***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Occupational low back pain ( OLBP ) is widespread in industrialized societies . We present a model to estimate the net economic costs of investments in ergonomic interventions at the company level to reduce work-related low back pain . METHODS Costs of interventions are defined by incorporating not only the costs of investment of equipment and labor , but also by taking into account the avoided costs of lost work time , medical care costs , and productivity improvements . In the net-cost model , all costs are annualized and are calculated at the level of an individual organization . Three case studies have been performed based on data from three companies in the manufacturing sector of the United States using the above approach . RESULTS The net-cost estimates for the three case studies consistently show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies . CONCLUSIONS Although generalizing on the basis of three case studies is not ideal , our analyses show that it might be in the economic interest of management to play a more active role to prevent back pain . Gathering useful retrospective cost data , even on interventions deemed effective by corporate innovators , proved to be extremely difficult . We conclude that it is essential to incorporate a protocol for collecting cost and effectiveness data in the st and ard operating procedures of ergonomists and companies introducing such innovation . We intend to vali date the net-cost model for the monitoring and reporting of such data through prospect i ve studies in a variety of industrial setting s and in countries at various stages of economic development BACKGROUND High rates of work-related injuries are seen among health care workers involved in lifting and transferring patients . We studied the effects of a participatory worker-management ergonomics team among hospital orderlies . METHODS This prospect i ve intervention trial examined work injuries and other outcomes before and after the intervention , with other hospital employees used as a concurrent control . All orderlies in a 1,200-bed urban hospital were studied using passively collected data ( mean employment during study period 100 - 110 orderlies ) ; 67 orderlies ( preintervention ) and 88 orderlies ( postintervention ) also completed a question naire . The intervention was the formation of a participatory ergonomics team with three orderlies , one supervisor , and technical advisors . This team design ed and implemented changes in training and work practice s. RESULTS The 2-year postintervention period was marked by decreased risks of work injury ( RR = 0.50 , 95 % CI 0.35 - 0.72 ) , lost time injury ( RR = 0.26 , 95 % CI 0.14 - 0.48 ) , and injury with three or more days of time loss ( RR = 0.19 , 95 % CI 0.07 - 0.53 ) . Total lost days declined from 136.2 to 23.0 annually per 100 full-time worker equivalents ( FTE ) . Annual workers ' compensation costs declined from $ 237/FTE to $ 139/FTE . The proportion of workers with musculoskeletal symptoms declined and there were statistically significant improvements in job satisfaction , perceived psychosocial stressors , and social support among the orderlies . CONCLUSION Substantial improvements in health and safety were seen following implementation of a participatory ergonomics program Study Design . R and omized controlled trial . Objectives . To investigate the effectiveness and costs of a mini-intervention , provided in addition to the usual care , and the incremental effect of a work site visit for patients with subacute disabling low back pain . Summary of Background Data . There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain . Methods . A total of 164 patients with subacute low back pain were r and omized to a  mini-intervention group ( A ) , a work site visit group ( B ) , or a usual care group ( C ) . Groups A ( n = 56 ) and B ( n = 51 ) underwent one assessment by a physician plus a physiotherapist . Group B received a work site visit in addition . Group C served as controls ( n = 57 ) and was treated in municipal primary health care . All patients received a leaflet on back pain . Pain , disability , specific and generic health-related quality of life , satisfaction with care , days on sick leave , and use and costs of health care consumption were measured at 3- , 6- , and 12-month follow-ups . Results . During follow-up , fewer subjects had daily pain in Groups A and B than in Group C ( Group A vs. Group C , P = 0.002 ; Group B vs. Group C , P = 0.030 ) . In Group A , pain was less bothersome ( Group A vs. Group C , P = 0.032 ) and interfered less with daily life ( Group A vs. Group C , P = 0.040 ) than among controls . Average days on sick leave were 19 in Group A , 28 in Group B , and 41 in Group C ( Group A vs. Group C , P = 0.019 ) . Treatment satisfaction was better in the intervention groups than among the controls , and costs were lowest in the mini-intervention group . Conclusions . Mini-intervention reduced daily back pain symptoms and sickness absence , improved adaptation to pain and patient satisfaction among patients with subacute low back pain , without increasing health care costs . A work site visit did not increase effectiveness Background : Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders . Methods : This one year , r and omised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company . Participants were r and omised to receive ( 1  ) ergonomics training only , ( 2 ) training plus a trackball , ( 3 ) training plus a forearm support , or ( 4 ) training plus a trackball and forearm support . Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention . Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors , baseline pain levels , and psychosocial job factors . Results : Post-intervention , 63 participants were diagnosed with one or more incident musculoskeletal disorders  . Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders ( HR = 0.49 , 95 % CI 0.24 to 0.97 ) after adjusting for baseline pain levels and demographic and psychosocial factors . The armboard also significantly reduced neck/shoulder pain ( p = 0.01 ) and right upper extremity pain ( p = 0.002 ) in comparison to the control group . A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months . Conclusion : Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees Musculoskeletal injuries in the workplace are recognized as a major health and economic problem ; however , little has been done to develop strategies that emphasize both quality and cost control . The purpose of this ten-year perspective investigation was to evaluate the use of quality -based st and ardized diagnostic and treatment protocol s as part of an unbiased injury surveillance system . The program was evaluated in a public utility company with more than 5300 employees , and result ed in a measurable and long-term improvement in all outcome parameters measured : ( 1 ) The number of days lost from work and the number of new injuries reported fell by 55 and 51 % , respectively . ( 2 ) The average time lost per injury dropped by 40 % . ( 3 ) The number of surgeries performed decreased by 67 % , and the operative success rate increased dramatically . ( 4 ) Finally , as an added benefit , there was a 60 % reduction in expenditures for lost time and replacement wages , result ing in a cumulative ten-year savings of more than 4.1 million dollars . The program accomplished the goal of ensuring quality care in a prospect i ve concurrent fashion . As an additional benefit , the program also reduced unjustified lost time and compensation costs through early functional return , efficient use of diagnostic studies , and avoidance of surgery whenever possible . Future emphasis on health-care delivery in the workers ' compensation setting should concentrate on high- quality medical care , which will , in turn , lead to secondary cost savings Study Design . A retrospective and prospect i ve cohort . Objectives . To compare the effectiveness of occupational intervention , early intervention , and st and ard care in the management of Worker ’s Compensation injury cl aims . Summary of Background Data . The current management of occupational back pain and work-related upper extremity disorders with either st and ard care or early intervention appears to be ineffective . Methods . A retrospective cohort compared injury cl aim incidence , duration ,  and costs  between one company with access to st and ard care and another similar company with access to early intervention .  A prospect i ve cohort looked at the effect of one company changing from  st and ard care to occupational management  in comparison with the control group with early intervention .  Survival analysis was used to attempt to explain differences in injury cl aim duration . Results . St and ard care result ed in lower injury cl aim incidence , duration , and costs than early intervention , whereas occupational management result ed in lower injury cl aim incidence , duration , and costs than st and ard care . The covariates of physical therapist involvement , chiropractor involvement , injury severity , and relationship between Worker ’s Compensation and the employer were associated with delayed time to cl aim closure in the company with access to early intervention with the most important covariate being physical therapist involvement ( hazard rate ratio 19.88 , 95 % confidence interval 7.95–39.77 ) . Only the covariate of injury severity was associated with delayed time to cl aim closure in the company with access to occupational management ( hazard rate ratio 1.67 , 95 % confidence interval 1.05–27.20 ) . Conclusions . It is recommended that an occupational management approach , in comparison with st and ard care or early intervention , be considered for management of occupational injuries Aims : To test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain , combining an occupational and a clinical rehabilitation intervention . Methods : A r and omised trial design with four arms was used : st and ard care , occupational arm , clinical arm , and Sherbrooke model arm ( combined occupational and clinical interventions ) . From the Quebec WCB perspective , a cost-benefit ( amount of consequence of disease costs saved ) and cost-effectiveness analysis ( amount of dollars spent for each saved day on full benefits ) were calculated for each experimental arm of the study , compared to st and ard care . Results : At the mean follow up of 6.4 years , all experimental study arms showed a trend towards cost benefit and cost effectiveness . These results were owing to a small number of very costly cases . The largest number of days saved from benefits was in the Sherbrooke model arm . Conclusions : A fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers ’ compensation board and to save more days on benefits than usual care or partial interventions . A limited number of cases were responsible for most of the long term disability costs , in accordance with occupational back pain epidemiology . However , further studies with larger sample s will be necessary to confirm these results OBJECTIVES To determine the effectiveness and direct of two protective devices-a shielded 3 ml safety syringe ( Safety-Lok ; Becton Dickinson and Co. , Becton Dickinson Division , Franklin Lakes , N.J. ) and the components of a needleless IV system ( InterLink ; Baxter Healthcare Corp. , Deerfield , Ill.)--in preventing needlestick injuries to health care workers . DESIGN Twelve-month prospect i ve , controlled , before- and -after trial with a st and ardized question naire to monitor needlestick injury rates . SETTING Six hospital inpatient units , consisting of three medical units , two surgical units ( all of which were similar in patient census , acuity , and frequency of needlesticks ) , and a surgical-trauma intensive care unit , at a 900-bed urban university medical center . PARTICIPANTS All nursing personnel , including registered nurses , licensed practical nurses , nursing aides , and students , as well as medical teams consisting of an attending physician , resident physician , interns , and medical students on the study units . INTERVENTION After a 6-month prospect i ve surveillance period , the protective devices were r and omly introduced to four of the chosen study units and to the surgical-trauma intensive care unit . RESULTS Forty-seven needlesticks were reported throughout the entire study period , 33 in the 6 months before and 14 in the 6 months after the introduction of the protective devices . Nursing staff members who were using hollow-bore needles and manipulating intravenous lines accounted for the greatest number of needlestick injuries in the pre-intervention period . The overall rate of needlestick injury was reduced by 61 % , from 0.785 to 0.303 needlestick injuries per 1000 health care worker-days after the introduction of the protective devices ( relative risk = 1.958 ; 95 % confidence interval , 1.012 to 3.790 ; p = 0.046 ) . Needlestick injury rates associated with intravenous line manipulation , procedures with 3 ml syringes , and sharps disposal were reduced by 50 % ; however , reductions in these subcategories were not statistically significant . No seroconversions to HIV-1 or hepatitis B virus seropositivity occurred among those with needlestick injuries . The direct cost for each needlestick prevented was $ 789 . CONCLUSIONS Despite an overall reduction in needlestick injury rates , no statistically significant reductions could be directly attributed to the protective devices . These devices are associated with 
    Output:
    
RESULTS We found strong evidence that ergonomic and other musculoskeletal injury prevention interventions in manufacturing and warehousing are worth undertaking in terms of their financial merits .
We also found strong evidence that multisector disability management interventions are worth undertaking .
While the economic evaluation of interventions in this literature warrants further expansion , we found a sufficient number of studies to identify strong , moderate , and limited evidence in certain industry-intervention clusters .