Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study)

Abstract

Background: In Denmark, exercise therapy in combination with work modifications is the first choice treatment for persons with shoulder complaints and high occupational shoulder exposures. To obtain this treatment they must visit several healthcare providers, which makes usual care fragmented and uncoordinated. Therefore, we developed a new intervention which unifies the expertise that is needed. The main hypotheses are that a group-based Shoulder-Café intervention will reduce (I) shoulder complaints and (II) occupational shoulder exposures more effectively than an individual-based Shoulder-Guidance intervention (active control – enhanced usual care). Methods: A cluster-randomised trial is conducted including 120 employees with high occupational shoulder exposures. Companies (clusters) are randomised to either Shoulder-Café or Shoulder-Guidance with a 1:1 allocation ratio. Participants are 18–65 years old and have an Oxford Shoulder Score (OSS) ≤ 40. Both interventions include a home-based shoulder exercise programme, assessment of shoulder exposures by technical measurements and self-report, and general information on how to reduce shoulder exposures. The Shoulder-Café course also includes three café meetings with physiotherapist-supervised exercises, clinical shoulder evaluation, education on shoulder anatomy, workplace-oriented counselling, and an opportunity for a workplace visit by a health and safety consultant. The primary outcomes are the OSS at 6 month follow-up (hypothesis I), and the mean number of minutes/day with the arm elevated > 60° shortly after end of intervention (hypothesis II). We will use mixed model analysis that allows for company clustering, and data will be analysed according to the intention-to-treat principle. Discussion: Persons with shoulder complaints and high occupational shoulder exposures are an obvious target group for secondary prevention efforts. We developed the Shoulder-Café to reduce shoulder complaints and shoulder exposures while unifying the expertise that is needed to evaluate and treat shoulder complaints. If the intervention is effective, it would warrant widespread implementation. Trial registration: The trial was registered at Clinicaltrials.gov on 18 May 2017 (ID: NCT03159910). Keywords: Exercise, Intervention, Mechanical exposure, Occupation, Randomised controlled trial, Shoulder, Training programme.

Inertial Measurement Unit–Derived Ergonomic Metrics for Assessing Arm Use in Manual Wheelchair Users With Spinal Cord Injury: A Preliminary Report

“…The RAMP II, which assesses musculoskeletal disorder risk factors in industrial occupations, provides thresholds for risk including upper arm postures and recovery time that are associated with pain and disorders of the shoulder, 8 such as working with arms in an elevated workspace. 9,10 In a trial that is underway for treating shoulder complaints among a variety of occupational workers, reducing arm elevations >60° was defined as a primary outcome associated with a reduction in shoulder complaints. 10 A >60° threshold was chosen as the focus for the study because limited time was spent in elevations >90° in some of the studied occupations, which is similar to our prior findings of MWC users.…”

“…9,10 In a trial that is underway for treating shoulder complaints among a variety of occupational workers, reducing arm elevations >60° was defined as a primary outcome associated with a reduction in shoulder complaints. 10 A >60° threshold was chosen as the focus for the study because limited time was spent in elevations >90° in some of the studied occupations, which is similar to our prior findings of MWC users. 11 Insufficient recovery time during manual labor is also associated with musculoskeletal disorders.…”