Self management and employability of workers with complaints of the arm, neck and / or shoulder

The increased use of computers in many professions in recent decades has been
accompanied by an increased incidence of pain and symptoms in the upper
extremity in the execution of repetitive work. These RSI (Repetitive Strain
Injury) complaints not only lead to great discomfort and pain but in some cases
also to non-attendance at work and / or work disability. In recent years, the
attention to RSI or CANS seems to be reduced which could suggest that these
symptoms occur less frequently. Figures from the Dutch annual National Survey
on Working Conditions show that CANS still occurs frequently. In 2007 and 2008,
36.5% of the participants suffered from neck, shoulder, arm, elbow, wrist, or
hand complaints and in 2009 this percentage was 36.8% (Koppes et al, 2009). The
prevalence of CANS varies from 5 to 10% in the general population and in
specific working populations the prevalence varies from 22 to 40% (Charles,
2010). Symptoms of CANS are persistent. In a Dutch prospective cohort study
was found that 77% of workers with CANS after 6 months follow up still
encountered complaints (Charles, 2010). Of the annual costs (estimated at 2.1
billion euros) involved in CANS, 962 million are caused by absenteeism and 808
million are caused by reduced labour productivity (TNO, 2005). Therefore
investing in sustainable employability in workers with (potential) CANS pays
off. The top-5 of sectors where the highest savings can be reached are probably
health care, industry, education, building industry and trade (TNO, 2005).

Given the persistence of CANS, the question is whether it is realistic to
expect that employees will become completely free of symptoms and pain. In the
absence of effective interventions, many employees continue to perform their
work with pain and limitations resulting in a reduced work capacity, reduced
productivity at work (presenteeism), decreased job satisfaction and possibly in
absenteeism and disability. Focussing on an active coping strategy in which
employees learn how to deal with the symptoms and limitations seems advisable
(Heemskerk et al, 2009).
A self-management approach of the workers was effective in other chronic
conditions but the effectivity of a self-management approach was never studied
in CANS (Detaille et al, 2010).

Moreover, self-management can both influence physical and psychosocial risk
factors of CANS. Because CANS have a chronic of intermittent course in many
cases, such an intervention seems ideal for workers with persistent CANS.
In the labor market the amount of workers working with computers is still
growing and also the time spend behind the computer is growing. Also workload
is cited as a major stressor. Therefore the prevention of CANS and learn how to
deal with CANS are very important for workers to achieve long-term
employability.

The objective of the study is to investigate the effectiveness of a combined
intervention on the disabilities, self-efficacy and long-term employability of
workers with complaints of the arm, neck and / or shoulder. Through a
self-management program - complemented by an e-health program * the employees
is given insight into the causes of the symptoms and disabilities and they get
better equipped to deal with these complaints and lower the risk of persistence
of the complaints and control to workplace absenteeism.

The study is a randomized controlled trail in which employees of UMC St Radboud
(UMC) and the HAN University of Applies Sciences (HAN) are randomly assigned to
a self-management intervention and an e-health program or to usual care.
Participants are recruited through a call on the websites of UMC and HAN and
newsletters and through health coordinators, occupational health physicians and
managers.
The self-management intervention consists of six group sessions over 2 months.
The e-health is available for participants from the start of the intervention
till the end of the follow-up period. The follow-up period is 12 months.

A self-management intervention offered to the participants (8-12 participants
in each group). The total program consists of six group meetings of two and a
half hours each. The meetings are weekly. Topics such as dealing with pain,
disability and fatigue, the balance between workload and capacity,
communication skills, stress management, (muscle) relaxation exercises, problem
solving, use of facilities, working with others and asking for help, dealing
with negative emotions and positive thinking will be discussed.
To influence the determinants of behaviour various techniques are used in the
course. Such as consciousness raising, risk perception, positive
(re)-formulation, self-(re) evaluation), obtaining confidence en mobilizing
social support, skill training, reinterpretation of symptoms, goal setting,
social comparison and modelling (Bandura 1986). To set targets (SMART and
formulated in terms of behaviour), action plans will be made (Lorig et al,
2006). A goal about management behaviour (eg exercises, take breaks at work,
ask the manager for a tool), including a statement of the employee on which he
/ she indicates how confident he / she is in achieving the goal, will be
formulated weekly. Thus unrealistic goals can be adjusted.

The group meetings are complemented by an e-health module. In the e-health
module the subjects of self-management training are also discussed and
assignments can be made. Also, participants can keep a diary. There is also
additional information about self-management and on specific topics of CANS
availible, such as: etiological factors (physical, psychological and social
(work) factors), prognostic factors, lifestyle factors, and other modifiable
factors.

There are no known risks associated with the intervention. The only demands
are participating in the training, performing homework assignments and fill
out questionnaires. Participants will receive a self-management training and
can use an e-health module. Participants will receive information and training
about complaints and dealing with complaints. It is expected that this will
have a positive effect on the experienced symptoms and sustained
employability. This justifies the requested time and effort to participate in
the training, use of e-health and completing the questionnaires.