human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The total costs for patients who are sick-listed due to back and neck problems have not previously been determined prospect ively on an individual basis . This study aim ed to determine the total cost to a society , based on individually assessed costs of health services and loss of production in people who are sick-listed 28 days or more for back or neck problems . Detailed data on individuals ’ health-care consumption due to back or neck problems was collected through prospect ively entered diaries and question naires , after 4 weeks , 3 months , 1 and 2 years , in a consecutively selected cohort of 1,822 employed persons aged between 18 and 59 years .  Costs for health care and production losses due to work absenteeism were determined individually and combined to render total costs to society . The costs for all medical services during the 2-year study were 6.9 % of total costs for back and neck problems . The single most expensive medical service was surgery . Transferred to a national level , annual total costs for back and neck problems corresponded to 1 % of GNP . In conclusion , direct health-service costs were a small fraction of the total costs , consequently indirect costs offer the greatest potential for savings 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 Study Design . A single‐blinded , r and omized treatment study with a follow‐up period of 6 months . Objective . To study the long‐term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident . Patients in the first group were encouraged to act as usual , i.e. , continue to engage in their normal , pre‐injury activities ; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar . The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident . Summary of Background Data . Few r and omized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain . Method . Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim , Norway . The study group included 201 patients ( 47 % of the study group ) with neck sprain that result ed from a car accident .  Neck and shoulder movements and subjective symptoms , which were assessed using several different measurements , were assessed during the follow‐up period . Results . There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups . There was a significantly better outcome for the act‐as‐usual group in terms of subjective symptoms , including pain localization , pain during daily activities , neck stiffness , memory , and concentration , and in terms of visual analog scale measurements of neck pain and headache . Conclusions . The outcome was better for patients who were encouraged to continue engaging in their normal , pre‐injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury 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 Former studies have question ed the quality and effectiveness of multidisciplinary rehabilitation for working-age adults with fibromyalgia and chronic widespread pain ( CWP ) . High- quality trials are needed , and return to work should also be included as an outcome variable . This r and omized study evaluated the return-to-work outcome of an extensive and a light multidisciplinary treatment program combining cognitive strategies and exercise versus treatment-as-usual initiated by a general practitioner , for CWP patients . The patients ( n=208 ) , on sick leave for 3 months on average , were r and omized to the extensive program including group sessions , a light and more individual program , and to treatment-as-usual . The number of days absent from work and full return to work were used as an outcome , and follow-up lasted 54 months after the programs ended . The regression analysis showed that the extensive program was associated with significantly fewer days absent from work among women . For women , the mean effect of extensive treatment versus treatment-as-usual on total number of days absent from work was estimated to -206.95 days . Among men , the light program was associated with significantly more days absent from work compared to treatment-as-usual . Both among men and women , independent of type of treatment , patients with poorer health ( poor prognosis ) were absent from work more days than patients with good prognosis . In our sample , higher age significantly increased the number of days absent from work , but only for women . The extensive outpatient multidisciplinary treatment program was effective in returning women to work 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 Background This is a r and omized clinical trial ( RCT ) to investigate the efficacy of a job placement and support program design ed for workers with musculoskeletal injuries and having difficulties in resuming the work role . The program was planned to help injured workers to successfully return to work ( RTW ) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach . Methodology A total of 66 injured workers were recruited and r and omly assigned into the job placement and support group ( PS group ) or the self-placement group ( SP group ) . A three-week job placement and support program was given to subjects in the PS group while subjects in the control group ( SP group ) were only given advice on job placement at a workers ’ health center . The PS program was comprised of an individual interview , vocational counseling , job preparation training , and assisted placement using the case management approach . The Chinese Lam Assessment of Stages of Employment Readiness ( C-LASER ) , the Chinese State Trait and Anxiety Inventory ( C-STAI ) , and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects ’ work readiness status , emotional status and their health related quality of life pre- and post-training program . The rate of return to work was measured for both groups of subjects after the training program . Results The results indicated that the rate of success in RTW ( 73 % ) was significantly higher in the job placement ( PS ) group than that of the self-placement ( SP ) group ( 51.6 % ) with P < 0.05 . Significant differences were also found in C-STAI ( P < 0.05 ) , SF-36 ( P < 0.05 ) and C-LASER scores on action ( P < 0.05 ) between the two groups . Conclusion The job placement ( PS ) program appeared to have enhanced the employability of injured workers . Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries The effects of two different prevention programmes on : ( 1 ) reported neck , shoulder and back pain , ( 2 ) perceived physical exertion at work and perceived work-related psychosocial factors , were evaluated by question naires after 12 and 18 months . Female nursing aides and assistant nurses ( n = 282 ) working in the home-care services , were r and omly assigned to one of three groups for : ( 1 ) individually design ed physical training programme , ( 2 ) work-place stress management , ( 3 ) control group . Results revealed no significant differences between the three groups . However , improvements in low back pain were registered within both intervention groups for up to 18 months . Perceived physical exertion at work was reduced in the physical training group . Improvements in neck and shoulder pain did not differ within the three groups . Dissatisfaction with work-related , psychosocial factors was generally increased in all groups . As the aetiology of neck , shoulder and back disorders is multifactorial , a combination of the two intervention programmes might be preferable and should be further studied Background Neck and upper limb symptoms are frequently reported by computer workers .  Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms . A combined approach targeting work style and lifestyle physical activity seems promising , but little is known on the effectiveness of such combined interventions . Methods / design The RSI@Work study is a r and omised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers . Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and /or the last two weeks are r and omised into three groups : ( 1 ) work style group , ( 2 ) work style and physical activity group , or ( 3 ) control group . The work style intervention consists of six group meetings in a six month period that take place at the workplace , during work time , and under the supervision of a specially trained counsellor . The goal of this intervention is to stimulate workplace adjustment and to improve body posture , the number and quality of breaks and coping behaviour with regard to high work dem and s. In the combined ( work style and physical activity ) intervention the additional goal is to increase moderate to heavy physical activity . The control group receives usual care . Primary outcome measures are degree of recovery , pain intensity , disability , number of days with neck and upper limb symptoms , and number of months without neck and upper limb symptoms . Outcome measures will be assessed at baseline and six and 1 
    Output:
    
agent
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 .
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The total costs for patients who are sick-listed due to back and neck problems have not previously been determined prospect ively on an individual basis . This study aim ed to determine the total cost to a society , based on individually assessed costs of health services and loss of production in people who are sick-listed 28 days or more for back or neck problems . Detailed data on individuals ’ health-care consumption due to back or neck problems was collected through prospect ively entered diaries and question naires , after 4 weeks , 3 months , 1 and 2 years , in a consecutively selected cohort of 1,822 employed persons aged between 18 and 59 years .  Costs for health care and production losses due to work absenteeism were determined individually and combined to render total costs to society . The costs for all medical services during the 2-year study were 6.9 % of total costs for back and neck problems . The single most expensive medical service was surgery . Transferred to a national level , annual total costs for back and neck problems corresponded to 1 % of GNP . In conclusion , direct health-service costs were a small fraction of the total costs , consequently indirect costs offer the greatest potential for savings 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 Study Design . A single‐blinded , r and omized treatment study with a follow‐up period of 6 months . Objective . To study the long‐term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident . Patients in the first group were encouraged to act as usual , i.e. , continue to engage in their normal , pre‐injury activities ; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar . The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident . Summary of Background Data . Few r and omized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain . Method . Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim , Norway . The study group included 201 patients ( 47 % of the study group ) with neck sprain that result ed from a car accident .  Neck and shoulder movements and subjective symptoms , which were assessed using several different measurements , were assessed during the follow‐up period . Results . There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups . There was a significantly better outcome for the act‐as‐usual group in terms of subjective symptoms , including pain localization , pain during daily activities , neck stiffness , memory , and concentration , and in terms of visual analog scale measurements of neck pain and headache . Conclusions . The outcome was better for patients who were encouraged to continue engaging in their normal , pre‐injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury 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 Former studies have question ed the quality and effectiveness of multidisciplinary rehabilitation for working-age adults with fibromyalgia and chronic widespread pain ( CWP ) . High- quality trials are needed , and return to work should also be included as an outcome variable . This r and omized study evaluated the return-to-work outcome of an extensive and a light multidisciplinary treatment program combining cognitive strategies and exercise versus treatment-as-usual initiated by a general practitioner , for CWP patients . The patients ( n=208 ) , on sick leave for 3 months on average , were r and omized to the extensive program including group sessions , a light and more individual program , and to treatment-as-usual . The number of days absent from work and full return to work were used as an outcome , and follow-up lasted 54 months after the programs ended . The regression analysis showed that the extensive program was associated with significantly fewer days absent from work among women . For women , the mean effect of extensive treatment versus treatment-as-usual on total number of days absent from work was estimated to -206.95 days . Among men , the light program was associated with significantly more days absent from work compared to treatment-as-usual . Both among men and women , independent of type of treatment , patients with poorer health ( poor prognosis ) were absent from work more days than patients with good prognosis . In our sample , higher age significantly increased the number of days absent from work , but only for women . The extensive outpatient multidisciplinary treatment program was effective in returning women to work 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 Background This is a r and omized clinical trial ( RCT ) to investigate the efficacy of a job placement and support program design ed for workers with musculoskeletal injuries and having difficulties in resuming the work role . The program was planned to help injured workers to successfully return to work ( RTW ) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach . Methodology A total of 66 injured workers were recruited and r and omly assigned into the job placement and support group ( PS group ) or the self-placement group ( SP group ) . A three-week job placement and support program was given to subjects in the PS group while subjects in the control group ( SP group ) were only given advice on job placement at a workers ’ health center . The PS program was comprised of an individual interview , vocational counseling , job preparation training , and assisted placement using the case management approach . The Chinese Lam Assessment of Stages of Employment Readiness ( C-LASER ) , the Chinese State Trait and Anxiety Inventory ( C-STAI ) , and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects ’ work readiness status , emotional status and their health related quality of life pre- and post-training program . The rate of return to work was measured for both groups of subjects after the training program . Results The results indicated that the rate of success in RTW ( 73 % ) was significantly higher in the job placement ( PS ) group than that of the self-placement ( SP ) group ( 51.6 % ) with P < 0.05 . Significant differences were also found in C-STAI ( P < 0.05 ) , SF-36 ( P < 0.05 ) and C-LASER scores on action ( P < 0.05 ) between the two groups . Conclusion The job placement ( PS ) program appeared to have enhanced the employability of injured workers . Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries The effects of two different prevention programmes on : ( 1 ) reported neck , shoulder and back pain , ( 2 ) perceived physical exertion at work and perceived work-related psychosocial factors , were evaluated by question naires after 12 and 18 months . Female nursing aides and assistant nurses ( n = 282 ) working in the home-care services , were r and omly assigned to one of three groups for : ( 1 ) individually design ed physical training programme , ( 2 ) work-place stress management , ( 3 ) control group . Results revealed no significant differences between the three groups . However , improvements in low back pain were registered within both intervention groups for up to 18 months . Perceived physical exertion at work was reduced in the physical training group . Improvements in neck and shoulder pain did not differ within the three groups . Dissatisfaction with work-related , psychosocial factors was generally increased in all groups . As the aetiology of neck , shoulder and back disorders is multifactorial , a combination of the two intervention programmes might be preferable and should be further studied Background Neck and upper limb symptoms are frequently reported by computer workers .  Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms . A combined approach targeting work style and lifestyle physical activity seems promising , but little is known on the effectiveness of such combined interventions . Methods / design The RSI@Work study is a r and omised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers . Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and /or the last two weeks are r and omised into three groups : ( 1 ) work style group , ( 2 ) work style and physical activity group , or ( 3 ) control group . The work style intervention consists of six group meetings in a six month period that take place at the workplace , during work time , and under the supervision of a specially trained counsellor . The goal of this intervention is to stimulate workplace adjustment and to improve body posture , the number and quality of breaks and coping behaviour with regard to high work dem and s. In the combined ( work style and physical activity ) intervention the additional goal is to increase moderate to heavy physical activity . The control group receives usual care . Primary outcome measures are degree of recovery , pain intensity , disability , number of days with neck and upper limb symptoms , and number of months without neck and upper limb symptoms . Outcome measures will be assessed at baseline and six and 1 
    Output:
    