Persistent musculoskeletal pain is a worldwide health problem resulting in negative effects on individuals' wellbeing and substantial costs to society. Recently, there has been discussion about effective treatment approaches to persistent musculoskeletal disorders, including low back pain. In this Viewpoint, the authors argue that self-management strategies are essential to the management of persistent musculoskeletal disorders and outline the physical therapist's role in supporting effective self-management. J Orthop Sports Phys Ther 2019;49(4):212–215. doi:10.2519/jospt.2019.0605

Background. At present, there is no consolidated evidence for workplace-based interventions for the prevention and reduction of neck pain in office workers. Purpose. The purpose of this review was to investigate the effectiveness of workplace-based interventions for neck pain in office workers. Data Sources. MEDLINE, PEDro, CINAHL, and CENTRAL were searched for trials published since inception and before May 31, 2016. Study Selection. Randomized controlled trials (RCTs) were considered when they met the following criteria: population consisted of office workers, intervention(s) was performed at the workplace, outcome measures included neck and/or neck/shoulder pain intensity and incidence/prevalence, and comparator groups included no/other intervention. Data Extraction. Data were extracted by 1 reviewer using predefined data fields and checked by a second reviewer. Risk of bias was assessed by 2 independent reviewers using the 2015 Cochrane Back and Neck Group guidelines. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Data Synthesis. Twenty-seven RCTs were included. There was moderate-quality evidence that neck/shoulder strengthening exercises and general fitness training were effective in reducing neck pain in office workers who were symptomatic, although the effect size was larger for strengthening exercises. Greater effects were observed with greater participation in exercise. Ergonomic interventions were supported by low-quality evidence. Limitations. Data could not be obtained from some studies for meta-analysis and assessment of risk of bias. Reporting bias might have been present because only studies in the English language were included. Conclusions. Workplace-based strengthening exercises were effective in reducing neck pain in office workers who were symptomatic, and the effect size was larger when the exercises were targeted to the neck/shoulder. Future RCTs of ergonomic interventions targeted at office workers who are symptomatic are required. More research on neck pain prevention is warranted.

Objectives Using an employer’s perspective, this study aimed to compare the immediate and longer-term impact of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion information on health-related productivity among a general population of office workers and those with neck pain. Methods A prospective one-year cluster randomized trial was conducted. Participants received an individualized workstation ergonomics intervention, combined with 12 weeks of either workplace neck-specific exercises or health promotion information. Health-related productivity at baseline, post-intervention and 12-months was measured with the Health and Work Performance Questionnaire. Intention-to-treat analysis was performed using multilevel mixed models. Results We recruited 763 office workers from 14 organizations and allocated them to 100 clusters. For the general population of office workers, monetized productivity loss at 12 months [AU$1464 (standard deviation [SD] 1318) versus AU$1563 (SD=1039); P=0.023]; and presenteeism at 12 months [2.0 (SD 1.2) versus 2.4 (SD 1.4); P=0.007] was lower in the exercise group compared to those in the health promotion information group. For office workers with neck pain, exercise participants had lower sickness absenteeism at 12 months compared to health promotion information participants [0.7 days (SD 1.0) versus 1.4 days (SD 3.1); P-=0.012], despite a short-term increase in sickness absenteeism post-intervention compared to baseline for the exercise group [1.2 days (SD 2.2) versus 0.6 days (SD 0.9); P<0.001]. Conclusion A workplace intervention combining ergonomics and neck-specific exercise offers possible benefits for sickness presenteeism and health-related productivity loss among a general population of office workers and sickness absenteeism for office workers with neck pain in the longer-term.

Background: Neck pain is prevalent among office workers. This study evaluated the impact of an ergonomic and exercise training (EET) intervention and an ergonomic and health promotion (EHP) intervention on neck pain intensity among the All Workers and a subgroup of Neck Pain cases at baseline. Methods: A 12-month cluster-randomized trial was conducted in 14 public and private organisations. Office workers aged ≥18 years working ≥30 h per week (n = 740) received an individualised workstation ergonomic intervention, followed by 1:1 allocation to the EET group (neck-specific exercise training), or the EHP group (health promotion) for 12 weeks. Neck pain intensity (scale: 0–9) was recorded at baseline, 12 weeks, and 12 months. Participants with data at these three time points were included for analysis (n = 367). Intervention group differences were analysed using generalized estimating equation models on an intention-to-treat basis and adjusted for potential confounders. Subgroup analysis was performed on neck cases reporting pain ≥3 at baseline (n = 96). Results: The EET group demonstrated significantly greater reductions in neck pain intensity at 12 weeks compared to the EHP group for All Workers (EET: β = − 0.53 points 95% CI: − 0.84– − 0.22 [36%] and EHP: β = − 0.17 points 95% CI: − 0.47–0.13 [10.5%], p-value = 0.02) and the Neck Cases (EET: β = − 2.32 points 95% CI: − 3.09– − 1.56 [53%] and EHP: β = − 1.75 points 95% CI: − 2.35– − 1.16 [36%], p = 0.04). Reductions in pain intensity were not maintained at 12 months with no between-group differences observed in All Workers (EET: β = − 0.18, 95% CI: − 0.53–0.16 and EHP: β = − 0.14 points 95% CI: − 0.49–0.21, p = 0.53) or Neck Cases, although in both groups an overall reduction was found (EET: β = − 1.61 points 95% CI: − 2.36– − 0.89 and EHP: β = − 1.9 points 95% CI: − 2.59– − 1.20, p = 0.26). Conclusion: EET was more effective than EHP in reducing neck pain intensity in All Workers and Neck Cases immediately following the intervention period (12 weeks) but not at 12 months, with changes at 12 weeks reaching clinically meaningful thresholds for the Neck Cases. Findings suggest the need for continuation of exercise to maintain benefits in the longer term. Clinical trial registration: hACTRN12612001154897 Date of Registration: 31/10/2012.