Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians: Randomized controlled trial

Kenneth Jay Andersen, Mikkel Brandt, Klaus Hansen, Emil Sundstrup, Markus D Jakobsen, M C Schraefel, Gisela Sjogaard, Lars L Andersen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem.

OBJECTIVES: This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements.

STUDY DESIGN: This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial "Implementation of physical exercise at the Workplace (IRMA09) - Laboratory technicians" was registered at ClinicalTrials.gov prior to participant enrolment.

SETTING: The study was conducted at the head division of a large private pharmaceutical company's research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up).

METHODS: Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0 - 10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen´s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures.

RESULTS: A significant (P < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain. Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome.

LIMITATIONS: Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations.

CONCLUSIONS: We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. A higher dose of physical-cognitive training appears to facilitate pain reduction, whereas a higher dose of mindfulness appears to increase pain. Hence, combining physical training with mindfulness may not be an optimal strategy for pain reduction.

TRIAL REGISTRATION: NCT02047669.

Original languageEnglish
JournalPain Physician
Volume18
Issue number5
Pages (from-to)459-471
ISSN1533-3159
Publication statusPublished - 1. Sep 2015

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Chronic Pain
Workplace
Randomized Controlled Trials
Outcome Assessment (Health Care)
Placebo Effect
Resistance Training
Neck Pain
Health
Motor Cortex
Denmark
Elbow
Linear Models
Joints
Exercise
Education

Keywords

  • Dynamic joint mobility
  • Fear avoidance
  • Mindfulness
  • Motor control exercise
  • Pain Catastrophizing
  • Strength
  • Work environment

Cite this

Andersen, K. J., Brandt, M., Hansen, K., Sundstrup, E., Jakobsen, M. D., Schraefel, M. C., ... Andersen, L. L. (2015). Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians: Randomized controlled trial. Pain Physician, 18(5), 459-471.
Andersen, Kenneth Jay ; Brandt, Mikkel ; Hansen, Klaus ; Sundstrup, Emil ; Jakobsen, Markus D ; Schraefel, M C ; Sjogaard, Gisela ; Andersen, Lars L. / Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians : Randomized controlled trial. In: Pain Physician. 2015 ; Vol. 18, No. 5. pp. 459-471.
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Andersen, KJ, Brandt, M, Hansen, K, Sundstrup, E, Jakobsen, MD, Schraefel, MC, Sjogaard, G & Andersen, LL 2015, 'Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians: Randomized controlled trial', Pain Physician, vol. 18, no. 5, pp. 459-471.

Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians : Randomized controlled trial. / Andersen, Kenneth Jay; Brandt, Mikkel; Hansen, Klaus; Sundstrup, Emil; Jakobsen, Markus D; Schraefel, M C; Sjogaard, Gisela; Andersen, Lars L.

In: Pain Physician, Vol. 18, No. 5, 01.09.2015, p. 459-471.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians

T2 - Randomized controlled trial

AU - Andersen, Kenneth Jay

AU - Brandt, Mikkel

AU - Hansen, Klaus

AU - Sundstrup, Emil

AU - Jakobsen, Markus D

AU - Schraefel, M C

AU - Sjogaard, Gisela

AU - Andersen, Lars L

PY - 2015/9/1

Y1 - 2015/9/1

N2 - BACKGROUND: Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem.OBJECTIVES: This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements.STUDY DESIGN: This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial "Implementation of physical exercise at the Workplace (IRMA09) - Laboratory technicians" was registered at ClinicalTrials.gov prior to participant enrolment.SETTING: The study was conducted at the head division of a large private pharmaceutical company's research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up).METHODS: Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0 - 10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen´s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures.RESULTS: A significant (P < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain. Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome.LIMITATIONS: Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations.CONCLUSIONS: We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. A higher dose of physical-cognitive training appears to facilitate pain reduction, whereas a higher dose of mindfulness appears to increase pain. Hence, combining physical training with mindfulness may not be an optimal strategy for pain reduction.TRIAL REGISTRATION: NCT02047669.

AB - BACKGROUND: Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem.OBJECTIVES: This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements.STUDY DESIGN: This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial "Implementation of physical exercise at the Workplace (IRMA09) - Laboratory technicians" was registered at ClinicalTrials.gov prior to participant enrolment.SETTING: The study was conducted at the head division of a large private pharmaceutical company's research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up).METHODS: Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0 - 10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen´s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures.RESULTS: A significant (P < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain. Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome.LIMITATIONS: Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations.CONCLUSIONS: We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. A higher dose of physical-cognitive training appears to facilitate pain reduction, whereas a higher dose of mindfulness appears to increase pain. Hence, combining physical training with mindfulness may not be an optimal strategy for pain reduction.TRIAL REGISTRATION: NCT02047669.

KW - Dynamic joint mobility

KW - Fear avoidance

KW - Mindfulness

KW - Motor control exercise

KW - Pain Catastrophizing

KW - Strength

KW - Work environment

M3 - Journal article

C2 - 26431123

VL - 18

SP - 459

EP - 471

JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

IS - 5

ER -