The Relationship Between Readiness to Change Pain-Related Exercise Participation and Perceived Work Function: A Cross-Sectional Study of Factory Workers

The Relationship Between Readiness to Change Pain-Related Exercise Participation and Perceived Work Function: A Cross-Sectional Study of Factory Workers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article The Relationship Between Readiness to Change Pain-Related Exercise Participation and Perceived Work Function: A Cross-Sectional Study of Factory Workers Paul Shawcross, Melinda Lyons, Victoria Filingeri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-482095/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Healthy lifestyle behaviours are associated with protection against health disorders and pain. Exercise participation is one such behaviour, associated with improved outcomes in those experiencing pain. Musculoskeletal pain is highly prevalent in the workplace, particularly in factory workers and associated loss of work function is recognised as having a great impact on individuals, society and the economy. A worker’s ‘readiness to change pain behaviour’ is an important factor to consider in achieving a healthy lifestyle behaviour and potentially improved function. This study aimed to examine the relationship between a cohort of factory workers ‘readiness to change pain behaviour’ such as exercise and their ‘perceived work function’. Methods: A cross-sectional study design was used to establish the relationship between ‘readiness to change pain behaviours’ and ‘perceived work function’. The Multidimensional Pain Related Change Questionnaire 2 (MPRCQ2) was used to measure readiness to change various pain behaviours including exercise. The Work Ability Index (WAI) was used to assess ‘perceived work function’. 75 participants were recruited using convenience sampling. Correlation and multiple regression were used for statistical analysis. Results: Mean WAI, MPRCQ2 and MPRCQ2 exercise component were 41.89 (SD 5.28), 4.26 (SD 1.01) and 4.40 (SD 1.69). MPRCQ2 and MPRCQ2 exercise component were not significant predictors of WAI in factory workers ( F (2, 72) = 2.17, p > 0.001). There was no significant relationship between MPRCQ2 and WAI (rs = .09, p > .05). However, there was a significant positive relationship between MPRCQ2 exercise component and WAI (rs = .23, p < .05). Conclusions: This study suggests that readiness to change pain-related exercise participation has a positive association with ‘perceived work function’. Further research should explore the causal relationship and consider strength training as a specific type of exercise. Orthopedics Pain work exercise lifestyle health Background Healthy Lifestyle Behaviours Obesity, physical inactivity, poor dietary habits and insufficient sleep are recognised as the key lifestyle risk factors that should be tackled by health professionals to improve health outcomes [ 1 ] For example, worldwide an estimated 1.6 million deaths per annum can be attributed to physical inactivity [ 2 ]. Pain is an important health outcome associated with a lack of healthy lifestyle behaviours [ 3 , 4 ]. Particularly, engagement with physical activity and exercise, with physical inactivity associated with increased back pain and disability [ 5 ] and more physical activity associated with less back pain [ 6 ]. A seminal paper [ 4 ] linked back pain and disability with various lifestyle factors such as poor sleep, inactivity and sedentary behaviour coupled with fear-avoidance beliefs. The association of such lifestyle behaviours and pain is further explained using the common-sense model [ 7 ] where a person believes that their body is damaged or vulnerable because they were told this by health professionals or society and subsequently avoid activity and movement as a result. This is an understandable common-sense behaviour which may lead to inactivity [ 7 ]. Behaviour Change and Pain A series of review papers were released by the Lancet journal in 2018 calling for a change in how we prevent and treat one of the most common pain areas, low back pain [ 8 ]. The main call for action was around changing the beliefs and behaviour of health professionals, patients and society to move away from a biological understanding of low back pain which creates fear and unhelpful behaviours, towards a holistic biopsychosocial understanding with person-centred care, focusing on self-management and healthy lifestyles [ 8 , 9 , 10 ]. Other recent research has suggested a change in current musculoskeletal healthcare practice to focus on identifying lifestyle and behavioural risk factors, challenge unhelpful thoughts and beliefs that lead to unhealthy behaviours and provide support with adopting healthy lifestyle behaviours [ 3 , 4 , 11 ]. The Stages of Change Model [ 12 ] presents 6 stages of readiness to change behaviour: pre-contemplation, contemplation, preparation, action, maintenance and relapse. Described as a continuous cycle of an individual’s state of readiness change. An individual’s readiness to change and adopt self-management strategies is associated with improved coping [ 13 ]. A recent systematic review reported moderate-quality evidence supporting the use of behaviour change techniques to enhance exercise adherence in people with musculoskeletal pain [ 14 ]. Pain, Work Disability and Work Ability Workplace disability is on the increase in the UK with more than 7 million working-age disabled people [ 15 ]. Pain has been identified as the leading cause of disability [ 15 ]. Work ability is defined as the balance between an employee’s individual resources and their work demands which can be used as a predictor of future sickness absence and work function [ 16 ]. Pain is recognised as a threat to work ability and function [ 17 , 18 , 19 ]. Poor self-efficacy [ 20 ], kinesiophobia (fear of movement) [ 21 ] and maladaptive pain behaviours [ 22 ] are all thought to reduce work ability in workers experiencing pain. Currently, factory workers have not been a focus of the research despite there being a high prevalence of musculoskeletal absence reported in the manufacturing and production industry [ 23 ]. Research Question This study will explore the relationship between pain behaviour and function at work (work ability) in factory workers by assessing for the presence of key behavioural risk factors and readiness to change these behaviours. Focus will be given to readiness to change exercise participation. Current research is now looking at prediction models for future sickness absence due to musculoskeletal disorders [ 24 ]. This current study will add to this body of research by identifying potential behavioural risk factors that need to be included in such prediction models for factory workers. The aim of this study was to examine the statistical relationship between a cohort of factory workers ‘readiness to change pain behaviours’ and their ‘perceived work function’. With particular focus on readiness to change ‘exercise participation’. The secondary aim was to compare this relationship in workers that were experiencing musculoskeletal pain and those that were not experiencing musculoskeletal pain. Methods Study Design A correlational design was used to assess the relationship between the variables of ‘readiness to change pain behaviour’ and ‘perceived work function’ in a cohort of factory workers and establish if ‘readiness to change pain behaviour’ was associated with ‘perceived work function’. This research used quantitative data to provide statistical analysis in the form of correlation and multiple regression. A cross-sectional study design was used for estimating the prevalence of readiness to change multiple pain behaviours, as the exercise component was considered independently. Variables and Measures The Work Ability Index (WAI) was used to measure ‘perceived work function’. This questionnaire has high validity and reliability (Cordeiro et al, 2017; 27]. The WAI gives a score from 2–49 and four categories; ‘poor’ (2–27), ‘medium’ (28–36), ‘good’ (37–43), ‘very good’ (44–49), corresponding with 4 actions; ‘reinstate work ability’ (2–27), ‘improve work ability’ (28–36), ‘support work ability’ (37–43), ‘maintain work ability’ (44–49). The Multidimensional Pain Readiness to Change Questionnaire 2 (MPRCQ2) was used to measure readiness to change various pain management behaviours. This questionnaire has good validity and reliability [ 25 , 26 ]. The MPRCQ2 gives a score from 1–7 using 69 questions covering 9 behaviour components; use of relaxation, cognitive control, assertive communication, exercise participation, avoid resting due to pain, avoid regularly asking for assistance, task persistence, pacing and use of taught body mechanics. For the first of two sections, 1 represents ‘I am not doing this now, and am not interested in ever doing it.’ and 7 represents ‘I have been doing this for a long time (at least 6 months.) ’. The second section inverts the scores, so 1 represents ‘I am doing this now and am not interested in ever stopping’ and 7 represents ‘ I have not done this for a long time (at least 6 months)’. An average score for each of the 9 behaviour components is calculated 1–7 and an overall score 9–63 [ 26 ]. The overall score and the ‘exercise participation’ behaviour component score were used in this study. Participants reported if they were currently experiencing musculoskeletal pain or not, to allow for comparison between these two groups. Other participant characteristics measured included; gender, age range, shift pattern, job role, time in current job role, current or recent pain experience and other current health issues (see a full list of health conditions in appendix 1). Participants The study population consisted of 75 factory workers from a factory in the UK which manufactures home and personal care products and consisted of 98 total factory workers. Convenience sampling was used to recruit participants between September-November 2019. Participants gave consent for use of their data in group analysis. Participant characteristics were collected for population, but not individual analysis. No other personal information was collected to maintain anonymity. The 75 participants (66 male, 9 female) modal age range was 55–64. Inclusion criteria were; aged over 18, employed within the factory for more than 3 months, English speaking. Exclusion criteria also included people registered as vulnerable. See Table 1 for participant characteristics. Materials The various questionnaires were inputted to Qualtrics software along with the consent form, debrief statement, participant information sheet (see appendix 1) and inclusion/exclusion criteria questions. A tablet computer was used to administer. SPSS (IBM, Armonk, NY) was used for statistical analysis. Procedure Invitation to take part in this research (see appendix 1) was displayed on a notice board and tables in a canteen area. Participants were able to sign up via their line manager or drop into a session during their working day, where a researcher was present. After an initial explanation (using the participant information sheet) and a chance to ask questions, the participant was left alone in a room for 20 minutes, to complete all questionnaires. The link to the Qualtrics questionnaire was distributed using a tablet computer. Qualtrics guided the participants through the consent process and various inclusion/exclusion criteria. If participants did not meet the criteria or consent, the questionnaire was stopped. Participants that did meet inclusion criteria and consented were taken through the WAI and MPRCQ2 questionnaires followed by a final study debrief. The details and answers for all participants were stored securely by Qualtrics. This data was cleansed and exported to SPSS for statistical analysis. SPSS analysis was completed on a secure password-protected laptop computer. Statistical Analysis Descriptive statistics were completed on ‘perceived work function’ and ‘readiness to change pain behaviours’. Average scores with standard deviations and distribution of data were reported. A correlational design was chosen to assess the relationship between two variables, both ‘readiness to change pain behaviour’ with ‘perceived work function’ and ‘readiness to change pain behaviour specific to exercise’ with ‘perceived work function’. A correlational design was also used to assess the variables for 2 groups; participants reporting a pain experience in the past 7 days (n = 52) and those that had not reported a pain experience in the past 7 days (n = 23). A multiple regression analysis was completed to test both ‘readiness to change pain behaviour’ and ‘readiness to change pain behaviour specific to exercise’ as predictors of ‘perceived work function’. Results Two potential participants were excluded because they were employed within the factory for less than 3 months and 2 potential participants did not consent after reading the participant information sheet. Giving a total of 75 participants participated in this study. Descriptive details of the participants are presented in Table 1 . Table 2 presents descriptive stats for WAI, MPRCQ2 and MPRCQ2 exercise component. Mean average WAI score was 41.89 (SD 5.28) which is categorised as a ‘good’ level of work ability [ 27 ] with a range of 28 to 49. Mean average MPRCQ2 score was 4.26 (SD 1.01) with a range of 2.1 to 6.6 and MPRCQ2 exercise component score was 4.40 (SD 1.69) with a range of 1 to 7. Skewness scores for WAI did not fall within the +/- 1.96 Z score range to meet assumptions of normality of data, Z > 3 (see Table 2 ). Non-parametric testing was used. Correlations between the variables are shown in Table 3 . The results showed that there was a positive relationship between MPRCQ2 and WAI, though this was not significant (rs = .09, p > .05). There was a significant positive relationship between MPRCQ2 exercise component and WAI (rs = .23, p < .05). This shows that ‘readiness to change pain behaviour specific to exercise’, has a positive association with ‘perceived work function’. Tests to see if the data met the assumption of collinearity indicated that multicollinearity was not a concern (MPRCQ2 VIF = 1.49; MPRCQ2 exercise component, VIF = 1.49). The data met the assumption of independent errors (Durbin-Watson value = 1.89). Data were analysed using a Multiple Regression using the Enter Method. The regression equation produced a small effect size ( R 2 = .06, R 2 Adj = .03), indicating that ‘readiness to change pain behaviour’ (when all components are measured together) was not a significant predictor of ‘perceived work function’ ( F (2, 72) = 2.17, p > 0.001). ‘Readiness to change pain behaviour’ was not a significant predictor of ‘perceived work function’ ( t = .29, df = 74, p = 0.776). ‘readiness to change pain behaviour related to exercise participation’ participation was not a significant predictor of ‘perceived work function’ ( t = 1.53, df = 74, p = 0.131). Data were split into 2 groups; participants reporting a pain experience in the past 7 days (n = 52) and those that hadn’t reported a pain experience in the past 7 days (n = 23). For participants in pain, correlations between the variables are shown in Table 4 . The results showed that there was a positive relationship between MPRCQ2 and WAI, though this was not significant (rs = .12, p > .05). There was a positive relationship between MPRCQ2 exercise component and WAI, though this was not significant (rs = .18, p > .05). For participants not in pain, correlations between the variables are shown in Table 5 . The results showed that there was a positive relationship between MPRCQ2 and WAI, though this was not significant (rs = .10, p > .05). There was a positive relationship between MPRCQ2 exercise participation and WAI, though this was not significant (rs = .41, p > .05). All raw data is presented in appendix 2 and SPSS outputs in appendix 3–5. Table 1 Description of the study population Characteristic Percentage (%) N Gender Female 12 9 Male 88 66 Age Range 18–24 9.3 7 25–34 17.3 13 35–44 25.3 19 45–54 20 15 55–64 26.7 20 65+ 1.3 1 Time worked in factory 3–12 months 1–3 years 13.3 22.7 10 17 3–5 years 22.7 17 5–10 years 17.3 13 10–20 years 14.7 11 20 + years 9.3 7 Job role Machine Operator 33.3 25 Technical Operator 42.7 32 Palletiser Operator 2.7 2 Despatch Operator 5.3 4 Manufacturing apprentice 2.7 2 Planner 8 6 Line Leader 5.3 4 Reported Pain Pain in past 7 days No pain in past 7 days Pain in past 3 months No pain in past 3 months 60 40 80 20 45 30 60 15 Other diagnosed health condition Yes No 46.7 53.3 35 40 Table 2 Descriptive statistics for WAI, MPRCQ2 and MPRCQ2 exercise component Mean (SD) Min Max Z Skewness Z Kurtosis K-S Test S-W Test N WAI 41.89 (5.28) 28.0 49.0 3.2 .66 .13 .93 75 MPRCQ2 4.26 (1.01) 2.1 6.6 .92 0.76 .08 .98 75 MPRCQ2 - exercise 4.40 (1.69) 1.0 7.0 .74 1.95 .09 .96 75 Table 3 Correlation coefficients and significance levels for MPRCQ2 and MPRCQ2 exercise component independently against WAI WAI MPRCQ2 .09 (.46) MPRCQ2 - exercise .23 (.05) Table 4 Correlation coefficients and significance levels for MPRCQ2 and MPRCQ2 exercise component independently against WAI for participants experiencing pain WAI MPRCQ2 .12 (.41) MPRCQ2 - exercise .18 (.19) Table 5 Correlation coefficients and significance levels for MPRCQ2 and MPRCQ2 – exercise independently against WAI for participants not experiencing pain WAI MPRCQ2 .10 (.65) MPRCQ2 - exercise .41 (.052) Discussion This study hypothesised that ‘readiness to change pain behaviour’ has a statistically significant positive relationship with ‘perceived work function’ in factory workers. The results indicated that this positive relationship was not statistically significant. Therefore, we accept the null hypothesis. A similarly unsupportive association was reported between readiness to self-manage pain and both physical and psychological functioning [ 13 ]. Although similar, the measure used was different, using the pain stages of change questionnaire (PSOCQ) instead of MPRCQ2 [ 13 ] which focuses on readiness to adopt a self-management approach rather than focusing on specific behavioural components like MPRCQ2. Patient disability and depression were the functional focus [ 13 ] opposed to ‘perceived work function’ as in this current study. One study [ 28 ] used the MPRCQ2 to measure readiness to change and assess the association with pain-related function (rather than ‘perceived work function’). No significant association was reported with the MPRCQ2 or any subcomponents (including exercise) with pain-related functioning. The cohort recruited [ 28 ] had some key differences with this current study populations as they all had low back pain and were general population rather than factory workers. In contrast to this current study’s results data reported by Pitt-Catsouphes [ 29 ] in support of a statistically significant relationship between health behaviour changes influencing physical health and work ability (measured by WAI). Various influential review papers are supportive of behaviour change, exercise and self-management strategies for managing pain and improving function at work [ 4 , 8 , 9 , 10 , 30 ]. This body of research is specific to low back pain rather than musculoskeletal pain as a whole and of these 5 studies, only NICE [ 30 ] completed a robust systematic literature review. Behaviour change and ‘readiness to change pain behaviour’ may be more important for people experiencing low back pain than other musculoskeletal pain. More primary research and systematic reviews are recommended focusing on musculoskeletal pain, other than low back pain. This study hypothesised that ‘readiness to change pain behaviour related to exercise participation’ has a statistically significant positive relationship with ‘perceived work function’ in factory workers. The results indicated that there was a statistically significant positive relationship. Therefore, this hypothesis was accepted. This finding builds on the already established research base linking higher levels of physical activity and exercise as a key lifestyle behaviour change for improving pain and function associated with musculoskeletal pain [ 4 , 6 , 8 , 9 , 10 , 14 , 30 ]. ‘Readiness to change’ is a new area of focus and the specific relationship between ‘readiness to change pain behaviour related to exercise participation’ and ‘perceived work function’ was not reported in these previous review papers, highlighting a new finding to add to the research base and investigate further. Applying these results practically, readiness to participate in exercise seems to be a positive behaviour and higher perceived work function seems to be a positive perception. Both of which should be encouraged. The mean average WAI score was categorised as a ‘good’ level of work ability [ 27 ] and seemed generally high for this cohort of factory workers, with no workers scoring in the lowest category. This mean average was similar to previous research mean average WAI scores of 42.2 (SD 4.2) [ 31 ] and 39.3 (SD 3) [ 32 ]. However, this current research presents a larger standard deviation for WAI scores, highlighting a greater spread of WAI scores. This may be related to this data not being normally distributed. Mean average MPRCQ2 in this study were similar to the original research populations mean average MPRCQ2 scores of 4.29 (SD 1.68). The MPRCQ2 exercise component was higher in this cohort of factory workers; 4.40 (SD 1.69) compared to the original cohort; 4.25 (SD 1.57) [ 26 ]. This difference may be the reason for the positive association with ‘perceived work function’ reported in the results of this current study. Future research with different study populations is recommended to explore this. This study hypothesised that ‘readiness to change pain behaviour’ and ‘readiness to change pain behaviour related to exercise participation’ are good predictors of ‘perceived work function’ in factory workers. The results indicate that neither ‘readiness to change pain behaviour’ and ‘readiness to change pain behaviour related to exercise participation’ are good predictors of ‘perceived work function’. Therefore, we accept the null hypothesis. No other research presents ‘readiness to change pain behaviour’ as a predictor of ‘perceived work function’. Several studies have linked exercise participation (as a behaviour, but not readiness to change) with work ability. A systematic review and meta-analysis on workplace health promotion on wellbeing and work ability was completed in 2008 [ 33 ]. Exercise was reported to increase both wellbeing and work ability of workers. A similar systematic review conducted more recently [ 34 ] reported moderate-quality evidence for exercise and lifestyle education as a workplace intervention. Research considering behaviour change specific to exercise and workability was reported on [ 29 ] in support of a predictor relationship between ‘behaviour change related to exercise participation’ and ‘perceived work function’. With changes in health behaviour specific to exercise associated with a statistically significant improvement in physical health and work ability [ 29 ]. ‘Readiness’ to change was not considered [ 29 ]. Exercise as a health behaviour has been considered as part of a paradigm for health performance [ 35 ], where exercise was 1 of 5 health behaviours considered to contribute to health performance. The authors [ 35 ] discuss attitudes as a key influencer of behaviour. They do not consider where readiness to change fits into this paradigm. The results from this current study suggest ‘readiness to change pain behaviour related to exercise participation’ should at least be considered. The exact nature of this association is still unclear and there does not appear to be a predictor relationship between ‘readiness to change pain behaviour’ and perceived work function, based on the results of this current study. The tertiary aim of this study was to compare the statistical relationship between factory workers ‘readiness to change pain behaviour’ and their ‘perceived work function’ in workers that were experiencing musculoskeletal pain and those that were not experiencing musculoskeletal pain. The results reported no statistically significant relationship for either group. A previous study with similarly unsupportive findings was a randomised controlled trial (RCT) of 66 slaughterhouse workers with upper limb pain and work disability [ 32 ]. Workers had either 10 weeks of strength exercise or ergonomic training. Strength exercise was reported as superior for preventing deterioration of work ability but not improving work ability. This was an insignificant finding with low effect size, although this may be due to the small sample size. The researchers [ 32 ] also focused on strength training as a particular type of exercise in contrast to any exercise participation in this current study. One previous study did report conflicting results [ 36 ] using a subset of 80 participants from a larger cohort study [ 37 ] to compare engagement in positive lifestyle behaviours between 36 adults with chronic low back pain and 44 adults with no history of chronic low back pain. The health literacy measurement scale was used, and results present a greater difficulty engaging in positive lifestyle behaviours for those in chronic low back pain compared to those without. The authors [ 36 ] assessed the comparison between the two groups in which this current research does not. However, a small convenience sample was used [ 36 ], made up of people from the same, middle-class geographical area in Australia. Subsequently, population validity was low, and the sample may be subject to selection bias. Both of these previous studies [ 32 , 36 ] assess exercise as an intervention rather than readiness to change. Further research is needed, comparing readiness to change lifestyle behaviours in people experiencing pain and people not experiencing pain. Directions For Further Research The concept of readiness to change was first discussed in 1983 [ 12 ], yet it has not been studied in great depth. Its importance was highlighted for adopting self-management strategies for managing chronic pain [ 13 ]. In contrast, Byrka & Kaiser [ 35 ] discuss health attitudes as a key influencer of health behaviour rather than readiness to change. Consensus is yet to be agreed on which individual characteristics (readiness, attitudes, motivation, beliefs and expectations) are most important for health and pain behaviour change. The results from this current study suggest ‘readiness to change pain behaviour related to exercise participation’ should at least be considered although the exact nature of this association is still unclear. The range of potential behaviour influencing characteristics may be the reason that readiness to change has not been studied in great depth since it was first proposed [ 12 ]. All are likely to play some role and further research is needed to clarify how these characteristics interact. The statistically significant positive relationship between ‘readiness to change pain behaviour related to exercise participation’ and ‘perceived work function’ in factory workers reported in the results, is a new finding to add to the current research base which already recognises exercise as a positive behaviour for improving pain and function associated with musculoskeletal pain [4, 6, 8, 9, 10, 14; 30]. It may be useful to attain from future research, which specific type of exercise is most beneficial for workers for improving pain and work function. This research area has already received attention in the literature with strength training emerging as the most effective exercise improving pain in the workplace. No less than 4 systematic reviews [38, 39; 40, 41] have been completed in recent years to evaluate the evidence of workplace strength training for managing musculoskeletal pain amongst workers. The first of these systematic revies [ 41 ] assessed the effectiveness of a range of workplace interventions in the prevention of upper limb pain. Strong evidence was reported for the effectiveness of workplace-based resistance training and moderate evidence for stretching programmes. A robust systematic review was completed [ 41 ], although they do not consider unpublished or grey literature and findings may be subject to publication bias. One systematic review [ 39 ] assessed the effectiveness of a range of workplace interventions for reducing chronic musculoskeletal pain and symptoms. The authors reported consistency in results for high-intensity exercises for decreasing pain and symptoms in employees with chronic musculoskeletal pain [ 39 ]. Another systematic review [ 38 ] focused on workplace-based rehabilitation of upper limb pain in their systematic review. Strong evidence was again reported for workplace exercise programs over ergonomic controls and training. The exercise programs were a mix of resistance training, stretching and conditioning exercise. The most recent systematic review [ 40 ] focusing on workplace interventions to rehabilitate musculoskeletal disorders among employees with physically demanding work, report further strong evidence for the positive effect or workplace strength training for rehabilitation of workers with musculoskeletal pain. The systematic review [ 40 ] was extremely robust, with multiple reviewers involved in the quality review process. None of the systematic reviews discussed concerning exercise and strength training for managing musculoskeletal pain in the workplace [ 38 , 39 , 40 , 41 ] consider ‘perceived work function’ and this was recommended as a sensible focus for future research [ 40 ]. In contrast, a prediction model was developed [ 24 ], for future sick leave and loss of work function due to musculoskeletal pain. They use the occupational health check questionnaire to measure predictor variables such as psychological distress, work pace and presence of musculoskeletal complaints, but this questionnaire does not consider strength training or any other exercise, physical activity, lifestyle behaviours or readiness to change. These variables are subsequently missing from the prediction model as they have not been considered. The findings of this current study would suggest that these two research areas would benefit from coming together; readiness to change exercise behaviour (specifically strength training) and ‘perceived work function’ in workers with musculoskeletal pain. Strengths And Limitations The regression equation produced a small effect size. A sample size of 81 was needed to achieve a larger effect size at a 95% confidence interval and a 5% precision rate [ 42 ]. The smaller sample of 75 participants used in this study could have contributed to a lack of statistical association between MPRCQ2 exercise component as a predictor and WAI as an outcome. Convenience sampling was used due to the nature of the study design and the small study population available. Convenience sampling does expose the study findings to selection bias and reduces population validity. For example, the researchers were unable to recruit any workers that were currently absent from work. All participants were currently at work and so the results of this study can only be applied to workers in work, not those absent. The controlled workplace environment where participants completed the survey, with the researcher partially present may have unwittingly led to researcher bias which is a threat to internal validity. A lack of normality of WAI data was identified for this sample of workers and so non-parametric testing was used. Non-parametric testing is less powerful for detecting variability in data [ 43 ]. The WAI was used to measure ‘perceived work function’ due to its high validity and reliability [ 27 , 44 ]. It is widely used in this field of research [29, 31, 32, 33). One alternative for the future may be the work ability survey (WAS-R). Early research [ 45 ] suggests the WAS-R extends the measurement of WAI to also reflect organisations work demands. Validity and reliability are yet to be reported on, but the WAS-R may be considered as an alternative to WAI in future studies measuring ‘perceived work function’. WAI seems to be the best current option and is a strength of this study. MPRCQ2 was used to measure readiness to change various pain management behaviours including exercise. MPRCQ2 has good validity and reliability [ 25 , 26 ]. Although this research focuses on patients with fibromyalgia, arthritis, spinal cord injury and amputation [ 26 ]. Patients with musculoskeletal pain such as back pain and upper limb pain have not been studied. MPRCQ2 is not as widely used as the WAI. Partly because of alternatives such as the PSOCQ [ 13 ] and partly because ‘readiness to change pain behaviour’ is yet to be studied in great depth. The MPRCQ2 was chosen for this study over PSOCQ due to the additional focus on specific behavioural components like exercise. Yet, the 9 behaviour components may need an update. ‘Use of taught body mechanics’ [ 26 ] for example has come under scrutiny as a risk factor for musculoskeletal pain. This change in understanding was well summarised by a recent systematic review [ 46 ] reporting that lumbar spine flexion when lifting was not a risk factor for low back pain onset, persistence or a differentiator for people in pain. Other important risk factors for pain, such as diet [ 35 ], sleep [ 11 ], smoking [ 10 , 11 ] and obesity [ 10 , 11 ] have also emerged but are not considered by MPRCQ2. This could be considered a limitation of the MPRCQ2 and subsequently this study. Future development and inclusion of these risk factors are recommended for any tool measuring ‘readiness to change pain behaviour’. Conclusions This research does not provide support for an association or predictor relationship between factory workers ‘readiness to change pain behaviour’ and their ‘perceived work function’. Previous research suggestive of any kind of relationship seems to focus on behaviour change as an intervention rather than readiness to change or focuses on different study populations outside of the workplace. Suggesting that these current results may be determined by ‘readiness to change’ as a concept and/or the findings may be specific to this study population of factory workers or this specific sample. This research does provide support for a positive relationship between factory workers ‘readiness to change pain behaviour related to exercise participation’ and their ‘perceived work function’. In a practical sense, readiness to participate in exercise seems to be a positive behaviour and may be constructive for improving ‘perceived work function’. Equally, the higher perceived work function seems to be a positive perception and may impact on readiness to participate in exercise. Both behaviours and perceptions should be encouraged and supported in a clinical setting. Although this finding doesn’t represent causation, this gives a good starting point for further research. To enhance the internal validity and population validity of these findings, future research should apply a methodology which reduces use the potential for selection and researcher bias and look to recruit a larger and more varied sample. Further research should explore the causal relationship between readiness to change exercise participation as a pain behaviour and ‘perceived work function’. This research should consider motivations, attitudes, beliefs and expectations in relation to exercise participation as well as readiness to change. Workers that are absent from work should also be included to compare differences. Given the emerging evidence base for strength training for rehabilitating workers with musculoskeletal pain, this specific type of exercise should be applied to future research exploring an association with work function. Declarations Ethics approval and consent to participate: Relevant ethical considerations (consent, deception, debriefing, withdrawal, data protection, confidentiality and anonymity) were addressed and approved following the University of Derby ethical framework. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2000. Informed consent was obtained from all patients for being included in the study. Consent for publication: Not applicable for individual data. The organisational involved did provide consent using the university of Derby ethical consent form. This is available upon request. Availability of data and materials: The raw data and datasets used and/or analysed during the current study are available from the corresponding authors upon reasonable request. Competing interests: No conflicts of interest to disclose. The organisation providing the participants for this research project was a paying customer of the author's employer at the time that this research was conducted. The organisation has had no involvement other than consenting for participant involvement, but the authors do acknowledge the potential presence of unconscious bias due to the customer relationship. This was a student project and carried out as part of study towards an MSc in Health Ergonomics at the University of Derby. Funding: No financial incentive, grants or funding were received. Authors Contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Paul Shawcross. The first draft of the manuscript was written by Paul Shawcross and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements: This paper and the research behind it would not have been possible without the support of colleagues at Connect Health who granted the time required to conduct this research. Also, Unilever PLC Human Resources and Health and Wellbeing Leads for permitting the recruitment of their employees for this study. This was a student project and carried out as part of study towards an MSc in Health Ergonomics at the University of Derby. References Housman J, Dorman S. The Alameda County study: a systematic, chronological review. Journal of Health Education. 2005;36(5):302–8. Ritchie H, Roser M. Causes of Death. Retrieved from: https://ourworldindata.org/causes-of-death ; 2020. Dean E, Söderlund A. What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain? BMC Musculoskelet Disord. 2015;16(1):1–7. O'Sullivan P, Caneiro JP, O'Keeffe M, O'Sullivan K. Unravelling the complexity of low back pain. Journal of Orthopaedic Sports Physical Therapy. 2016;46(11):932–7. 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Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review. Br J Health Psychol. 2019;24(1):10–30. Public Health England. (2017). Improving lives: the future of work, health and disability. Retrieved from: https://www.gov.uk/government/publications/improving-lives-the-future-of-work-health-and-disability.2019 . Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work ability index. Helsinki: Finnish Institute of Occupational Health; 1998. Higgins NM, Cochrane A, Rothwell CJ, FitzGerald O, Gallagher P, Ashton J, Breen R, Brennan A, Corcoran O, Desmond D. Work impairment in patients experiencing musculoskeletal pain. Ann Rheum Dis. 2017;76:1434. Miranda H, Kaila-Kangas L, Heliövaara M, Leino-Arjas P, Haukka E, Liira J, Viikari-Juntura E. Musculoskeletal pain at multiple sites and its effects on work ability in a general working population. Occup Environ Med. 2010;67(7):449–55. Nordstoga AL, Vasseljen O, Meisingset I, Nilsen TI, Unsgaard-Tøndel M. Improvement in work ability, psychological distress and pain sites in relation to low back pain prognosis: a longitudinal observational study in primary care. Spine. 2019;44(7):E423-9. de Vries HJ, Reneman MF, Groothoff JW, Geertzen JH, Brouwer S. Self-reported work ability and work performance in workers with chronic nonspecific musculoskeletal pain. J Occup Rehabil. 2013;23(1):1–0. Åkerström ML, Grimby-Ekman A, Lundberg M. Work ability is influenced by kinesiophobia among patients with persistent pain. Physiotherapy Theory Practice. 2017;33(8):634–43. Rasmussen CD, Holtermann A, Jørgensen MB, Ørberg A, Mortensen OS, Søgaard K. A multi-faceted workplace intervention targeting low back pain was effective for physical work demands and maladaptive pain behaviours, but not for work ability and sickness absence: stepped wedge cluster randomised trial. Scandinavian journal of public health. 2016;44(6):560–70. CIPD. Health and well-being at work: Survey Report. London: CIPD & Simply Health; 2019. Bosman LC, Roelen CA, Twisk JW, Eekhout I, Heymans MW. Development of prediction models for sick leave due to musculoskeletal disorders. J Occup Rehabil. 2019;29(3):617–24. Nielson WR, Jensen MP, Kerns RD. Initial development and validation of a multidimensional pain readiness to change questionnaire. The Journal of Pain. 2003;4(3):148–58. Nielson WR, Jensen MP, Ehde DM, Kerns RD, Molton IR. Further development of the multidimensional pain readiness to change questionnaire: The MPRCQ2. The Journal of Pain. 2008;9(6):552–65. Ilmarinen J. The work ability index (WAI). Occupational medicine. 2007 Mar 1;57(2):160. Finan PH, Burns JW, Jensen MP, Nielson WR, Kerns RD. Pain coping but not readiness to change is associated with pre-treatment pain-related functioning. Clin J Pain. 2012;28(8):687–92. Pitt-Catsouphes M, James JB, Matz-Costa C. Workplace-based health and wellness programs: the intersection of aging, work, and health. The Gerontologist. 2015 Apr 1;55(2):262 – 70. National Institute of Clinical Excellence. Low back pain and sciatica in over 16s: assessment and management. Nice.org.uk/ guidance/ng59 . 2016. Rongen A, Robroek SJ, Schaufeli W, Burdorf A. The contribution of work engagement to self-perceived health, work ability, and sickness absence beyond health behaviors and work-related factors. J Occup Environ Med. 2014;56(8):892–7. Sundstrup E, Jakobsen MD, Brandt M, Jay K, Persson R, Aagaard P, Andersen LL. Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial. Scandinavian journal of work, environment & health. 2014:244–51. Kuoppala J, Lamminpää A, Husman P. Work health promotion, job well-being, and sickness absences—a systematic review and meta-analysis. Journal of occupational environmental medicine. 2008;50(11):1216–27. Oakman J, Neupane S, Proper KI, Kinsman N, Nygård CH. Workplace interventions to improve work ability: A systematic review and meta-analysis of their effectiveness. Scandinavian Journal of work environment health. 2018;44(2):134–46. Byrka K, Kaiser FG. Health performance of individuals within the Campbell paradigm. International journal of psychology. 2013;48(5):986–99. Briggs AM, Jordan JE, Buchbinder R, Burnett AF, O’Sullivan PB, Chua JY, Osborne RH, Straker LM. Health literacy and beliefs among a community cohort with and without chronic low back pain. Pain. 2010;150(2):275–83. Briggs AM, Jordan JE, O'Sullivan PB, Buchbinder R, Burnett AF, Osborne RH, Straker LM. Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: an assessment of health literacy. BMC Musculoskelet Disord. 2011;12(1):161. Hoosain M, de Klerk S, Burger M. Workplace-based rehabilitation of upper limb conditions: a systematic review. J Occup Rehabil. 2019;29(1):175–93. Skamagki G, King A, Duncan M, Wåhlin C. A systematic review on workplace interventions to manage chronic musculoskeletal conditions. Physiotherapy Research International. 2018;23(4):e1738. Sundstrup E, Seeberg KG, Bengtsen E, Andersen LL. A Systematic Review of Workplace Interventions to Rehabilitate Musculoskeletal Disorders Among Employees with Physical Demanding Work. Journal of Occupational Rehabilitation. 2020:1–25. Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, Van Der Beek AJ, Dennerlein JT, Tullar J, Skivington K, Pinion C, Amick B. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med. 2016;73(1):62–70. Cohen J. A power primer. Psychological bulletin. 1992;112(1):155. Kitchen CM. Nonparametric vs parametric tests of location in biomedical research. Am J Ophthalmol. 2009;147(4):571–2. Cordeiro TM, Araújo TM, Santos KO. Exploratory study of the validity and internal consistency of the Work Ability Index among health workers. Salud colectiva. 2018;14(4):713. Saraceni N, Kent P, Ng L, Campbell A, Straker L, O'Sullivan P. To flex or not to flex? is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta-analysis. journal of orthopaedic sports physical therapy. 2020;50(3):121–30. Voltmer JB, Deller J. Measuring work ability with its antecedents: Evaluation of the Work Ability Survey. J Occup Rehabil. 2018;28(2):307–21. Cite Share Download PDF Status: Under Review Version 1 posted Review # 1 received at journal 26 Apr, 2021 Reviewer # 3 agreed at journal 19 Apr, 2021 Reviewer # 2 agreed at journal 17 Apr, 2021 Reviewers invited by journal 16 Apr, 2021 Reviewer # 1 agreed at journal 16 Apr, 2021 Editor assigned by journal 15 Apr, 2021 Submission checks completed at journal 15 Apr, 2021 Editor invited by journal 15 Apr, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-482095","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":24360590,"identity":"f9ccc4fa-3505-4ab9-a749-a28d2c6470aa","order_by":0,"name":"Paul Shawcross","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYFACxsYHDAw2CWB2QgFRWpgPGzAwpCUwsIG0GBClhS1NgIHhMEQLAzFa5Gf3mDEX/Dmfxy/fnfjhgQGDPL/YAfxaDO6cMXs8s+12sWQb72YJoMMMZ85OIKBFIsfcmLfhduKGY7wbQFoSDG4T0CI/I8dMmufPOZCWzT+I0sJwIy1NmoftAEjLNuJsMbhz+LDxzLbkxJltudssEgwkCPtFfnZj4+OCP3aJ/cxnN9/8UWEjzy9NyGESwMhE5RIEaFpGwSgYBaNgFGACAB1WRIz7S4txAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-7059-0008","institution":"University of Derby","correspondingAuthor":true,"prefix":"","firstName":"Paul","middleName":"","lastName":"Shawcross","suffix":""},{"id":24360591,"identity":"0b271299-85d2-491a-9f93-9dbf23ef6965","order_by":1,"name":"Melinda Lyons","email":"","orcid":"","institution":"University of Derby","correspondingAuthor":false,"prefix":"","firstName":"Melinda","middleName":"","lastName":"Lyons","suffix":""},{"id":24360592,"identity":"d06f2829-6c5b-497c-98c6-ae6843b62a5e","order_by":2,"name":"Victoria Filingeri","email":"","orcid":"","institution":"University of Derby","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Filingeri","suffix":""}],"badges":[],"createdAt":"2021-04-30 22:15:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-482095/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-482095/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13690576,"identity":"ffd7f865-ee4f-4fb4-ad85-caf724c5b014","added_by":"auto","created_at":"2021-09-17 12:34:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":392539,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-482095/v1/2d0621b4-72d0-4c55-b342-66c93358e145.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eThe Relationship Between Readiness to Change Pain-Related Exercise Participation and Perceived Work Function: A Cross-Sectional Study of Factory Workers\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eHealthy Lifestyle Behaviours\u003c/h2\u003e \u003cp\u003eObesity, physical inactivity, poor dietary habits and insufficient sleep are recognised as the key lifestyle risk factors that should be tackled by health professionals to improve health outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] For example, worldwide an estimated 1.6\u0026nbsp;million deaths per annum can be attributed to physical inactivity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePain is an important health outcome associated with a lack of healthy lifestyle behaviours [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Particularly, engagement with physical activity and exercise, with physical inactivity associated with increased back pain and disability [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and more physical activity associated with less back pain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A seminal paper [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] linked back pain and disability with various lifestyle factors such as poor sleep, inactivity and sedentary behaviour coupled with fear-avoidance beliefs. The association of such lifestyle behaviours and pain is further explained using the common-sense model [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] where a person believes that their body is damaged or vulnerable because they were told this by health professionals or society and subsequently avoid activity and movement as a result. This is an understandable common-sense behaviour which may lead to inactivity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eBehaviour Change and Pain\u003c/h2\u003e \u003cp\u003eA series of review papers were released by the Lancet journal in 2018 calling for a change in how we prevent and treat one of the most common pain areas, low back pain [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The main call for action was around changing the beliefs and behaviour of health professionals, patients and society to move away from a biological understanding of low back pain which creates fear and unhelpful behaviours, towards a holistic biopsychosocial understanding with person-centred care, focusing on self-management and healthy lifestyles [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Other recent research has suggested a change in current musculoskeletal healthcare practice to focus on identifying lifestyle and behavioural risk factors, challenge unhelpful thoughts and beliefs that lead to unhealthy behaviours and provide support with adopting healthy lifestyle behaviours [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Stages of Change Model [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] presents 6 stages of readiness to change behaviour: pre-contemplation, contemplation, preparation, action, maintenance and relapse. Described as a continuous cycle of an individual\u0026rsquo;s state of readiness change. An individual\u0026rsquo;s readiness to change and adopt self-management strategies is associated with improved coping [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A recent systematic review reported moderate-quality evidence supporting the use of behaviour change techniques to enhance exercise adherence in people with musculoskeletal pain [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePain, Work Disability and Work Ability\u003c/h2\u003e \u003cp\u003eWorkplace disability is on the increase in the UK with more than 7\u0026nbsp;million working-age disabled people [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Pain has been identified as the leading cause of disability [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Work ability is defined as the balance between an employee\u0026rsquo;s individual resources and their work demands which can be used as a predictor of future sickness absence and work function [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Pain is recognised as a threat to work ability and function [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Poor self-efficacy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], kinesiophobia (fear of movement) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and maladaptive pain behaviours [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] are all thought to reduce work ability in workers experiencing pain. Currently, factory workers have not been a focus of the research despite there being a high prevalence of musculoskeletal absence reported in the manufacturing and production industry [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eResearch Question\u003c/h2\u003e \u003cp\u003eThis study will explore the relationship between pain behaviour and function at work (work ability) in factory workers by assessing for the presence of key behavioural risk factors and readiness to change these behaviours. Focus will be given to readiness to change exercise participation.\u003c/p\u003e \u003cp\u003eCurrent research is now looking at prediction models for future sickness absence due to musculoskeletal disorders [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This current study will add to this body of research by identifying potential behavioural risk factors that need to be included in such prediction models for factory workers.\u003c/p\u003e \u003cp\u003eThe aim of this study was to examine the statistical relationship between a cohort of factory workers \u0026lsquo;readiness to change pain behaviours\u0026rsquo; and their \u0026lsquo;perceived work function\u0026rsquo;. With particular focus on readiness to change \u0026lsquo;exercise participation\u0026rsquo;. The secondary aim was to compare this relationship in workers that were experiencing musculoskeletal pain and those that were not experiencing musculoskeletal pain.\u003c/p\u003e \u003c/div\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA correlational design was used to assess the relationship between the variables of \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and \u0026lsquo;perceived work function\u0026rsquo; in a cohort of factory workers and establish if \u0026lsquo;readiness to change pain behaviour\u0026rsquo; was associated with \u0026lsquo;perceived work function\u0026rsquo;. This research used quantitative data to provide statistical analysis in the form of correlation and multiple regression. A cross-sectional study design was used for estimating the prevalence of readiness to change multiple pain behaviours, as the exercise component was considered independently.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eVariables and Measures\u003c/h2\u003e \u003cp\u003eThe Work Ability Index (WAI) was used to measure \u0026lsquo;perceived work function\u0026rsquo;. This questionnaire has high validity and reliability (Cordeiro et al, 2017; 27]. The WAI gives a score from 2\u0026ndash;49 and four categories; \u0026lsquo;poor\u0026rsquo; (2\u0026ndash;27), \u0026lsquo;medium\u0026rsquo; (28\u0026ndash;36), \u0026lsquo;good\u0026rsquo; (37\u0026ndash;43), \u0026lsquo;very good\u0026rsquo; (44\u0026ndash;49), corresponding with 4 actions; \u0026lsquo;reinstate work ability\u0026rsquo; (2\u0026ndash;27), \u0026lsquo;improve work ability\u0026rsquo; (28\u0026ndash;36), \u0026lsquo;support work ability\u0026rsquo; (37\u0026ndash;43), \u0026lsquo;maintain work ability\u0026rsquo; (44\u0026ndash;49).\u003c/p\u003e \u003cp\u003eThe Multidimensional Pain Readiness to Change Questionnaire 2 (MPRCQ2) was used to measure readiness to change various pain management behaviours. This questionnaire has good validity and reliability [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The MPRCQ2 gives a score from 1\u0026ndash;7 using 69 questions covering 9 behaviour components; use of relaxation, cognitive control, assertive communication, exercise participation, avoid resting due to pain, avoid regularly asking for assistance, task persistence, pacing and use of taught body mechanics. For the first of two sections, 1 represents \u003cem\u003e\u0026lsquo;I am not doing this now, and am not interested in ever doing it.\u0026rsquo;\u003c/em\u003e and 7 represents \u003cem\u003e\u0026lsquo;I have been doing this for a long time (at least 6 months.)\u003c/em\u003e\u0026rsquo;. The second section inverts the scores, so 1 represents \u003cem\u003e\u0026lsquo;I am doing this now and am not interested in ever stopping\u0026rsquo;\u003c/em\u003e and 7 represents \u0026lsquo;\u003cem\u003eI have not done this for a long time (at least 6 months)\u0026rsquo;.\u003c/em\u003e An average score for each of the 9 behaviour components is calculated 1\u0026ndash;7 and an overall score 9\u0026ndash;63 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The overall score and the \u0026lsquo;exercise participation\u0026rsquo; behaviour component score were used in this study.\u003c/p\u003e \u003cp\u003eParticipants reported if they were currently experiencing musculoskeletal pain or not, to allow for comparison between these two groups. Other participant characteristics measured included; gender, age range, shift pattern, job role, time in current job role, current or recent pain experience and other current health issues (see a full list of health conditions in appendix 1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study population consisted of 75 factory workers from a factory in the UK which manufactures home and personal care products and consisted of 98 total factory workers. Convenience sampling was used to recruit participants between September-November 2019. Participants gave consent for use of their data in group analysis. Participant characteristics were collected for population, but not individual analysis. No other personal information was collected to maintain anonymity.\u003c/p\u003e \u003cp\u003eThe 75 participants (66 male, 9 female) modal age range was 55\u0026ndash;64. Inclusion criteria were; aged over 18, employed within the factory for more than 3 months, English speaking. Exclusion criteria also included people registered as vulnerable. See Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for participant characteristics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eMaterials\u003c/h2\u003e \u003cp\u003eThe various questionnaires were inputted to Qualtrics software along with the consent form, debrief statement, participant information sheet (see appendix 1) and inclusion/exclusion criteria questions. A tablet computer was used to administer. SPSS (IBM, Armonk, NY) was used for statistical analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eInvitation to take part in this research (see appendix 1) was displayed on a notice board and tables in a canteen area. Participants were able to sign up via their line manager or drop into a session during their working day, where a researcher was present.\u003c/p\u003e \u003cp\u003eAfter an initial explanation (using the participant information sheet) and a chance to ask questions, the participant was left alone in a room for 20 minutes, to complete all questionnaires. The link to the Qualtrics questionnaire was distributed using a tablet computer.\u003c/p\u003e \u003cp\u003e Qualtrics guided the participants through the consent process and various inclusion/exclusion criteria. If participants did not meet the criteria or consent, the questionnaire was stopped. Participants that did meet inclusion criteria and consented were taken through the WAI and MPRCQ2 questionnaires followed by a final study debrief.\u003c/p\u003e \u003cp\u003eThe details and answers for all participants were stored securely by Qualtrics. This data was cleansed and exported to SPSS for statistical analysis. SPSS analysis was completed on a secure password-protected laptop computer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were completed on \u0026lsquo;perceived work function\u0026rsquo; and \u0026lsquo;readiness to change pain behaviours\u0026rsquo;. Average scores with standard deviations and distribution of data were reported. A correlational design was chosen to assess the relationship between two variables, both \u0026lsquo;readiness to change pain behaviour\u0026rsquo; with \u0026lsquo;perceived work function\u0026rsquo; and \u0026lsquo;readiness to change pain behaviour specific to exercise\u0026rsquo; with \u0026lsquo;perceived work function\u0026rsquo;. A correlational design was also used to assess the variables for 2 groups; participants reporting a pain experience in the past 7 days (n\u0026thinsp;=\u0026thinsp;52) and those that had not reported a pain experience in the past 7 days (n\u0026thinsp;=\u0026thinsp;23).\u003c/p\u003e \u003cp\u003eA multiple regression analysis was completed to test both \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and \u0026lsquo;readiness to change pain behaviour specific to exercise\u0026rsquo; as predictors of \u0026lsquo;perceived work function\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cp\u003eTwo potential participants were excluded because they were employed within the factory for less than 3 months and 2 potential participants did not consent after reading the participant information sheet. Giving a total of 75 participants participated in this study. Descriptive details of the participants are presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents descriptive stats for WAI, MPRCQ2 and MPRCQ2 exercise component. Mean average WAI score was 41.89 (SD 5.28) which is categorised as a \u0026lsquo;good\u0026rsquo; level of work ability [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] with a range of 28 to 49. Mean average MPRCQ2 score was 4.26 (SD 1.01) with a range of 2.1 to 6.6 and MPRCQ2 exercise component score was 4.40 (SD 1.69) with a range of 1 to 7.\u003c/p\u003e \u003cp\u003eSkewness scores for WAI did not fall within the +/- 1.96 Z score range to meet assumptions of normality of data, Z\u0026thinsp;\u0026gt;\u0026thinsp;3 (see Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Non-parametric testing was used.\u003c/p\u003e \u003cp\u003eCorrelations between the variables are shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The results showed that there was a positive relationship between MPRCQ2 and WAI, though this was not significant (rs\u0026thinsp;=\u0026thinsp;.09, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). There was a significant positive relationship between MPRCQ2 exercise component and WAI (rs\u0026thinsp;=\u0026thinsp;.23, p\u0026thinsp;\u0026lt;\u0026thinsp;.05). This shows that \u0026lsquo;readiness to change pain behaviour specific to exercise\u0026rsquo;, has a positive association with \u0026lsquo;perceived work function\u0026rsquo;.\u003c/p\u003e \u003cp\u003eTests to see if the data met the assumption of collinearity indicated that multicollinearity was not a concern (MPRCQ2 VIF\u0026thinsp;=\u0026thinsp;1.49; MPRCQ2 exercise component, VIF\u0026thinsp;=\u0026thinsp;1.49). The data met the assumption of independent errors (Durbin-Watson value\u0026thinsp;=\u0026thinsp;1.89).\u003c/p\u003e \u003cp\u003eData were analysed using a Multiple Regression using the Enter Method. The regression equation produced a small effect size (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.06, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003eAdj\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.03), indicating that \u0026lsquo;readiness to change pain behaviour\u0026rsquo; (when all components are measured together) was not a significant predictor of \u0026lsquo;perceived work function\u0026rsquo; (\u003cem\u003eF\u003c/em\u003e (2, 72)\u0026thinsp;=\u0026thinsp;2.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.001). \u0026lsquo;Readiness to change pain behaviour\u0026rsquo; was not a significant predictor of \u0026lsquo;perceived work function\u0026rsquo; (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.29, \u003cem\u003edf\u003c/em\u003e\u0026thinsp;=\u0026thinsp;74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.776). \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; participation was not a significant predictor of \u0026lsquo;perceived work function\u0026rsquo; (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.53, \u003cem\u003edf\u003c/em\u003e\u0026thinsp;=\u0026thinsp;74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.131).\u003c/p\u003e \u003cp\u003eData were split into 2 groups; participants reporting a pain experience in the past 7 days (n\u0026thinsp;=\u0026thinsp;52) and those that hadn\u0026rsquo;t reported a pain experience in the past 7 days (n\u0026thinsp;=\u0026thinsp;23). For participants in pain, correlations between the variables are shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The results showed that there was a positive relationship between MPRCQ2 and WAI, though this was not significant (rs\u0026thinsp;=\u0026thinsp;.12, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). There was a positive relationship between MPRCQ2 exercise component and WAI, though this was not significant (rs\u0026thinsp;=\u0026thinsp;.18, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). For participants not in pain, correlations between the variables are shown in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The results showed that there was a positive relationship between MPRCQ2 and WAI, though this was not significant (rs\u0026thinsp;=\u0026thinsp;.10, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). There was a positive relationship between MPRCQ2 exercise participation and WAI, though this was not significant (rs\u0026thinsp;=\u0026thinsp;.41, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). All raw data is presented in appendix 2 and SPSS outputs in appendix 3\u0026ndash;5.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime worked in factory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;12 months\u003c/p\u003e \u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob role\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMachine Operator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnical Operator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalletiser Operator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDespatch Operator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManufacturing apprentice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlanner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLine Leader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReported Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain in past 7 days\u003c/p\u003e \u003cp\u003eNo pain in past 7 days\u003c/p\u003e \u003cp\u003ePain in past 3 months\u003c/p\u003e \u003cp\u003eNo pain in past 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003cp\u003e40\u003c/p\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e60\u003c/p\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther diagnosed health condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics for WAI, MPRCQ2 and MPRCQ2 exercise component\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003e(SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ Skewness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eZ Kurtosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eK-S Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eS-W Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWAI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.89\u003c/p\u003e \u003cp\u003e(5.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.26\u003c/p\u003e \u003cp\u003e(1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2 - exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.40\u003c/p\u003e \u003cp\u003e(1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCorrelation coefficients and significance levels for MPRCQ2 and MPRCQ2 exercise\u003c/b\u003e component independently against WAI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWAI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003cp\u003e(.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2 - exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.23\u003c/p\u003e \u003cp\u003e(.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation coefficients and significance levels for MPRCQ2 and MPRCQ2 exercise component independently against WAI for participants experiencing pain\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWAI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.12\u003c/p\u003e \u003cp\u003e(.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2 - exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003cp\u003e(.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation coefficients and significance levels for MPRCQ2 and MPRCQ2 \u0026ndash; exercise independently against WAI for participants not experiencing pain\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWAI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003cp\u003e(.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPRCQ2 - exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.41\u003c/p\u003e \u003cp\u003e(.052)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eThis study hypothesised that \u0026lsquo;readiness to change pain behaviour\u0026rsquo; has a statistically significant positive relationship with \u0026lsquo;perceived work function\u0026rsquo; in factory workers. The results indicated that this positive relationship was not statistically significant. Therefore, we accept the null hypothesis. A similarly unsupportive association was reported between readiness to self-manage pain and both physical and psychological functioning [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although similar, the measure used was different, using the pain stages of change questionnaire (PSOCQ) instead of MPRCQ2 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] which focuses on readiness to adopt a self-management approach rather than focusing on specific behavioural components like MPRCQ2. Patient disability and depression were the functional focus [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] opposed to \u0026lsquo;perceived work function\u0026rsquo; as in this current study. One study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] used the MPRCQ2 to measure readiness to change and assess the association with pain-related function (rather than \u0026lsquo;perceived work function\u0026rsquo;). No significant association was reported with the MPRCQ2 or any subcomponents (including exercise) with pain-related functioning. The cohort recruited [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] had some key differences with this current study populations as they all had low back pain and were general population rather than factory workers.\u003c/p\u003e \u003cp\u003eIn contrast to this current study\u0026rsquo;s results data reported by Pitt-Catsouphes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] in support of a statistically significant relationship between health behaviour changes influencing physical health and work ability (measured by WAI). Various influential review papers are supportive of behaviour change, exercise and self-management strategies for managing pain and improving function at work [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This body of research is specific to low back pain rather than musculoskeletal pain as a whole and of these 5 studies, only NICE [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] completed a robust systematic literature review. Behaviour change and \u0026lsquo;readiness to change pain behaviour\u0026rsquo; may be more important for people experiencing low back pain than other musculoskeletal pain. More primary research and systematic reviews are recommended focusing on musculoskeletal pain, other than low back pain.\u003c/p\u003e \u003cp\u003eThis study hypothesised that \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; has a statistically significant positive relationship with \u0026lsquo;perceived work function\u0026rsquo; in factory workers. The results indicated that there was a statistically significant positive relationship. Therefore, this hypothesis was accepted. This finding builds on the already established research base linking higher levels of physical activity and exercise as a key lifestyle behaviour change for improving pain and function associated with musculoskeletal pain [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. \u0026lsquo;Readiness to change\u0026rsquo; is a new area of focus and the specific relationship between \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; and \u0026lsquo;perceived work function\u0026rsquo; was not reported in these previous review papers, highlighting a new finding to add to the research base and investigate further. Applying these results practically, readiness to participate in exercise seems to be a positive behaviour and higher perceived work function seems to be a positive perception. Both of which should be encouraged.\u003c/p\u003e \u003cp\u003eThe mean average WAI score was categorised as a \u0026lsquo;good\u0026rsquo; level of work ability [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and seemed generally high for this cohort of factory workers, with no workers scoring in the lowest category. This mean average was similar to previous research mean average WAI scores of 42.2 (SD 4.2) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and 39.3 (SD 3) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, this current research presents a larger standard deviation for WAI scores, highlighting a greater spread of WAI scores. This may be related to this data not being normally distributed. Mean average MPRCQ2 in this study were similar to the original research populations mean average MPRCQ2 scores of 4.29 (SD 1.68). The MPRCQ2 exercise component was higher in this cohort of factory workers; 4.40 (SD 1.69) compared to the original cohort; 4.25 (SD 1.57) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This difference may be the reason for the positive association with \u0026lsquo;perceived work function\u0026rsquo; reported in the results of this current study. Future research with different study populations is recommended to explore this.\u003c/p\u003e \u003cp\u003eThis study hypothesised that \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; are good predictors of \u0026lsquo;perceived work function\u0026rsquo; in factory workers. The results indicate that neither \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; are good predictors of \u0026lsquo;perceived work function\u0026rsquo;. Therefore, we accept the null hypothesis. No other research presents \u0026lsquo;readiness to change pain behaviour\u0026rsquo; as a predictor of \u0026lsquo;perceived work function\u0026rsquo;. Several studies have linked exercise participation (as a behaviour, but not readiness to change) with work ability. A systematic review and meta-analysis on workplace health promotion on wellbeing and work ability was completed in 2008 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Exercise was reported to increase both wellbeing and work ability of workers. A similar systematic review conducted more recently [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported moderate-quality evidence for exercise and lifestyle education as a workplace intervention. Research considering behaviour change specific to exercise and workability was reported on [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] in support of a predictor relationship between \u0026lsquo;behaviour change related to exercise participation\u0026rsquo; and \u0026lsquo;perceived work function\u0026rsquo;. With changes in health behaviour specific to exercise associated with a statistically significant improvement in physical health and work ability [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. \u0026lsquo;Readiness\u0026rsquo; to change was not considered [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExercise as a health behaviour has been considered as part of a paradigm for health performance [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], where exercise was 1 of 5 health behaviours considered to contribute to health performance. The authors [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] discuss attitudes as a key influencer of behaviour. They do not consider where readiness to change fits into this paradigm. The results from this current study suggest \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; should at least be considered. The exact nature of this association is still unclear and there does not appear to be a predictor relationship between \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and perceived work function, based on the results of this current study.\u003c/p\u003e \u003cp\u003eThe tertiary aim of this study was to compare the statistical relationship between factory workers \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and their \u0026lsquo;perceived work function\u0026rsquo; in workers that were experiencing musculoskeletal pain and those that were not experiencing musculoskeletal pain. The results reported no statistically significant relationship for either group. A previous study with similarly unsupportive findings was a randomised controlled trial (RCT) of 66 slaughterhouse workers with upper limb pain and work disability [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Workers had either 10 weeks of strength exercise or ergonomic training. Strength exercise was reported as superior for preventing deterioration of work ability but not improving work ability. This was an insignificant finding with low effect size, although this may be due to the small sample size. The researchers [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] also focused on strength training as a particular type of exercise in contrast to any exercise participation in this current study. One previous study did report conflicting results [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] using a subset of 80 participants from a larger cohort study [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] to compare engagement in positive lifestyle behaviours between 36 adults with chronic low back pain and 44 adults with no history of chronic low back pain. The health literacy measurement scale was used, and results present a greater difficulty engaging in positive lifestyle behaviours for those in chronic low back pain compared to those without. The authors [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] assessed the comparison between the two groups in which this current research does not. However, a small convenience sample was used [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], made up of people from the same, middle-class geographical area in Australia. Subsequently, population validity was low, and the sample may be subject to selection bias. Both of these previous studies [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] assess exercise as an intervention rather than readiness to change. Further research is needed, comparing readiness to change lifestyle behaviours in people experiencing pain and people not experiencing pain.\u003c/p\u003e \n\u003ch2\u003eDirections For Further Research\u003c/h2\u003e\n \u003cp\u003eThe concept of readiness to change was first discussed in 1983 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], yet it has not been studied in great depth. Its importance was highlighted for adopting self-management strategies for managing chronic pain [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In contrast, Byrka \u0026amp; Kaiser [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] discuss health attitudes as a key influencer of health behaviour rather than readiness to change. Consensus is yet to be agreed on which individual characteristics (readiness, attitudes, motivation, beliefs and expectations) are most important for health and pain behaviour change. The results from this current study suggest \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; should at least be considered although the exact nature of this association is still unclear. The range of potential behaviour influencing characteristics may be the reason that readiness to change has not been studied in great depth since it was first proposed [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. All are likely to play some role and further research is needed to clarify how these characteristics interact.\u003c/p\u003e \u003cp\u003eThe statistically significant positive relationship between \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; and \u0026lsquo;perceived work function\u0026rsquo; in factory workers reported in the results, is a new finding to add to the current research base which already recognises exercise as a positive behaviour for improving pain and function associated with musculoskeletal pain [4, 6, 8, 9, 10, 14; 30]. It may be useful to attain from future research, which specific type of exercise is most beneficial for workers for improving pain and work function.\u003c/p\u003e \u003cp\u003eThis research area has already received attention in the literature with strength training emerging as the most effective exercise improving pain in the workplace. No less than 4 systematic reviews [38, 39; 40, 41] have been completed in recent years to evaluate the evidence of workplace strength training for managing musculoskeletal pain amongst workers. The first of these systematic revies [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] assessed the effectiveness of a range of workplace interventions in the prevention of upper limb pain. Strong evidence was reported for the effectiveness of workplace-based resistance training and moderate evidence for stretching programmes. A robust systematic review was completed [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], although they do not consider unpublished or grey literature and findings may be subject to publication bias. One systematic review [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] assessed the effectiveness of a range of workplace interventions for reducing chronic musculoskeletal pain and symptoms. The authors reported consistency in results for high-intensity exercises for decreasing pain and symptoms in employees with chronic musculoskeletal pain [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Another systematic review [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] focused on workplace-based rehabilitation of upper limb pain in their systematic review. Strong evidence was again reported for workplace exercise programs over ergonomic controls and training. The exercise programs were a mix of resistance training, stretching and conditioning exercise. The most recent systematic review [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] focusing on workplace interventions to rehabilitate musculoskeletal disorders among employees with physically demanding work, report further strong evidence for the positive effect or workplace strength training for rehabilitation of workers with musculoskeletal pain. The systematic review [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] was extremely robust, with multiple reviewers involved in the quality review process.\u003c/p\u003e \u003cp\u003eNone of the systematic reviews discussed concerning exercise and strength training for managing musculoskeletal pain in the workplace [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] consider \u0026lsquo;perceived work function\u0026rsquo; and this was recommended as a sensible focus for future research [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In contrast, a prediction model was developed [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], for future sick leave and loss of work function due to musculoskeletal pain. They use the occupational health check questionnaire to measure predictor variables such as psychological distress, work pace and presence of musculoskeletal complaints, but this questionnaire does not consider strength training or any other exercise, physical activity, lifestyle behaviours or readiness to change. These variables are subsequently missing from the prediction model as they have not been considered. The findings of this current study would suggest that these two research areas would benefit from coming together; readiness to change exercise behaviour (specifically strength training) and \u0026lsquo;perceived work function\u0026rsquo; in workers with musculoskeletal pain.\u003c/p\u003e \n\u003ch2\u003eStrengths And Limitations\u003c/h2\u003e\n \u003cp\u003eThe regression equation produced a small effect size. A sample size of 81 was needed to achieve a larger effect size at a 95% confidence interval and a 5% precision rate [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The smaller sample of 75 participants used in this study could have contributed to a lack of statistical association between MPRCQ2 exercise component as a predictor and WAI as an outcome. Convenience sampling was used due to the nature of the study design and the small study population available. Convenience sampling does expose the study findings to selection bias and reduces population validity. For example, the researchers were unable to recruit any workers that were currently absent from work. All participants were currently at work and so the results of this study can only be applied to workers in work, not those absent. The controlled workplace environment where participants completed the survey, with the researcher partially present may have unwittingly led to researcher bias which is a threat to internal validity. A lack of normality of WAI data was identified for this sample of workers and so non-parametric testing was used. Non-parametric testing is less powerful for detecting variability in data [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe WAI was used to measure \u0026lsquo;perceived work function\u0026rsquo; due to its high validity and reliability [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. It is widely used in this field of research [29, 31, 32, 33). One alternative for the future may be the work ability survey (WAS-R). Early research [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] suggests the WAS-R extends the measurement of WAI to also reflect organisations work demands. Validity and reliability are yet to be reported on, but the WAS-R may be considered as an alternative to WAI in future studies measuring \u0026lsquo;perceived work function\u0026rsquo;. WAI seems to be the best current option and is a strength of this study.\u003c/p\u003e \u003cp\u003eMPRCQ2 was used to measure readiness to change various pain management behaviours including exercise. MPRCQ2 has good validity and reliability [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Although this research focuses on patients with fibromyalgia, arthritis, spinal cord injury and amputation [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Patients with musculoskeletal pain such as back pain and upper limb pain have not been studied. MPRCQ2 is not as widely used as the WAI. Partly because of alternatives such as the PSOCQ [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and partly because \u0026lsquo;readiness to change pain behaviour\u0026rsquo; is yet to be studied in great depth. The MPRCQ2 was chosen for this study over PSOCQ due to the additional focus on specific behavioural components like exercise. Yet, the 9 behaviour components may need an update. \u0026lsquo;Use of taught body mechanics\u0026rsquo; [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] for example has come under scrutiny as a risk factor for musculoskeletal pain. This change in understanding was well summarised by a recent systematic review [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] reporting that lumbar spine flexion when lifting was not a risk factor for low back pain onset, persistence or a differentiator for people in pain. Other important risk factors for pain, such as diet [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], sleep [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], smoking [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and obesity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] have also emerged but are not considered by MPRCQ2. This could be considered a limitation of the MPRCQ2 and subsequently this study. Future development and inclusion of these risk factors are recommended for any tool measuring \u0026lsquo;readiness to change pain behaviour\u0026rsquo;.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eThis research does not provide support for an association or predictor relationship between factory workers \u0026lsquo;readiness to change pain behaviour\u0026rsquo; and their \u0026lsquo;perceived work function\u0026rsquo;. Previous research suggestive of any kind of relationship seems to focus on behaviour change as an intervention rather than readiness to change or focuses on different study populations outside of the workplace. Suggesting that these current results may be determined by \u0026lsquo;readiness to change\u0026rsquo; as a concept and/or the findings may be specific to this study population of factory workers or this specific sample.\u003c/p\u003e \u003cp\u003eThis research does provide support for a positive relationship between factory workers \u0026lsquo;readiness to change pain behaviour related to exercise participation\u0026rsquo; and their \u0026lsquo;perceived work function\u0026rsquo;. In a practical sense, readiness to participate in exercise seems to be a positive behaviour and may be constructive for improving \u0026lsquo;perceived work function\u0026rsquo;. Equally, the higher perceived work function seems to be a positive perception and may impact on readiness to participate in exercise. Both behaviours and perceptions should be encouraged and supported in a clinical setting.\u003c/p\u003e \u003cp\u003eAlthough this finding doesn\u0026rsquo;t represent causation, this gives a good starting point for further research. To enhance the internal validity and population validity of these findings, future research should apply a methodology which reduces use the potential for selection and researcher bias and look to recruit a larger and more varied sample.\u003c/p\u003e \u003cp\u003eFurther research should explore the causal relationship between readiness to change exercise participation as a pain behaviour and \u0026lsquo;perceived work function\u0026rsquo;. This research should consider motivations, attitudes, beliefs and expectations in relation to exercise participation as well as readiness to change. Workers that are absent from work should also be included to compare differences. Given the emerging evidence base for strength training for rehabilitating workers with musculoskeletal pain, this specific type of exercise should be applied to future research exploring an association with work function.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate: \u003c/strong\u003eRelevant ethical considerations (consent, deception, debriefing, withdrawal, data protection, confidentiality and anonymity) were addressed and approved following the University of Derby ethical framework. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2000. Informed consent was obtained from all patients for being included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: \u003c/strong\u003eNot applicable for individual data. The organisational involved did provide consent using the university of Derby ethical consent form. This is available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: \u003c/strong\u003eThe raw data and datasets used and/or analysed during the current study are available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003eNo conflicts of interest to disclose. The organisation providing the participants for this research project was a paying customer of the author's employer at the time that this research was conducted. The organisation has had no involvement other than consenting for participant involvement, but the authors do acknowledge the potential presence of unconscious bias due to the customer relationship. This was a student project and carried out as part of study towards an MSc in Health Ergonomics at the University of Derby.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eNo financial incentive, grants or funding were received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions: \u003c/strong\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Paul Shawcross. The first draft of the manuscript was written by Paul Shawcross and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements: \u003c/strong\u003eThis paper and the research behind it would not have been possible without the support of colleagues at Connect Health who granted the time required to conduct this research. Also, Unilever PLC Human Resources and Health and Wellbeing Leads for permitting the recruitment of their employees for this study. This was a student project and carried out as part of study towards an MSc in Health Ergonomics at the University of Derby.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHousman J, Dorman S. The Alameda County study: a systematic, chronological review. Journal of Health Education. 2005;36(5):302\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRitchie H, Roser M. Causes of Death. Retrieved from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ourworldindata.org/causes-of-death\u003c/span\u003e\u003c/span\u003e; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDean E, S\u0026ouml;derlund A. 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Salud colectiva. 2018;14(4):713.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaraceni N, Kent P, Ng L, Campbell A, Straker L, O'Sullivan P. To flex or not to flex? is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta-analysis. journal of orthopaedic sports physical therapy. 2020;50(3):121\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoltmer JB, Deller J. Measuring work ability with its antecedents: Evaluation of the Work Ability Survey. J Occup Rehabil. 2018;28(2):307\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pain, work, exercise, lifestyle, health","lastPublishedDoi":"10.21203/rs.3.rs-482095/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-482095/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBackground: \u003c/em\u003e\u003c/strong\u003eHealthy lifestyle behaviours are associated with protection against health disorders and pain. Exercise participation is one such behaviour, associated with improved outcomes in those experiencing pain. Musculoskeletal pain is highly prevalent in the workplace, particularly in factory workers and associated loss of work function is recognised as having a great impact on individuals, society and the economy. A worker’s ‘readiness to change pain behaviour’ is an important factor to consider in achieving a healthy lifestyle behaviour and potentially improved function. This study aimed to examine the relationship between a cohort of factory workers ‘readiness to change pain behaviour’ such as exercise and their ‘perceived work function’.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMethods: \u003c/em\u003e\u003c/strong\u003eA cross-sectional study design was used to establish the relationship between ‘readiness to change pain behaviours’ and ‘perceived work function’. The Multidimensional Pain Related Change Questionnaire 2 (MPRCQ2) was used to measure readiness to change various pain behaviours including exercise. The Work Ability Index (WAI) was used to assess ‘perceived work function’. 75 participants were recruited using convenience sampling. Correlation and multiple regression were used for statistical analysis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResults: \u003c/em\u003e\u003c/strong\u003eMean WAI, MPRCQ2 and MPRCQ2 exercise component were 41.89 (SD 5.28), 4.26 (SD 1.01) and 4.40 (SD 1.69). MPRCQ2 and MPRCQ2 exercise component were not significant predictors of WAI in factory workers (\u003cem\u003eF \u003c/em\u003e(2, 72) = 2.17, \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.001). There was no significant relationship between MPRCQ2 and WAI (rs = .09, p \u0026gt; .05). However, there was a significant positive relationship between MPRCQ2 exercise component and WAI (rs = .23, p \u0026lt; .05). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConclusions:\u003c/em\u003e\u003c/strong\u003e This study suggests that readiness to change pain-related exercise participation has a positive association with ‘perceived work function’. Further research should explore the causal relationship and consider strength training as a specific type of exercise.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Readiness to Change Pain-Related Exercise Participation and Perceived Work Function: A Cross-Sectional Study of Factory Workers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-05-04 20:44:22","doi":"10.21203/rs.3.rs-482095/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-04-27T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable pending editorial decision\n"},{"type":"reviewerAgreed","content":"","date":"2021-04-20T00:00:00+00:00","index":3,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-04-18T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-04-17T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-04-17T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2021-04-16T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-04-15T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-04-15T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5aaade9-d9b5-4fe2-92fc-5188a5c13610","owner":[],"postedDate":"May 4th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":4071002,"name":"Orthopedics"}],"tags":[],"updatedAt":"2021-05-04T20:44:22+00:00","versionOfRecord":[],"versionCreatedAt":"2021-05-04 20:44:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-482095","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-482095","identity":"rs-482095","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}