMed and SPORTDiscus, to obtain literature from January 1990 to January 2015. To be eligible for inclusion, a study had to examine the relationship between TBI and the consequences for several aspects of functioning in professional American football players older than 18 years. Methodological quality was assessed using a 5-item checklist which assessed selection bias, information bias, and correct reporting of the population and exposure characteristics. MAIN RESULTS: The search yielded 21 studies that met our inclusion criteria. An evidence synthesis was performed on the extracted data and resulted in 5 levels of evidence. The evidence synthesis revealed that there is strong evidence that concussions are associated with late-life depression and short-term physical dysfunctions. Evidence for the relationship between concussion and impaired sports-related function, prolonged reaction time, memory impairment, and visual-motor speed was inconclusive. Moderate evidence was found for the association between TBI and mild cognitive impairment (MCI), and limited evidence was found for the association between TBI and executive dysfunction. CONCLUSIONS: There is strong evidence that a history of concussion in American football players is associated with depression later in life and short-term physical dysfunctions. Also cognitive dysfunctions such as MCI are seen in older players with a history of TBI. These results provide input for actions to prevent TBI and their consequences in (retired) American football players.

Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work.

PURPOSE: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems. METHODS: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data. RESULTS: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers' attitudes towards their own RTW process: (1) "frozen"; (2) "insightful though passive"; and (3) "action mode". CONCLUSIONS: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers' characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment. Implications for Rehabilitation Unemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers' attitude may provide useful information on their own return-to-work process. In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment. Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers' coping methods according to one of three types of workers' attitudes towards their own RTW process.

Within-person fluctuations in wellbeing and task-specific work ability.

PURPOSE: To research within-person fluctuations in occupational health, work ability and wellbeing, we need new measurement strategies. We studied absolute agreement for weekly measurements of task-specific work ability and relationships between wellbeing, work demands and personal factors and task-specific work ability over time. METHODS: Forty-eight Dutch academic researchers answered questions during 12 consecutive weeks. Physical and mental work demands, indicators of wellbeing and task-specific work ability in each week were measured. Intra-class correlation coefficients (ICC) for absolute agreement between task-specific work ability measures were calculated. For application in individual workers, an ICC > 0.90 was regarded as suitable. Multilevel models were used to relate both time-invariant and time-varying predictors to task-specific work ability. RESULTS: Multiple measurements increased the reliability. Absolute agreement, however, did not reach the optimal level, except for the task 'ability to conduct data analyses' which had an ICC value of 0.95 (95% CI 0.91-0.98). Individuals' leisure time physical activity (p = 0.03) and relational (p = 0.02) and social (p = 0.02) wellbeing were related to their average task-specific work ability. Weekly physical demands (p = 0.01) and personal (p = 0.04) and general wellbeing (p = 0.03) were related to weekly fluctuations in work ability. CONCLUSIONS: We demonstrated intra-individual variability in repeated assessments of task-specific work ability, pointing to the need for multiple measurements when characterizing work ability. The finding that some time-invariant and time-varying predictors can be related to the estimate of aspects of task-specific work ability and its fluctuations is helpful in understanding the dynamics of this concept.

Evaluation of a randomized controlled trial on the effect on return to work with coaching combined with light therapy and pulsed electromagnetic field therapy for workers with work-related chronic stress.

BACKGROUND: Chronic work-related stress is quite prevalent in the working population and is in some cases accompanied by long-term sick leave. These stress complaints highly impact employees and are costly due to lost productivity and medical expenses. A new treatment platform with light therapy plus Pulsed Electro Magnetic Fields (PEMF) in combination with coaching was used to assess whether more positive effects on return to work, stress, work-related fatigue, and quality of life could be induced compared to coaching alone. METHODS: A placebo-controlled trial was executed after inclusion of 96 workers, aged 18-65 with work-related chronic stress complaints and who were on sick leave (either part-time or full-time). Participants were divided into three arms at random. Group 1 (n = 28) received the treatment and coaching (Intervention group), group 2 (n = 28) received the treatment with the device turned off and coaching (Placebo group) and group 3 (n = 28) received coaching only (Control group). The data were collected at baseline, and after 6, 12 and 24 weeks. The primary outcome was % return to work, and secondary outcomes were work-related fatigue (emotional exhaustion and need for recovery after work), stress (distress and hair cortisol), and quality of life (SF-36 dimensions: vitality, emotional role limitation, and social functioning). RESULTS: Eighty-four workers completed all measurements, 28 in each group. All groups improved significantly over time in the level of return to work, as well as on all secondary outcomes. No statistical differences between the three groups were found either on the primary outcome or on any of the secondary outcomes. CONCLUSIONS: Light therapy with Pulsed Electro Magnetic Fields PEMF therapy has no additional effect on return to work, stress, fatigue, and quality of live compared to coaching alone. TRIAL REGISTRATION: NTR4794 , registration date: 18-sep-2014.