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Objectives This randomized controlled trial (RCT) evaluated the effect of a participatory organizational intervention for improved use of assistive devices (AD) in patient transfer. Methods We randomly allocated 27 departments from five hospitals in Denmark to a participatory intervention (14 clusters, 316 healthcare workers) or a control group (13 clusters, 309 healthcare workers). The intervention consisted of 2×2 hour workshops with managers, the hospital's health and safety staff, and 2-5 healthcare workers from each department. Based on an assessment of barriers and solutions conducted prior to randomization, participants developed an action plan for implementing department-specific solutions for improving the use of AD. Use of necessary AD (using digital counters as primary outcome), and general use of AD (using accelerometers as secondary outcome), pain intensity in the low-back, work-related back injuries during patient transfer, and communication and guidance in the use of AD were measured at baseline, 6 and 12 months. Results Use of necessary AD (primary outcome), low-back pain, and back injuries did not change in the intervention compared with control group at 12-month follow-up. However, general use of AD measured with accelerometers as well as communication and guidance improved significantly in the intervention versus control group. Conclusion The intervention did not result in more frequent use of the necessary AD but led to more general use of AD, as well as increased communication and guidance.

Objectives The capability of safety climate to predict accidents has been the target of widespread debate in occupational health and safety research. The objective of this prospective cohort study was to employ a shortened five-item safety climate survey to investigate whether safety climate reports in 2012 are predictive for accidents reported within the last 12 months in 2014. Methods In both 2012 and 2014, 3864 blue-collar workers answered the Danish Working Environment and Health Cohort Study. Logistic regression was used to study the association [odds ratio (OR)] of reporting a work-related accident (yes/no) with more than one day of sickness absence (outcome) within the last 12 months in 2014 with the number of safety climate problems (predictor). The analyses were cumulatively adjusted for age, gender (model 1), socioeconomic class, occupational group, lifestyle (model 2), and previous accidents in 2012 (model 3). Results Of the safety climate problems reported in 2012, 1017 (28%) participants reported one problem, 357 (10%) reported two and 614 (17%) reported three or more problems. Using the number of safety climate problems as a continuous variable, all models showed a dose-response relationship between number of safety climate problems in 2012 and at least one accident in 2014 (trend-test, P<0.001). Compared to participants with no safety climate problems, participants reporting two safety climate problems in 2012 had a higher risk for reporting an accident in 2014 [OR 1.84, 95% confidence interval (CI) 1.22-2.77], and the risk was higher for participants reporting three or more safety problems (OR 2.22, 95% CI 1.60-3.09). Conclusions A higher number of safety climate problems progressively increased the OR for reporting at least one accident within the last 12 months at the two-year follow-up. The five-item safety climate survey is a simple and important tool that can be used as part of risk assessment in blue-collar workplaces.

Objectives The aim of this study was to determine the joint association of multimorbidity and work ability with the risk of long-term sickness absence (LTSA) in the general working population. Methods Cox regression analysis censoring for competing events (statutory retirement, early retirement, disability pension, immigration, or death) was performed to estimate the joint association of chronic diseases and work ability in relation to physical and mental demands of the job with the prospective risk for LTSA (defined as ≥6 consecutive weeks during 2-year follow-up) among 10 427 wage earners from the general working population (2010 Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, body mass index, job group, and previous LTSA. Results Of the 10 427 respondents, 56.8% had experienced ≥1 chronic disease at baseline. The fully adjusted model showed an association between number of chronic diseases and risk of LTSA. This association was stronger among employees with poor work ability (either physical or mental). Compared to employees with no diseases and good physical work ability, the risk estimate for LTSA was 1.95 [95% confidence interval (95% CI) 1.50-2.52] for employees with ≥3 chronic diseases and good physical work ability, whereas it was 3.60 (95% CI 2.50-5.19) for those with ≥3 chronic diseases and poor physical work ability. Overall, the joint association of chronic disease and work ability with LTSA appears to be additive. Conclusions Poor work ability combined with ≥1 chronic diseases is associated with high risk of long-term sickness absence in the general working population. Initiatives to improve or maintain work ability should be highly prioritized to secure sustainable employability among workers with ≥1 chronic diseases.

Objective This study aimed to investigate the association between occupational lifting and day-to-day change in low-back pain (LBP) intensity. Methods Each day for three consecutive weeks, 95 full-time workers from 51 Danish supermarkets with frequent occupational lifting replied to daily text messages about LBP intensity (scale 0-10). Supervisors at the supermarkets provided information about daily working hours and load (number of different pallets handled) for each worker during the three weeks. Linear mixed models with repeated measures tested the association between variables controlled for LBP during the previous day and various confounders. Results Workers handled on average 1212 [standard deviation (SD) 861] kg and worked 8.5 (SD 1.8) hours per workday. LBP intensity was higher in the morning after work- compared with non-workdays [difference of 0.55, 95% confidence interval (95% CI) 0.39-0.71]. A cumulative effect of consecutive workdays existed, ie, pain intensity increased approximately 0.30 points per day for up to three days. For three consecutive work- compared with non-workdays, the difference was 0.92 (95% CI 0.50-1.34). Higher load resulted in higher pain intensity in the morning after workdays [0.16 (95% CI 0.02-0.31) per ton lifted], while no effect was found for number of daily working hours. Conclusion Among workers with frequent occupational lifting, workdays are associated, in a cumulative manner, with increased LBP intensity. Furthermore, an exposure-response association exists between workload and increased LBP intensity. However, the increase in pain intensity was small and future studies should assess whether long-term consequences exist.

Objective: Numerous studies has shown that regular physical exercise can reduce musculoskeletal pain, but the optimal setting to achieve high adherence and effectiveness remains unknown. This study investigated the effect of workplace versus home-based physical exercise on musculoskeletal pain among healthcare workers., Methods: The randomized controlled trial (RCT) comprised 200 female healthcare workers from 18 departments at 3 hospitals. Participants were randomly allocated at the cluster level to ten weeks of: (i) workplace physical exercise (WORK) performed during working hours for 5×10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed during leisure time for 5×10 minutes per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. Average pain intensity (0-10 scale) in the low back and neck/shoulder was the primary outcome., Results: Per week, 2.2 (SD 1.1) and 1.0 (SD 1.2) training sessions were performed in WORK and HOME groups, respectively. Pain intensity, back muscle strength and use of analgesics improved more following WORK than HOME (P<0.05). Between-group differences at follow-up (WORK versus HOME) was -0.7 points for pain intensity [95% confidence interval (95% CI) -1.0- -0.3], 5.5 Nm for back muscle strength (95% CI 2.0-9.0), and -0.4 days per week for use of analgesics (95% CI -0.7- -0.2). The effect size for between-group differences in pain intensity was small (Cohen's d=0.31)., Conclusions: Workplace physical exercise is more effective than home-based exercise in reducing musculoskeletal pain, increasing muscle strength and reducing the use of analgesics among healthcare workers.

Objective: Imbalance between work demands and individual resources can lead to musculoskeletal disorders and reduced work ability. The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability., Methods: Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were randomly allocated to 10 weeks of either strength training for the shoulder, arm, and hand muscles (3 times per week, 10 minutes per session) or ergonomic training (usual care control group) from September to December 2012. The outcome measure was the change from baseline to 10-week follow-up in the work ability index (WAI)., Results: A priori hypothesis testing showed a group×time interaction for WAI (P<0.05). Compared with the ergonomic training group, WAI increased 2.3 [95% confidence interval (95% CI) 0.9-3.7] in the strength training group corresponding to a moderate effect size (Cohen's d 0.52). Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group. Of the 7 items of WAI, item 2 (work ability in relation to the demands of the job) and item 7 (mental resources) increased following strength training compared with ergonomic training (P<0.05)., Conclusions: Implementation of strength training at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks. Thus, strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se.

Objectives: This prospective cohort study investigates work-related risk factors for occupational back injury among healthcare workers., Methods: The study comprised 5017 female healthcare workers in eldercare from 36 municipalities in Denmark who responded to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using logistic regression, the odds for occupational back injury (ie, sudden onset episodes) in 2006 from patient transfers in 2005 was modeled., Results: In the total study population, 3.9% experienced back injury during follow-up, of which 0.5% were recurrent events. When adjusting for lifestyle (body mass index, leisure-time physical activity, smoking), work-related characteristics (seniority and perceived influence at work), and history of back pain and injury, daily patient transfers increased the risk for back injury (trend, P=0.03): odds ratio (OR) 1.75 [95% confidence interval (95% CI) 1.05-2.93] for 1-2 transfers per day, OR 1.81 (95% CI 1.14-2.85) for 3-10 transfers per day, and OR 1.56 (95% CI 0.96-2.54) for >10 transfers per day, referencing those with <1 patient transfer on average per day. The population attributable fraction of daily patient transfer for back injury was estimated to be 36%. Among those with daily patient transfer (N=3820), using an assistive device decreased the risk for back injury for "often" and "very often" use [OR 0.59 (95% CI 0.36-0.98) and OR 0.62 (95% CI 0.38-1.00), respectively] referencing those who "seldom" use assistive devices., Conclusion: Daily patient transfer was associated with increased risk for back injury among healthcare workers. Persistent use of an assistive device was associated with reduced risk for back injury among healthcare workers with daily patient transfers.