Prevention and Intervention of Neck Pain in Swiss Office-Workers (NEXpro)

On-site Multi-component Intervention to Improve Productivity and Reduce the Economic and Personal Burden of Neck Pain in Swiss Office-Workers

This study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, neck pain, and headache.

Study Overview

• Status: Completed
• Conditions: Musculoskeletal Diseases; Neck Pain; Headache; Health Promotion; Adherence, Patient; Occupational Health; Surveys and Questionnaires; Adult; Absenteeism; Exercise Therapy; Ergonomics; Workplace; Efficiency; Work Performance; Presenteeism
• Intervention / Treatment: Other: Multi-component intervention; Other: Control

Detailed Description

Non-specific neck pain and headache are major economic and individual burdens in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of neck pain and headache in office workers.

This study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18-65 years from two Swiss organisations in the Canton of Zurich and Canton of Aargau, working more than 25 hours a week in predominantly sedentary office work and without serious health conditions of the neck. 120 voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes will include neck disability and pain. Physical and health outcomes (e.g. Neck Disability Index, muscle strength, and endurance), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), and individual outcomes (e.g. socio-demographic data, adherence to intervention) will be assessed. Measurements will take place at baseline, 4 months, 8 months, 12 months, 16 months, and 28 months after commencement. Data will be analysed on an 'intention to treat' basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models.

This study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers.

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Aarau, Switzerland, 5001
    • Kanton Aargau, Departement Bau, Verkehr und Umwelt
  • Winterthur, Switzerland, 8400
    • ZHAW

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion criteria:

• Swiss office-workers, who suffer from NP or want to take prevention of neck pain or headache
• 18-65 years old
• working more than 25 hours per week (0.6 full-time equivalent) in predominantly sedentary office work
• be able to communicate in German (written, spoken)
• have provided written informed consent

Exclusion criteria:

• previous trauma or injuries to the neck (NP grade 4)
• specific diagnosed pathologies (e.g., congenital cervical abnormalities, stenosis, fracture, radiculopathy)
• inflammatory condition (e.g., rheumatoid arthritis)
• any history of cervical spine surgery
• if exercise is contraindicated (e.g., medical advice, own beliefs)
• prolonged absence from work (more than four consecutive weeks) during the study intervention period
• pregnant women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control	Other: Control; No intervention takes place during the control phase.
Other: Intervention; Multi-component intervention	Other: Multi-component intervention; Participants' workstation ergonomics will be assessed using an observation-based ergonomics assessment checklist for office-workers adapted to Swiss guidelines. Based on the initial assessment, best practice ergonomics will be applied individually using existing infrastructure. Participants will attend health promotion information group workshops for approximately one hour per week for 12 weeks. it. Participants will receive an individual progressive exercise programme aimed at conditioning the muscles of the neck and shoulder girdle. The exercises will be performed in groups (maximum of ten per group) at the workplace in a dedicated room, for approximately one hour (3x20 minutes) per week; once per week supervised by a physiotherapist, a human movement scientist, or a health scientist, and twice per week individually. Workshop session attendance will be recorded as an indication of adherence to health promotion. Adherence to neck exercises will be recorded with the Physitrack® app.; Other Names: Workstation Ergonomics, Health promotion, Neck exercise, Adherence to intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in NP-related productivity loss	Change in NP-related productivity loss will be measured in percentages of the working time, using the Work Productivity and Activity Impairment Questionnaire for Specific Health Problem (WPAI German version) and converted into monetary units using individual earnings. Absenteeism is assessed by asking the participants about the number of hours missed because of NP as well as the number of hours they have actually worked. To assess presenteeism, the participants are asked to indicate on a 10-score scale how much the NP affected productivity while working, with 0 indicating no effect on productivity and 10 indicating total disability. Scoring rules of the developers of the questionnaire will then be used to obtain self-reported absenteeism and presenteeism expressed as impairment percentages. The monetary value for the lost productivity will be obtained for each individual by multiplying the impairment percentages by the individual gross wage.	change from baseline at 16 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck pain	Neck pain intensity, occurence and frequency will be measured based on existing questionnaires (Standardised Nordic questionnaires for the analysis of musculoskeletal Symptoms; Neuromuscular assessment in Elderly Workers with and without work related) (open questions and numeric pain rating scale ranging from 0 to 10). neck/shoulder trouble).	change from baseline at 16 months
Neck Disability Index	The German version of the Neck Disability Index (NDI) will be used to evaluate the extent to which NP interferes with vocational, recreational, social, and functional aspects of living. (score from 0 to 100)	change from baseline at 16 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pre-existing headache conditions	Pre-existing headache conditions will be screened for by an adapted headache screening questionnaire, based on validated German questionnaires (German Language Questionnaire for Screening for Migraine, Tension-Type Headache, and Trigeminal Autonomic Cephalgias; German-Language Self-Administered Headache Questionnaire; Der Rostocker Kopfschmerzfragen-Komplex)	baseline
Physical activity level	Short-form International Physical Activity Questionnaire (IPAQ German version) with data expressed as a continuous variable in metabolic equivalent of task (MET) min per week	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Health related Quality of life	The EuroQoL Five Dimension (ordinal scale) and EuroQoL visual analogue scale VAS (0-100 representing worst to best imaginable health state, respectively) will be used.	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Job-Stress-Index	The Job-Stress-Index provides the ratio between resources and work stressors. Normative statements (percentile ranks) will be given for representative groups of office-workers	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Health beliefs	Health beliefs will be assessed using three questions of the Fear-Avoidance Beliefs Questionnaire FABQ (dichotomous yes/no variable)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Psychosocial workplace factors	Psychosocial workplace factors will be measured using a questionnaire (Copenhagen Psychosocial Questionnaire)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Workplace ergonomics	observation-based ergonomics assessment checklist for office workers is adapted according to Swiss guidelines and used to assess the workplace ergonomics (dichotomous yes/no variable; score)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Work implementation	a single question asking whether the participant felt their workplace culture supported the intervention (dichotomous yes/no variable).	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Adherence to intervention	neck and shoulder exercise performance and health promotion session attendance are documented. Next to this, participant's adherence to intervention (workplace ergonomics, exercises, health promotion) is asked using a self-reported scale (ordinal scale)	after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Participants' impression of change	patients' global impression of change scale (PGIC) is used to reflect the participant's belief about the efficacy of intervention (numeric rating scale ranging from 0 to 10).	after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Care seeking	Evaluated by two questions: "Have you received healthcare services (e.g. doctor, physiotherapist, or other) because of work-related neck trouble in the past 12 months?" (yes/no; what); "Have you required pharmaceutical medications due to neck trouble or headache in the last week?" (yes/no; what)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Breaks and Smartphone use	three questions asking about the number of breaks during work, duration of each break (in minutes) and duration of daily smartphone use (in minutes)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Job satisfaction	single item based on a 10-point numeric rating scale	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Movement control	Movement control dysfunction tests for the cervical spine (dichotomous, positive/negative)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Mobility of neck and head	Mobility of the neck and head will be measured by an experienced and trained physiotherapist assessor using a CROM (range of motion, degree)	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Muscle endurance	Muscle endurance (time in seconds to task failure) of neck extensor and flexor muscles will be measured in a standardized testing position, either lying prone for neck extensors or supine for testing neck flexor muscles.	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Muscle strength	Muscle strength of neck extensor and flexor muscles and shoulder abductor muscles, in Newton peak force will be standardized measured with three repetitions and by using a handheld Dynamometer.	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Pain pressure threshold	Pain pressure threshold of the upper cervical spine (occiput, atlas) and of the trapezius muscle will be determined by using an Algometer.	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Pain drawings	Pain drawings: participants will be asked to complete their pain profile during the last week on two body charts (frontal and dorsal views) by using a pen. An operator will instruct the participants to shade their pain experience/complaints. The pain profile will include the aspects of pain extent (expressed as the percentage of the total body chart area where the pain will be reported), pain locations, pain intensity (using a numeric pain rating scale ranging from 0 to 10), location of the most painful spot, and pain intensity of the most painful spot (using a numeric pain rating scale ranging from 0 to 10).	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Headache	Headache will be measured using the questionnaire "headache impact test" (open questions and numeric pain rating scale ranging from 0 to 10).	baseline, after 4 months, after 8 months, after 12 months, after 16 months, after 28 months
Demographic information	(self-reported) including employee's age (in years), sex, body-mass-index BMI (weight (kg) / height (m2)), duration of computer use/day (in minutes), occupation and income range (in CHF), working distance (in minutes, used transport system), general health conditions (diseases, nutrition, health literacy)	baseline, (after 4 months, after 8 months, after 12 months, after 16 months, after 28 months)

Collaborators and Investigators

• Sponsor: Zurich University of Applied Sciences
• Collaborators: Swiss National Science Foundation

Publications and helpful links

General Publications

• Aegerter AM, Deforth M, Volken T, Johnston V, Luomajoki H, Dressel H, Dratva J, Ernst MJ, Distler O, Brunner B, Sjogaard G, Melloh M, Elfering A; NEXpro Collaboration Group. A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers. J Occup Rehabil. 2022 Sep 27:1-13. doi: 10.1007/s10926-022-10069-0. Online ahead of print.
• Aegerter AM, Deforth M, Johnston V, Sjogaard G, Volken T, Luomajoki H, Dratva J, Dressel H, Distler O, Elfering A, Melloh M; NEXpro collaboration group. No evidence for an effect of working from home on neck pain and neck disability among Swiss office workers: Short-term impact of COVID-19. Eur Spine J. 2021 Jun;30(6):1699-1707. doi: 10.1007/s00586-021-06829-w. Epub 2021 Apr 4.
• Aegerter AM, Deforth M, Sjogaard G, Johnston V, Volken T, Luomajoki H, Dratva J, Dressel H, Distler O, Melloh M, Elfering A; NEXpro Collaboration Group. No Evidence for a Decrease in Physical Activity Among Swiss Office Workers During COVID-19: A Longitudinal Study. Front Psychol. 2021 Feb 11;12:620307. doi: 10.3389/fpsyg.2021.620307. eCollection 2021.
• Aegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H, Brunner B, Dratva J, Sjogaard G, Elfering A, Melloh M; NEXpro collaboration group. On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord. 2020 Jun 19;21(1):391. doi: 10.1186/s12891-020-03388-x. Erratum In: BMC Musculoskelet Disord. 2020 Jul 25;21(1):488. Dressler, Holger [corrected to Dressel, Holger].

Study record dates

Study Major Dates

• Study Start (Actual): October 28, 2019
• Primary Completion (Actual): July 31, 2022
• Study Completion (Actual): July 31, 2022

Study Registration Dates

• First Submitted: November 13, 2019
• First Submitted That Met QC Criteria: November 15, 2019
• First Posted (Actual): November 20, 2019

Study Record Updates

• Last Update Posted (Actual): March 22, 2023
• Last Update Submitted That Met QC Criteria: March 21, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: productivity; stepped wedge design; office-worker; neck-specific exercises
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain; Headache; Musculoskeletal Diseases
• Other Study ID Numbers: 32003B_182389

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After the statistical analysis of this trial, the NEXpro team will make every endeavour to publish data in a journal (e.g. medical, health sciences). In particular, the following publications are planned: study protocol, primary outcome (productivity analysis), and several studies on the secondary and additional outcomes (e.g. neck pain analysis).
• IPD Sharing Time Frame: From June 2020 on (publication)
• IPD Sharing Access Criteria: Open access
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No