Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial

Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial | 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 Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial Sirinant Channak, Erwin M. Speklé, Allard J. Beek, Prawit Janwantanakul This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4324521/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Oct, 2024 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Neck and low back pain are prevalent issues among office workers due to prolonged sitting, necessitating effective interventions. Dynamic seat cushion, designed to promote postural shifts have emerged as promising solutions to address these concern. This study aims to evaluate the effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers. Methods: This study used 6-month follow-up data of a randomized controlled trial, involving 66 office workers who reported pain in the trial. At baseline, participants were cluster-randomized into an intervention group, which received a dynamic seat cushion designed to encourage postural shifts, or a control group, which received a placebo seat pad. Health outcomes included recovery duration and recurrence of pain. Analyses utilized log rank test and Cox proportional hazard models. Results: In the intervention group, the recovery rate from neck and low back pain was 100%, which was 86% for the control group. The median recovery duration in the intervention group (1 month) was two months shorter than in the control group (3 months). The intervention group had a higher probability of recovery compared to the control group (HR adj 4.35, 95% CI 1.87 – 10.11; p < 0.01). The recurrence rate of neck and low back pain was 27% in the intervention group, which was 75% in the control group. The Hazard Ratio, after adjustment, for the intervention group compared to the control group was 0.50 (95% CI = 0.11 – 2.12). Conclusions: A dynamic seat cushion that encourages postural shifts shortened recovery duration of neck and low back pain among office workers. Due to small numbers, however, a potentially relevant reduction of recurrence of neck and low back pain could not be statistically confirmed. Thai Clinical Trials Registry: TCTR20230623002 (23/06/2023). dynamic sitting postural shift office worker Figures Figure 1 Figure 2 Figure 3 1. Introduction During the past decades, neck pain (NP) and low back pain (LBP) have emerged as significant global health challenges, characterized by high prevalence and incidence rates, and years lived with disability [ 1 ]. By 2050, the estimated global number of NP cases is forecasted to increase by 32.5%, and LBP is expected to rise by 36.4% from 2020 [ 2 , 3 ]. NP and LBP often contribute to the development of other chronic pain conditions, becoming a major cause of sickness absenteeism, reduced work ability, decreased work productivity, and early retirement [ 1 , 4 , 5 ]. Although most individuals recover quickly from new episodes of NP and LBP, recurrence is common; over two-thirds experience a recurrence within one year after recovery, and almost half continue to experience persistent pain or frequent occurrences [ 6 , 7 ]. For instance, NP and LBP episodes among eldercare workers showed a consistently high four-weekly prevalence (between 61% and 72%), along with a high recurrence rate of pain, reaching 33% every four weeks [ 8 ]. A recent study with a 12-month follow-up period found that the recurrence rate of NP and LBP among office workers was 44% [ 9 ]. For recovery, a minimum duration of 30 days free of pain has been recommended, signifying the conclusion of an episode [ 10 ]. Recovery duration, however, varies widely, reflecting the diverse nature of recovery experiences [ 11 ]. An earlier systematic review revealed a broad range in recovery duration from NP and LBP, spanning from 1 week up to 12 months [ 12 ]. Therefore, identifying effective interventions to reduce the development of chronic pain involves enabling a swift and complete recovery when pain occurs and preventing the recurrence of pain. Office workers spend a significant proportion of their time working in a sitting position, with more than half of them engaging in prolonged sitting (≥ 30 minutes) [ 13 ]. Work-related prognostic factors for recurrence of NP and LBP include exposure to static posture, poor posture, sitting for a prolonged period, and history of NP and LBP [ 6 , 14 ]. Breaking up prolonged sitting with dynamic sitting has attributed to increased body movement during sitting [ 15 , 16 ], improved muscle performance [ 17 , 18 ], and reduced perceived discomfort [ 19 ]. Recent studies indicate that using smart seat interventions, which promote postural shifts through automatic air pumping, can reduce new onset and recurrence of NP and LBP, as well as shorten the recovery time from pain among office workers [ 9 , 20 ]. Postural shifts, identified through analysis of ischial tuberosity data considering both sagittal and frontal movements, revealed that each posture adjustment increased subcutaneous oxygen saturation by 2.2% [ 21 ]. Movement facilitated by the air cushion enhances tissue blood perfusion and improves pressure distribution beneath the sitting area, possibly indicating a positive effect on tissue viability [ 22 ]. Additionally, a frequency of postural shifting 10 to 30 times per hour during sitting significantly reduced neck and lower back discomfort [ 23 ]. Therefore, we designed a portable dynamic seat cushion with a specific air volume that encourages postural shifts, targeting discomfort reduction for the neck and low back. The cushion also aims to facilitate trunk muscle activation, as observed earlier in a laboratory setting. To date, there is only one study that investigated the effects of an automatically air pumping seat cushion to encourage postural shifts during prolonged sitting, specifically examining interventions on recovery from and recurrence of NP and LBP in office workers. Therefore, this study aimed to investigate the impact of a portable dynamic air-filled seat cushion encouraging postural shifts on the duration of recovery from NP and LBP as well as to determine the efficacy of these interventions on the recurrence of NP and LBP among office workers who have recovered from NP and/or LBP. 2. Methods 2.1 Study design This study used 6-month follow-up data of a randomized controlled trial (RCT), involving 66 office workers who reported pain in the trial. The study obtained approval from the research ethics review committee at Chulalongkorn University (COA No.015/2023) and is registered in the Thai Clinical Trials Registry (TCTR20230623002). 2.2 Participants Office workers from seven organizations in the Bangkok area, Thailand, including the Court of Justice, two universities, and four private companies, participated in this study. Office workers were eligible to participate in the RCT study if they met the following criteria; a minimum of 5 years of experience in the current position at the office; an age range between 23–55 years; a normal body mass index (BMI: 18.5–22.9 kg/m 2 ); at risk of non-specific NP as evaluated by the Neck Pain Risk Score for Office Workers (NROW; score ≥ 2) [ 24 ]; and non-specific LBP as determined by the Back Pain Risk Score for Office Workers (BROW; score ≥ 53) [ 25 ]. Participants were excluded if they met the following criteria; those who reported NP or LBP within the past 6 months; those exhibiting signs of neurological deficits (weakness or impaired/loss sensation); those with a history of trauma or accidents in the spinal region; those who had undergone spinal, abdominal, pelvic or thigh surgery within the past 12 months; those diagnosed with cancer, tumors, systemic lupus erythematosus, rheumatoid arthritis, gout, abnormalities of the spine, spinal infections, ankylosing spondylitis, scoliosis, spondylolisthesis, spondylosis, osteoporosis, osteoarthritis, or kidney disease; those with hemorrhoids, contusions, wounds, or keloid scar in the buttocks or posterior thigh region; those who reported pregnancy and planned within 6 months; or those engaged in regular exercise. Seven organizations were randomly assigned at the cluster level by computer-generated randomization into intervention or control groups. Clusters of participants were located in the same organization to prevent contamination of the intervention and facilitate compliance within the group. 2.3 Questionnaires At baseline, eligible participants completed a self-administered questionnaire, including individual factors (age, gender, educational level, underlying health condition and medication intake, frequency of regular exercise, alcohol intake, and tobacco habits, and mode of transportation to work), work-related physical factors (working position, working hours and rest breaks, working experience, activities during work, ergonomic characteristics of workstations, and work environment conditions), and work-related psychosocial factors (measured by the Job Content Questionnaire-Thai version; JCQ-54 items) [ 26 , 27 ] to gather exposure data. Participants recorded a self-diary, documenting the incidence of NP or LBP occurring over the month. Cases of NP and LBP were defined as reporting pain lasting more than 24 hours, pain intensity greater than 30/100 mm on the visual analog scale (VAS) and having no weakness or numbness in their body. Participants who reported as cases of pain were assessed for disability levels related to NP using the Neck Disability Index (NDI-10 items) [ 28 ] and for LBP using the Roland-Morris Low Back Disability Questionnaire (RMDQ-24 items) [ 29 ]. 2.4 Intervention All participants had their hip breadth measured by a physical therapist, while sitting on a stool, to determine the cushion size that matches the individual's hip breadth. In the control group, participants received a placebo seat cushion made of polypropylene foam, similar to the material of the seat pan of the office chair. In the intervention group, participants received an air-filled dynamic seat cushion. Through repetitive testing in the laboratory, this dynamic seat cushion, which is round in size and filled with appropriate air, appeared to be optimal for facilitating postural shifts targeting health benefits and providing greater back muscle activation compared to a standard office chair, all while maintaining comfort. Participants in the intervention group received instructions on how to move and maintain their posture on the cushion. Practical training was conducted over two weeks before data collection to minimize the risk of injury associated with using the dynamic seat cushion. After participants in both groups received the cushion or seat pad, the researcher (SC) adjusted the computer workstation and office chair by placing the cushion on top of the seat. These adjustments followed standard guidelines, with minor individual modifications made to ensure the comfort of each participant. Throughout 6-month follow up, participants in both groups were asked to use the cushion for the entire working day and received a notification message to remind them to use it in the morning. All participants were instructed to strictly follow the group instructions, maintained their physical activity levels, and refrained from adding other exercises for a 6-month period. 2.5 Outcome measurement Outcomes were recovery duration and recurrence of NP and LBP during the 6-month period. Recovery duration from NP and LBP was defined as the time (in months) taken to achieve complete recovery, being pain-free (VAS = 0), with no disability (NDI = 0 or RMDQ = 0), sustained for a continuous month [ 30 ]. Recurrence of NP and LBP was defined as a return to NP or LBP lasting at least 24 hours with a pain intensity of more than 30 mm on a 100-mm VAS without weakness and loss/impaired sensation, following at least 30 days without pain [ 31 ]. The recurrent rate of NP or LBP was calculated by dividing the number of participants with a recurrence by the total number of participants who recovered fully [ 32 ]. 2.6 Statistical analysis Statistical analyses were performed using IBM SPSS software (version 29.0 for Windows, SPSS Inc., Chicago, IL, USA). The baseline characteristics of participants, both between the intervention and control groups and among those reporting pain, were assessed using the independent t-test for continuous variables and the chi-square (Χ 2 ) test for nominal and ordinal variables. The analysis, adopting an intention-to-treat approach, utilized hot-deck imputation to handle missing data, which were replaced with observed values from a randomly selected respondent within the study [ 33 ]. The 6-month recovery duration and recurrence of NP and LBP were calculated for each group. The follow-up data for individuals initially identified as recovered or recurrent cases were not further used in the analysis. Kaplan–Meier survival curves were employed to measure the median duration to recovery and cases with recurrent NP and LBP. The curves were also used to compare the intervention and control groups using the log-rank test. If participants were lost to follow-up, their data were censored at the midpoint between the last completed follow-up and the next scheduled follow-up time, handling the uncertainty of the exact event time [ 34 ]. Participants not recovered after 6 months were censored at this point. The Cox proportional hazards model was used to calculate hazard ratios (HR) for both recovery duration and recurrent cases of NP and LBP. The possible covariates, 41 factors, were individually assessed in multivariate models. If a tested covariate resulted in a change greater than or equal to 0.05 in the HR of the intervention variable, then it was included in the final adjusted model. Additionally, the relationship between NP and LBP intensities and recovery duration was examined using Pearson correlation coefficients. 3. Results One hundred and thirty-two participants were successfully followed for 6 months (99.3%), and only one participant (0.8%) was lost to follow-up because of pregnancy (Fig. 1 ). In both groups, there were no reported adverse events or harm throughout the follow-up period. Sixty-six out of 133 office workers reported pain; 20 participants reported NP, 13 participants reported LBP, and 33 participants reported NP and LBP during the 6-month period. At baseline, there was no significant difference between the intervention and control groups except for gender, work experience, job control, physical job demand, and social support. For those reporting neck and/or low back pain, there was no significant difference between the intervention and control groups except for hip breadth, smoking, job control, and hazard at work (Table 1 ). Table 1 Characteristics of office workers at baseline (n = 133) and those reporting neck and/or low back pain during follow-up (n = 66). Baseline Characteristic Mean (SD) P -value (Baseline comparison) P -value (Case comparison) Intervention Control Baseline (N = 67) Case (n = 15) Baseline (N = 66) Case (n = 51) Demographic Age (years) 41.0 (8.0) 38.9 (9.1) 37.5 (7.7) 37.6 (7.6) 0.48 0.19 Gender: female (%) 80.5 86.7 89.6 82.4 < 0.001* 0.42 Body mass index (kg/m 2 ) 21.2 (1.5) 21.2 (1.3) 20.8 (1.6) 20.8 (1.6) 0.20 0.15 Hip Breath (cm) 38.3 (2.5) 38.3 (1.5) 37.5 (2.5) 37.6 (2.5) 0.64 0.04* Smoking (%) 3.0 13.3 3.0 2.0 0.61 < 0.001* Pain intensity 3.38 (0.66) 3.86 (0.95) 0.13 Education (%) 0.27 0.05 Bachelor’s degree 27.8 13.3 20.9 27.5 Exercise frequency in the past 12 months (%) 0.85 0.71 Never 55.2 86.7 43.9 92.2 Occasionally 44.8 13.3 56.1 7.8 Work-related Employment (years) 15.4 (8.2) 13.2 (8.1) 10.0 (7.3) 9.9 (7.1) 0.04* 0.43 Working hours per day 8.3 (1.0) 8.6 (1.0) 8.1 (1.3) 8.3 (1.3) 0.87 0.98 Rest time per day (min) 58.2 (13.7) 58.0 (7.7) 59.5 (16.2) 58.2 (16.3) 0.52 0.08 Psychosocial Job control 35.8 (4.5) 35.6 (3.3) 37.6 (5.6) 37.7 (5.8) 0.01* 0.01* Psychological job demands 32.3 (4.4) 31.7 (3.3) 33.2 (5.0) 33.9 (4.8) 0.08 0.13 Physical job demands 13.1 (2.3) 12.8 (2.5) 14.1 (3.3) 14.4 (3.1) < 0.001* 0.29 Job security 9.9 (1.0) 9.9 (1.0) 10.5 (1.2) 10.5 (1.2) 0.08 0.51 Social support 37.5 (4.5) 37.6 (4.3) 38.0 (5.7) 38.1 (5.9) 0.01* 0.06 Hazards at work 14.8 (2.4) 14.7 (2.1) 15.8 (4.0) 16.0 (4.1) < 0.001* 0.01* *P-value < 0.05. 3.1 Recovery duration from NP and LBP During the 6-month follow-up, 100% (15/15) of participants in the intervention group and 86% (44/51) in the control group reported full recovery from their neck and/or low back pain, with those who experienced neck and/or low back pain reporting a median recovery duration of two months (range: 1–5 months). The median duration of recovery from NP and LBP was one months in the intervention group and three months in the control group. Significant differences in recovery duration were found between the intervention and control groups (log-rank test χ 2 (1) = 26.51, p < 0.001) (Fig. 2 ). The adjusted Cox proportional hazard model indicated a statistically significant difference between the intervention and control group in recovery duration from neck and/or low back pain (HR adj 4.35, 95% CI 1.87–10.11; p < 0.001) (Table 2 ). A significant correlation was found between NP and LBP intensity and recovery duration (r = 0.6; p < 0.001); higher pain intensity indicated a longer recovery duration. Table 2 Unadjusted and adjusted hazard rates (HR) evaluating the effects of intervention on recovery duration from and recurrence of neck and low back pain (n = 66). Unadjusted P -value Adjusted P -value HR (95% CI) HR (95% CI) Recovery Control group (n = 44) 1.00 1.00 Intervention (n = 15) 4.52 (2.20–9.31) < 0.001* 4.35 (1.87–10.11) a < 0.001* Recurrence Control group (n = 38) 1.00 1.00 Intervention (n = 4) 0.47 (0.17–1.33) 0.16 0.50 (0.11–2.12) b 0.36 * P value < 0.05. a Variables; age, gender, body mass index, hip breath, education level, smoking, work experience, changing position during work, psychological job demand, physical job demand, job security. b Variables; body mass index, education level, underlying, work experience, prolonged sitting, computer workstation suitability, using the energy-saving device, physical job demand. 3.2 Recurrence of NP and LBP During the 6-month follow-up, 27% (4/15) of participants in the intervention group and 75% (38/51) in the control group reported recurrence of neck and/or low back pain. Participants who reported neck and/or low back pain indicated that the recurrence duration for NP and LBP took a median time of five months (range: 3–6 months). Significant differences in recurrence duration were found between the intervention and control groups (log-rank test χ2 (1) = 4.27, p = 0.039) (Fig. 3 ). The adjusted Cox proportional hazard model, however, indicated no statistically significant difference between the intervention and control group in recurrence of neck and/or low back pain (HR adj 0.50, 95% CI = 0.11–2.12; p = 0.36) (Table 2 ). 4. Discussion The present study suggests that among office workers sitting on a dynamic seat cushion that encourages postural shifts can enhance the rate of full recovery and shorten duration for recovery from NP and LBP. The recurrent rate of NP and LBP was 27% in the intervention group, with the dynamic seat cushion, and 75% in the control group. Due to small numbers, however, this potentially relevant reduction in recurrence of NP and LBP could not be statistically confirm 4.1 Recovery duration from NP and LBP Participants in the control group reported a full recovery rate of 86% from NP and LBP, which aligns with previous study investigating active break and postural shift interventions in office workers (89%) [ 9 ]. However, the present findings indicate that individuals with NP and LBP had a median recovery duration of 3 months, which is greater than the durations reported in a previous study among office workers (2 months) [ 35 ]. This disparity may be attributed to variations in participant characteristics. In our RCT study, all participants were high-risk office workers with a history of NP, and over 90% reported no exercise habits. In contrast, Areerak's study included participants with a lower proportion reporting a history of NP (68%) and a higher percentage engaging in occasional exercise (61%). Findings from a systematic review provide moderate evidence suggesting that a previous period of NP is a prognostic factor for both recovery and non-recovery outcomes [ 36 ]. Furthermore, previous studies highlight the positive impact of physical activity on facilitating quick and early recovery from NP [ 37 , 38 ]. Thus, individuals with a history of NP and LBP, along with being physically inactive, might experience a longer recovery period in the case of NP and LBP. The present results showed that sitting on a dynamic seat cushion designed to encourage postural shifts resulted in a full recovery rate of 100% from NP and LBP. Participants who experienced NP and LBP also reported a shorter median recovery duration (1 month) when compared to the control group (3 months). These findings are consistent with Akkarakittichoke's study [ 9 ], who demonstrated the effectiveness of automatically air-filled cushions in promoting postural shifts and facilitating recovery. Each postural shift during sitting has been reported to induce subcutaneous oxygen saturation in the tissue [ 21 ]. Ensuring an adequate number of postural shifts during sitting has the potential to reduce perceived musculoskeletal discomfort. In particular, implementing these shifts before the onset of tissue irritation or injury [ 23 ], might be beneficial to recovery from pain. Recovery appears to occur most rapidly in the first 6 to 12 weeks, with considerable slowing thereafter and little recovery after 12 months [ 38 ]. Therefore, utilizing a dynamic seat cushion encouraging postural shifts early at the first sign of pain may facilitate a more rapid recovery period. Our results indicated a statistically significant correlation between the intensity and recovery duration of NP and LBP, meaning that higher pain intensity is associated with a longer recovery period. It is plausible that the observed correlation between pain intensity and recovery duration may partly be influenced by the well-established connection between exercise and reduced pain sensitivity in healthy participants. According to Rojas-Galleguillos et al. (2024), increasing the frequency of exercise, eventually practicing daily, could potentially diminish the effects of exercise-induced hypoalgesia [ 39 ]. Sitting on a dynamic seat cushion that encourages postural movement is similar to engaging in light exercise shifts during sitting. 4.2 Recurrence of NP and LBP During the months following recovery, 75% of participants in the control group experienced a recurrence of NP and LBP. Our findings align with previous studies, which consistently demonstrate that a history of previous episodes of NP and LBP strongly predicts the recurrence of pain [ 40 , 41 ]. In our RCT study, we specifically focused on high-risk office workers with a history of NP and LBP. This targeted approach revealed a heightened recurrence of pain among the present study’s population. Additionally, the 1-year incidence of recurrence of NP and LBP varied from 33–69% [ 6 , 9 , 32 ]. This large variation may be attributable to differences in population studied and the criteria for defining recurrence. We specifically focused on office workers and defined the recurrence of NP and LBP as pain lasting at least 24 hours with an intensity over 30 mm on a 100-mm VAS, following a minimum of 30 days without pain, in accordance with the definition provided by Stanton et al. (2011) [ 31 ]. Contrastingly, de Silva et al. (2019) [ 6 ] and Machado et al. (2017) [ 32 ] studied the general population. Da Silva et al. (2019) [ 6 ] defined recurrence of LBP as an episode lasting at least 24 hours with a pain intensity greater than 2 on an 11-point numerical rating scale (NRS), following a period of at least 30 days without pain. Machado et al. (2017) [ 32 ] defined a recurrence as an episode of LBP that persisted for at least 24 hours after the onset of symptoms, with at least mild pain intensity, and followed a period of at least 30 days without pain (pain intensity of 0 or 1). When reviewing these definitions, we note that all studies agree on the criterion of pain returning for at least 24 hours after at least 30 days pain-free. The crucial difference lies in the threshold for pain intensity deemed to constitute a recurrence. Our findings indicate that among participants using dynamic seat cushions, only 27% experienced a recurrence of NP and LBP. While these results are potentially relevant, caution is warranted in their interpretation due to the lack of statistical significance. Therefore, the observed 50% reduction compared to the control group over a 6-month follow-up might be occurred by chance. Our results contrast with Akkarakittichoke et al.'s (2021) findings, who reported that a smart seat cushion, providing postural shifts, resulted in a notable 65% reduction in NP and LBP recurrence rates over the 12-month follow-up [ 9 ]. The observed differences might be attributed to variations in baseline characteristics and the nature of the postural shift intervention. In Akkarakittichoke et al.'s (2021) study, participants were younger and had a habitual tendency to exercise occasionally, while our study involved older participants who almost never engaged in physical exercise in their daily lives. Both of these factors pose a risk of recurrence for NP and LBP [ 41 , 42 ]. Moreover, in the previous study, postural shifts were induced by an external processor that calculated and automatically facilitated these shifts if the participant remained in a static posture for an prolonged period [ 20 ]. In contrast, participants in our study were required to initiate the postural shifts by themselves, as we did not employ a system to facilitate the movement. Moderate-quality evidence in systematic reviews indicates that targeted muscle exercise, such as strengthening the abdominal and pelvic regions, is effective for preventing recurrence of LBP [ 43 ], representing a form of direct prevention treatment. In contrast, the present study involves cushions that encourage postural shifts during sitting, resembling light exercise, which may serve as an indirect way to prevent the occurrence of NP and LBP, but may not directly prevent their recurrence. 4.3 Strengths and limitations Strengths of the present study are that it used data from a cluster RCT and that double-blinding occurred for both participants and assessors. However, it is crucial to consider several limitations when interpreting its results. First, the RCT study focused on high-risk healthy, primarily female office workers in the metropolitan area, which may limit the generalizability of the findings to other populations. Future studies should consider evaluating the effects of a dynamic seat cushion that encourages postural shift intervention on the recovery duration and recurrence of NP and LBP in different occupational settings and among patients with NP and LBP. Second, we performed a secondary analysis to investigate the effects of this intervention on the recovery duration and recurrence of NP and LBP for the 6-month follow-up. Although this is relatively long, it may not capture potential long-term effects or changes in the recurrence of NP and LBP beyond that period. Thus, future studies should investigate over a prolonged period, such as a 1-year follow-up or even longer than that. Last, although the recurrence rate was 27% in the intervention group and 75% in the control group, the difference did not reach statistical significance. Thus, further study with an expanded sample size may enhance proper statistical power and facilitate a more precise evaluation of the intervention's impact on recurrence rates. 5. Conclusion The present study showed that sitting on a dynamic seat cushion that encourages postural shifts improved recovery rate and duration of NP and LBP among office workers. Due to small numbers, however, a potentially relevant reduction of recurrence of NP and LBP could not be statistically confirmed. Declarations Ethics approval and consent to participate The study obtained approval from the research ethics review committee at Chulalongkorn University (COA No.015/2023) and is registered in the Thai Clinical Trials Registry (TCTR20230623002) at June 23 th 2023. All participants signed informed consent forms. Consent for publication Not applicable. This study contains no identifiable data of participants. Availability of data and materials The datasets used during the current study are available from the corresponding author (PJ) on reasonable request and after ethical permission. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper. The Research and Researchers for Industry Program (NRCT5-RRI63001-P01) and the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) provided financial support for this study. It is important to note that these sponsors did not interfere with the methodology, data collection, or data analysis of the study. However, it is worth mentioning that the cushion being studied is currently in the process of obtaining a patent. The patent ownership belongs to the National Research Council of Thailand (NRCT) and Chulalongkorn University. It is essential to clarify that the research team did and will not derive any benefits from this patent. Funding The funding sources of this research: Research and Researchers for Industry Program (NRCT5-RRI63001-P01), the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) and Huachiew Chalermprakiet University Fund. Authors' contributions The authors have contributed in the following ways: SC provided the concept/research design, data collection, data analysis and manuscript writing. AJvdB, ES and PJ contributed to the concept/research design, data analysis and manuscript writing. All authors read and approved the final manuscript. Acknowledgements The authors would like to acknowledge the funding source of this research: Research and Researchers for Industry Program (NRCT5-RRI63001-P01), the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) and Huachiew Chalermprakiet University Fund. Authors' information a Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand b Arbo Unie, Occupational Health Service, Nieuwegein, The Netherlands c Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands References GBD 2021 Other Musculoskeletal Disorders Collaborators: Global, regional, and national burden of other musculoskeletal disorders, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023, 5(11):e670-e682. https://doi.org/10.1016/S2665-9913(23)00232-1. GBD 2021 Other Musculoskeletal Disorders Collaborators: Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. 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Eur Spine J 2011, 20(1):9-18. https://dx.doi.org/ 10.1007/s00586-010-1477-8. Hadgraft NT, Healy GN, Owen N, Winkler EA, Lynch BM, Sethi P, Eakin EG, Moodie M, LaMontagne AD, Wiesner G et al: Office workers' objectively assessed total and prolonged sitting time: Individual-level correlates and worksite variations. Prev Med Rep 2016, 4:184-191. https://dx.doi.org/10.1016/j.pmedr.2016.06.011. Ehsani F, Mosallanezhad Z, Vahedi G: The Prevalence, Risk Factors and Consequences of Neck Pain in Office Employees. Middle East J Rehabil Health Stud 2017, 4(2):e42031. https://dx.doi.org/10.5812/mejrh.42031. Tanoue H, Mitsuhashi T, Sako S, Inaba R: An exploratory study on the impact of static and dynamic sitting postures on lumbar and pelvic mobility during visual display terminal work. J Phys Ther Sci 2021, 33(5):406-412. https://dx.doi.org/10.1589/jpts.33.406. Schäfer H, Schäfer R, Platen P: A novel motorized office chair causes low-amplitude spinal movements and activates trunk muscles: A cross-over trial. PLoS One 2023, 18(12):e0294778. https://dx.doi.org/10.1371/journal.pone.0294778. Elliott TL, Marshall KS, Lake DA, Wofford NH, Davies GJ: The Effect of Sitting on Stability Balls on Nonspecific Lower Back Pain, Disability, and Core Endurance: A Randomized Controlled Crossover Study. Spine (Phila Pa 1976) 2016, 41(18):E1074-1080. https://dx.doi.org/10.1097/brs.0000000000001576. Dickin DC, Surowiec RK, Wang H: Energy expenditure and muscular activation patterns through active sitting on compliant surfaces. Journal of Sport and Health Science 2017, 6(2):207-212. https://doi.org/10.1016/j.jshs.2015.10.004. Cardoso MR, Cardenas AK, Albert WJ: A biomechanical analysis of active vs static office chair designs. Appl Ergon 2021, 96:103481. https://dx.doi.org/10.1016/j.apergo.2021.103481. Waongenngarm P, van der Beek AJ, Akkarakittichoke N, Janwantanakul P: Effects of an active break and postural shift intervention on preventing neck and low-back pain among high-risk office workers: a 3-arm cluster-randomized controlled trial. Scand J Work Environ Health 2021, 47(4):306-317. https://dx.doi.org/10.5271/sjweh.3949. Reenalda J, Van Geffen P, Nederhand M, Jannink M, M IJ, Rietman H: Analysis of healthy sitting behavior: interface pressure distribution and subcutaneous tissue oxygenation. J Rehabil Res Dev 2009, 46(5):577-586. https://dx.doi.org/10.1682/jrrd.2008.12.0164. Fadil R, Hoffmann B, Lovelace S, Farahani B, Arzanpour S, Loscheider J, Aboonabi A, Tavakolian K: Design and evaluation of a dynamic air cushion for pressure ulcers prevention. J Tissue Viability 2022, 31(3):491-500. https://dx.doi.org/10.1016/j.jtv.2022.04.004. Akkarakittichoke N, Waongenngarm P, Janwantanakul P: Effects of Postural Shifting Frequency on Perceived Musculoskeletal Discomfort During 1-Hour Sitting in Office Workers. J Manipulative Physiol Ther 2023, 46(2):76-85. https://dx.doi.org/10.1016/j.jmpt.2023.06.003. Paksaichol A, Janwantanakul P, Lawsirirat C: Development of a neck pain risk score for predicting nonspecific neck pain with disability in office workers: a 1-year prospective cohort study. J Manipulative Physiol Ther 2014, 37(7):468-475. https://dx.doi.org/10.1016/j.jmpt.2014.07.004. Janwantanakul P, Sihawong R, Sitthipornvorakul E, Paksaichol A: A screening tool for non-specific low back pain with disability in office workers: a 1-year prospective cohort study. BMC musculoskeletal disorders 2015, 16:298-298. https://dx.doi.org/10.1186/s12891-015-0768-y. Bhuanantanondh P, Buchholz B, Arphorn S, Kongtip P, Woskie S: The Prevalence of and Risk Factors Associated with Musculoskeletal Disorders in Thai Oil Palm Harvesting Workers: A Cross-Sectional Study. Int J Environ Res Public Health 2021, 18(10). https://dx.doi.org/ Phakthongsuk P: Construct validity of the Thai version of the job content questionnaire in a large population of heterogeneous occupations. J Med Assoc Thai 2009, 92(4):564-572. https://dx.doi.org/10.3390/ijerph18105474. Uthaikhup S, Paungmali A, Pirunsan U: Validation of Thai versions of the Neck Disability Index and Neck Pain and Disability Scale in patients with neck pain. Spine (Phila Pa 1976) 2011, 36(21):E1415-1421. https://dx.doi.org/10.1097/BRS.0b013e31820e68ac. Wiangkham T, Phungwattanakul N, Thongbai N, Situy N, Polchaika T, Kongmee I, Thongnoi D, Chaisang R, Suwanmongkhon W: Translation, cross-cultural adaptation and psychometric validation of the Thai version of the STarT Back Screening Tool in patients with non-specific low back pain. BMC Musculoskelet Disord 2021, 22(1):454. https://dx.doi.org/10.1186/s12891-021-04347-w. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH: Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. Bmj 2008, 337(7662):a171. https://dx.doi.org/10.1136/bmj.a171. Stanton TR, Latimer J, Maher CG, Hancock MJ: A modified Delphi approach to standardize low back pain recurrence terminology. European Spine Journal 2011, 20(5):744-752. https://dx.doi.org/10.1007/s00586-010-1671-8. Machado GC, Maher CG, Ferreira PH, Latimer J, Koes BW, Steffens D, Ferreira ML: Can Recurrence After an Acute Episode of Low Back Pain Be Predicted? Physical Therapy 2017, 97(9):889-895. https://dx.doi.org/ Andridge RR, Little RJ: A Review of Hot Deck Imputation for Survey Non-response. Int Stat Rev 2010, 78(1):40-64. https://dx.doi.org/ Dudley WN, Wickham R, Coombs N: An introduction to survival statistics: Kaplan-Meier analysis. Journal of the advanced practitioner in oncology 2016, 7(1):91. https://dx.doi.org/10.1093/ptj/pzx067. Areerak K, van der Beek AJ, Janwantanakul P: Recovery from nonspecific neck pain in office workers. J Back Musculoskelet Rehabil 2018, 31(4):727-734. https://dx.doi.org/10.3233/bmr-170958. Verwoerd M, Wittink H, Maissan F, de Raaij E, Smeets RJEM: Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review. Musculoskeletal Science and Practice 2019, 42:13-37. https://doi.org/10.1016/j.msksp.2019.03.009. Palmlöf L, Holm LW, Alfredsson L, Magnusson C, Vingård E, Skillgate E: The impact of work related physical activity and leisure physical activity on the risk and prognosis of neck pain - a population based cohort study on workers. BMC Musculoskelet Disord 2016, 17:219. https://dx.doi.org/10.1186/s12891-016-1080-1. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK: Neck Pain: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy 2017, 47(7):A1-A83. https://dx.doi.org/10.2519/jospt.2017.0302. Rojas-Galleguillos F, Clark-Hormazábal C, Méndez-Fuentes E, Guede-Rojas F, Mendoza C, Riveros Valdés A, Carvajal-Parodi C: Exercise-induced hypoalgesia in chronic neck pain: A narrative review. Sports Medicine and Health Science 2024, 6(1):37-47. https://doi.org/10.1016/j.smhs.2023.09.011. da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ: Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther 2017, 47(5):305-313. https://dx.doi.org/10.2519/jospt.2017.7415. Langenfeld A, Humphreys BK, Swanenburg J, Peterson CK: Prognostic factors for recurrences in neck pain patients up to 1 year after chiropractic care. J Manipulative Physiol Ther 2015, 38(7):458-464. https://dx.doi.org/10.1016/j.jmpt.2015.06.014. Baradaran Mahdavi S, Riahi R, Vahdatpour B, Kelishadi R: Association between sedentary behavior and low back pain; A systematic review and meta-analysis. Health Promot Perspect 2021, 11(4):393-410. https://dx.doi.org/10.34172/hpp.2021.50. Campos-Fumero A, Delclos GL, Douphrate DI, Felknor SA, Vargas-Prada S, Serra C, Coggon D, Gimeno Ruiz de Porras D: Low back pain among office workers in three Spanish-speaking countries: findings from the CUPID study. Inj Prev 2017, 23(3):158-164. https://dx.doi.org/10.1136/injuryprev-2016-042091. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Oct, 2024 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 15 May, 2024 Submission checks completed at journal 14 May, 2024 Editor assigned by journal 14 May, 2024 First submitted to journal 25 Apr, 2024 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. 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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-4324521","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":302734519,"identity":"420aa48f-fc62-48b3-9f84-db8449b7e6f4","order_by":0,"name":"Sirinant Channak","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Sirinant","middleName":"","lastName":"Channak","suffix":""},{"id":302734520,"identity":"4caf98d9-e557-499b-a607-261021183924","order_by":1,"name":"Erwin M. Speklé","email":"","orcid":"","institution":"Arbo Unie, Occupational Health Service","correspondingAuthor":false,"prefix":"","firstName":"Erwin","middleName":"M.","lastName":"Speklé","suffix":""},{"id":302734521,"identity":"4ee1d898-4bf4-42de-b453-5319b21fccc0","order_by":2,"name":"Allard J. Beek","email":"","orcid":"","institution":"Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam","correspondingAuthor":false,"prefix":"","firstName":"Allard","middleName":"J.","lastName":"Beek","suffix":""},{"id":302734522,"identity":"e2e5271a-4b23-4cd6-ae36-8bf68049bbd5","order_by":3,"name":"Prawit Janwantanakul","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIie3OsQrCMBCA4ZOAXQJdTxx8hZRCq1D1VVIKncTVxaEuuoiufQzBFxCEusS9Y106O0knMW0Ft5hRMP8SDu4jB2Ay/WocgNhAAYp27moQDqSX0MbKiAapV9lJl/j9c4m3Ciz3cs2QL2FgJ3ZWqMhoF3tYH+aJeYw8Ayc9EYupCBPg5Q3JqbRd6BzkYagm1qMhblqTJ0w1CG1/YShJuIbwKxlt6aLiMRIUM3cY7jBKz8RTEp9aR6cKgsjeCCe/P4LxfrMq1Ye1D0bvWS4T1f6HwOTLnslkMv1zL1v4O5W0LrxOAAAAAElFTkSuQmCC","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":true,"prefix":"","firstName":"Prawit","middleName":"","lastName":"Janwantanakul","suffix":""}],"badges":[],"createdAt":"2024-04-25 13:44:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4324521/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4324521/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-024-07947-4","type":"published","date":"2024-10-25T15:57:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57308241,"identity":"7b9f0321-7083-4cd1-ad69-c64f5494fcd3","added_by":"auto","created_at":"2024-05-29 02:24:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":275990,"visible":true,"origin":"","legend":"\u003cp\u003eConsolidated Standards of Reporting Trials (CONSORT) flowchart of the study\u003c/p\u003e","description":"","filename":"floatimage1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4324521/v1/93276f76fea501ed56f91e7d.jpg"},{"id":57308239,"identity":"c3e52758-32fb-4f8f-86c9-ba86bdbae446","added_by":"auto","created_at":"2024-05-29 02:24:54","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":75495,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curves for recovery duration from neck and/or low back pain.\u003c/p\u003e","description":"","filename":"floatimage2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4324521/v1/7581a150923b2ede42ccec45.jpg"},{"id":57308566,"identity":"23893420-7a02-4cc2-ab54-a29be92dd3ba","added_by":"auto","created_at":"2024-05-29 02:32:54","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":342880,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curves for recurrence of neck and/or low back pain\u003c/p\u003e","description":"","filename":"floatimage3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4324521/v1/b503ee481ffccb6673981334.jpg"},{"id":67684125,"identity":"2a2f5f7e-52ee-48c3-897d-a9ded518579a","added_by":"auto","created_at":"2024-10-28 16:23:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1362906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4324521/v1/e4e3aa69-7d7f-4c6f-82e3-86e0227e4452.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDuring the past decades, neck pain (NP) and low back pain (LBP) have emerged as significant global health challenges, characterized by high prevalence and incidence rates, and years lived with disability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. By 2050, the estimated global number of NP cases is forecasted to increase by 32.5%, and LBP is expected to rise by 36.4% from 2020 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. NP and LBP often contribute to the development of other chronic pain conditions, becoming a major cause of sickness absenteeism, reduced work ability, decreased work productivity, and early retirement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although most individuals recover quickly from new episodes of NP and LBP, recurrence is common; over two-thirds experience a recurrence within one year after recovery, and almost half continue to experience persistent pain or frequent occurrences [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For instance, NP and LBP episodes among eldercare workers showed a consistently high four-weekly prevalence (between 61% and 72%), along with a high recurrence rate of pain, reaching 33% every four weeks [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A recent study with a 12-month follow-up period found that the recurrence rate of NP and LBP among office workers was 44% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. For recovery, a minimum duration of 30 days free of pain has been recommended, signifying the conclusion of an episode [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Recovery duration, however, varies widely, reflecting the diverse nature of recovery experiences [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. An earlier systematic review revealed a broad range in recovery duration from NP and LBP, spanning from 1 week up to 12 months [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, identifying effective interventions to reduce the development of chronic pain involves enabling a swift and complete recovery when pain occurs and preventing the recurrence of pain.\u003c/p\u003e \u003cp\u003eOffice workers spend a significant proportion of their time working in a sitting position, with more than half of them engaging in prolonged sitting (\u0026ge;\u0026thinsp;30 minutes) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Work-related prognostic factors for recurrence of NP and LBP include exposure to static posture, poor posture, sitting for a prolonged period, and history of NP and LBP [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Breaking up prolonged sitting with dynamic sitting has attributed to increased body movement during sitting [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], improved muscle performance [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and reduced perceived discomfort [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Recent studies indicate that using smart seat interventions, which promote postural shifts through automatic air pumping, can reduce new onset and recurrence of NP and LBP, as well as shorten the recovery time from pain among office workers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Postural shifts, identified through analysis of ischial tuberosity data considering both sagittal and frontal movements, revealed that each posture adjustment increased subcutaneous oxygen saturation by 2.2% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Movement facilitated by the air cushion enhances tissue blood perfusion and improves pressure distribution beneath the sitting area, possibly indicating a positive effect on tissue viability [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Additionally, a frequency of postural shifting 10 to 30 times per hour during sitting significantly reduced neck and lower back discomfort [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Therefore, we designed a portable dynamic seat cushion with a specific air volume that encourages postural shifts, targeting discomfort reduction for the neck and low back. The cushion also aims to facilitate trunk muscle activation, as observed earlier in a laboratory setting.\u003c/p\u003e \u003cp\u003eTo date, there is only one study that investigated the effects of an automatically air pumping seat cushion to encourage postural shifts during prolonged sitting, specifically examining interventions on recovery from and recurrence of NP and LBP in office workers. Therefore, this study aimed to investigate the impact of a portable dynamic air-filled seat cushion encouraging postural shifts on the duration of recovery from NP and LBP as well as to determine the efficacy of these interventions on the recurrence of NP and LBP among office workers who have recovered from NP and/or LBP.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis study used 6-month follow-up data of a randomized controlled trial (RCT), involving 66 office workers who reported pain in the trial. The study obtained approval from the research ethics review committee at Chulalongkorn University (COA No.015/2023) and is registered in the Thai Clinical Trials Registry (TCTR20230623002).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003e Office workers from seven organizations in the Bangkok area, Thailand, including the Court of Justice, two universities, and four private companies, participated in this study. Office workers were eligible to participate in the RCT study if they met the following criteria; a minimum of 5 years of experience in the current position at the office; an age range between 23\u0026ndash;55 years; a normal body mass index (BMI: 18.5\u0026ndash;22.9 kg/m\u003csup\u003e2\u003c/sup\u003e); at risk of non-specific NP as evaluated by the Neck Pain Risk Score for Office Workers (NROW; score\u0026thinsp;\u0026ge;\u0026thinsp;2) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]; and non-specific LBP as determined by the Back Pain Risk Score for Office Workers (BROW; score\u0026thinsp;\u0026ge;\u0026thinsp;53) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants were excluded if they met the following criteria; those who reported NP or LBP within the past 6 months; those exhibiting signs of neurological deficits (weakness or impaired/loss sensation); those with a history of trauma or accidents in the spinal region; those who had undergone spinal, abdominal, pelvic or thigh surgery within the past 12 months; those diagnosed with cancer, tumors, systemic lupus erythematosus, rheumatoid arthritis, gout, abnormalities of the spine, spinal infections, ankylosing spondylitis, scoliosis, spondylolisthesis, spondylosis, osteoporosis, osteoarthritis, or kidney disease; those with hemorrhoids, contusions, wounds, or keloid scar in the buttocks or posterior thigh region; those who reported pregnancy and planned within 6 months; or those engaged in regular exercise.\u003c/p\u003e \u003cp\u003eSeven organizations were randomly assigned at the cluster level by computer-generated randomization into intervention or control groups. Clusters of participants were located in the same organization to prevent contamination of the intervention and facilitate compliance within the group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Questionnaires\u003c/h2\u003e \u003cp\u003eAt baseline, eligible participants completed a self-administered questionnaire, including individual factors (age, gender, educational level, underlying health condition and medication intake, frequency of regular exercise, alcohol intake, and tobacco habits, and mode of transportation to work), work-related physical factors (working position, working hours and rest breaks, working experience, activities during work, ergonomic characteristics of workstations, and work environment conditions), and work-related psychosocial factors (measured by the Job Content Questionnaire-Thai version; JCQ-54 items) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] to gather exposure data.\u003c/p\u003e \u003cp\u003eParticipants recorded a self-diary, documenting the incidence of NP or LBP occurring over the month. Cases of NP and LBP were defined as reporting pain lasting more than 24 hours, pain intensity greater than 30/100 mm on the visual analog scale (VAS) and having no weakness or numbness in their body. Participants who reported as cases of pain were assessed for disability levels related to NP using the Neck Disability Index (NDI-10 items) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and for LBP using the Roland-Morris Low Back Disability Questionnaire (RMDQ-24 items) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Intervention\u003c/h2\u003e \u003cp\u003eAll participants had their hip breadth measured by a physical therapist, while sitting on a stool, to determine the cushion size that matches the individual's hip breadth. In the control group, participants received a placebo seat cushion made of polypropylene foam, similar to the material of the seat pan of the office chair. In the intervention group, participants received an air-filled dynamic seat cushion. Through repetitive testing in the laboratory, this dynamic seat cushion, which is round in size and filled with appropriate air, appeared to be optimal for facilitating postural shifts targeting health benefits and providing greater back muscle activation compared to a standard office chair, all while maintaining comfort. Participants in the intervention group received instructions on how to move and maintain their posture on the cushion. Practical training was conducted over two weeks before data collection to minimize the risk of injury associated with using the dynamic seat cushion.\u003c/p\u003e \u003cp\u003eAfter participants in both groups received the cushion or seat pad, the researcher (SC) adjusted the computer workstation and office chair by placing the cushion on top of the seat. These adjustments followed standard guidelines, with minor individual modifications made to ensure the comfort of each participant. Throughout 6-month follow up, participants in both groups were asked to use the cushion for the entire working day and received a notification message to remind them to use it in the morning. All participants were instructed to strictly follow the group instructions, maintained their physical activity levels, and refrained from adding other exercises for a 6-month period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Outcome measurement\u003c/h2\u003e \u003cp\u003eOutcomes were recovery duration and recurrence of NP and LBP during the 6-month period. Recovery duration from NP and LBP was defined as the time (in months) taken to achieve complete recovery, being pain-free (VAS\u0026thinsp;=\u0026thinsp;0), with no disability (NDI\u0026thinsp;=\u0026thinsp;0 or RMDQ\u0026thinsp;=\u0026thinsp;0), sustained for a continuous month [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Recurrence of NP and LBP was defined as a return to NP or LBP lasting at least 24 hours with a pain intensity of more than 30 mm on a 100-mm VAS without weakness and loss/impaired sensation, following at least 30 days without pain [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The recurrent rate of NP or LBP was calculated by dividing the number of participants with a recurrence by the total number of participants who recovered fully [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS software (version 29.0 for Windows, SPSS Inc., Chicago, IL, USA). The baseline characteristics of participants, both between the intervention and control groups and among those reporting pain, were assessed using the independent t-test for continuous variables and the chi-square (Χ\u003csup\u003e2\u003c/sup\u003e) test for nominal and ordinal variables. The analysis, adopting an intention-to-treat approach, utilized hot-deck imputation to handle missing data, which were replaced with observed values from a randomly selected respondent within the study [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 6-month recovery duration and recurrence of NP and LBP were calculated for each group. The follow-up data for individuals initially identified as recovered or recurrent cases were not further used in the analysis.\u003c/p\u003e \u003cp\u003eKaplan\u0026ndash;Meier survival curves were employed to measure the median duration to recovery and cases with recurrent NP and LBP. The curves were also used to compare the intervention and control groups using the log-rank test. If participants were lost to follow-up, their data were censored at the midpoint between the last completed follow-up and the next scheduled follow-up time, handling the uncertainty of the exact event time [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Participants not recovered after 6 months were censored at this point.\u003c/p\u003e \u003cp\u003eThe Cox proportional hazards model was used to calculate hazard ratios (HR) for both recovery duration and recurrent cases of NP and LBP. The possible covariates, 41 factors, were individually assessed in multivariate models. If a tested covariate resulted in a change greater than or equal to 0.05 in the HR of the intervention variable, then it was included in the final adjusted model. Additionally, the relationship between NP and LBP intensities and recovery duration was examined using Pearson correlation coefficients.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eOne hundred and thirty-two participants were successfully followed for 6 months (99.3%), and only one participant (0.8%) was lost to follow-up because of pregnancy (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In both groups, there were no reported adverse events or harm throughout the follow-up period. Sixty-six out of 133 office workers reported pain; 20 participants reported NP, 13 participants reported LBP, and 33 participants reported NP and LBP during the 6-month period.\u003c/p\u003e \u003cp\u003eAt baseline, there was no significant difference between the intervention and control groups except for gender, work experience, job control, physical job demand, and social support. For those reporting neck and/or low back pain, there was no significant difference between the intervention and control groups except for hip breadth, smoking, job control, and hazard at work (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \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\u003eCharacteristics of office workers at baseline (n\u0026thinsp;=\u0026thinsp;133) and those reporting neck and/or low back pain during follow-up (n\u0026thinsp;=\u0026thinsp;66).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBaseline Characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value (Baseline comparison)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value (Case comparison)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline (N\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBaseline (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCase (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.0 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.9 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.5 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.6 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender: female (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.2 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.8 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.8 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Breath (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.3 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.5 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.38 (0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.86 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;Bachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;Bachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eExercise frequency in the past 12 months (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork-related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.4 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.2 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.0 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.9 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking hours per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.6 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.3 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRest time per day (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.2 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.0 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.5 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.2 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychosocial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.8 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.6 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.7 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological job demands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.3 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.7 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.9 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical job demands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.1 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.8 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.4 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob security\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.9 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.5 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.5 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.5 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.6 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.0 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHazards at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.8 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.0 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01*\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*P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Recovery duration from NP and LBP\u003c/h2\u003e \u003cp\u003eDuring the 6-month follow-up, 100% (15/15) of participants in the intervention group and 86% (44/51) in the control group reported full recovery from their neck and/or low back pain, with those who experienced neck and/or low back pain reporting a median recovery duration of two months (range: 1\u0026ndash;5 months). The median duration of recovery from NP and LBP was one months in the intervention group and three months in the control group. Significant differences in recovery duration were found between the intervention and control groups (log-rank test χ\u003csup\u003e2\u003c/sup\u003e\u003csub\u003e(1)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;26.51, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The adjusted Cox proportional hazard model indicated a statistically significant difference between the intervention and control group in recovery duration from neck and/or low back pain (HR\u003csub\u003eadj\u003c/sub\u003e 4.35, 95% CI 1.87\u0026ndash;10.11; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A significant correlation was found between NP and LBP intensity and recovery duration (r\u0026thinsp;=\u0026thinsp;0.6; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); higher pain intensity indicated a longer recovery duration.\u003c/p\u003e \u003cp\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\u003eUnadjusted and adjusted hazard rates (HR) evaluating the effects of intervention on recovery duration from and recurrence of neck and low back pain (n\u0026thinsp;=\u0026thinsp;66).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.52 (2.20\u0026ndash;9.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.35 (1.87\u0026ndash;10.11) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.47 (0.17\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50 (0.11\u0026ndash;2.12) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.36\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* P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Variables; age, gender, body mass index, hip breath, education level, smoking, work experience, changing position during work, psychological job demand, physical job demand, job security.\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003e Variables; body mass index, education level, underlying, work experience, prolonged sitting, computer workstation suitability, using the energy-saving device, physical job demand.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Recurrence of NP and LBP\u003c/h2\u003e \u003cp\u003eDuring the 6-month follow-up, 27% (4/15) of participants in the intervention group and 75% (38/51) in the control group reported recurrence of neck and/or low back pain. Participants who reported neck and/or low back pain indicated that the recurrence duration for NP and LBP took a median time of five months (range: 3\u0026ndash;6 months). Significant differences in recurrence duration were found between the intervention and control groups (log-rank test χ2\u003csub\u003e(1)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;4.27, p\u0026thinsp;=\u0026thinsp;0.039) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The adjusted Cox proportional hazard model, however, indicated no statistically significant difference between the intervention and control group in recurrence of neck and/or low back pain (HR\u003csub\u003eadj\u003c/sub\u003e 0.50, 95% CI\u0026thinsp;=\u0026thinsp;0.11\u0026ndash;2.12; p\u0026thinsp;=\u0026thinsp;0.36) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe present study suggests that among office workers sitting on a dynamic seat cushion that encourages postural shifts can enhance the rate of full recovery and shorten duration for recovery from NP and LBP. The recurrent rate of NP and LBP was 27% in the intervention group, with\u003c/p\u003e \u003cp\u003ethe dynamic seat cushion, and 75% in the control group. Due to small numbers, however, this potentially relevant reduction in recurrence of NP and LBP could not be statistically confirm\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Recovery duration from NP and LBP\u003c/h2\u003e \u003cp\u003eParticipants in the control group reported a full recovery rate of 86% from NP and LBP, which aligns with previous study investigating active break and postural shift interventions in office workers (89%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the present findings indicate that individuals with NP and LBP had a median recovery duration of 3 months, which is greater than the durations reported in a previous study among office workers (2 months) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This disparity may be attributed to variations in participant characteristics. In our RCT study, all participants were high-risk office workers with a history of NP, and over 90% reported no exercise habits. In contrast, Areerak's study included participants with a lower proportion reporting a history of NP (68%) and a higher percentage engaging in occasional exercise (61%). Findings from a systematic review provide moderate evidence suggesting that a previous period of NP is a prognostic factor for both recovery and non-recovery outcomes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Furthermore, previous studies highlight the positive impact of physical activity on facilitating quick and early recovery from NP [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Thus, individuals with a history of NP and LBP, along with being physically inactive, might experience a longer recovery period in the case of NP and LBP.\u003c/p\u003e \u003cp\u003eThe present results showed that sitting on a dynamic seat cushion designed to encourage postural shifts resulted in a full recovery rate of 100% from NP and LBP. Participants who experienced NP and LBP also reported a shorter median recovery duration (1 month) when compared to the control group (3 months). These findings are consistent with Akkarakittichoke's study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], who demonstrated the effectiveness of automatically air-filled cushions in promoting postural shifts and facilitating recovery. Each postural shift during sitting has been reported to induce subcutaneous oxygen saturation in the tissue [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Ensuring an adequate number of postural shifts during sitting has the potential to reduce perceived musculoskeletal discomfort. In particular, implementing these shifts before the onset of tissue irritation or injury [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], might be beneficial to recovery from pain. Recovery appears to occur most rapidly in the first 6 to 12 weeks, with considerable slowing thereafter and little recovery after 12 months [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Therefore, utilizing a dynamic seat cushion encouraging postural shifts early at the first sign of pain may facilitate a more rapid recovery period.\u003c/p\u003e \u003cp\u003eOur results indicated a statistically significant correlation between the intensity and recovery duration of NP and LBP, meaning that higher pain intensity is associated with a longer recovery period. It is plausible that the observed correlation between pain intensity and recovery duration may partly be influenced by the well-established connection between exercise and reduced pain sensitivity in healthy participants. According to Rojas-Galleguillos et al. (2024), increasing the frequency of exercise, eventually practicing daily, could potentially diminish the effects of exercise-induced hypoalgesia [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Sitting on a dynamic seat cushion that encourages postural movement is similar to engaging in light exercise shifts during sitting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Recurrence of NP and LBP\u003c/h2\u003e \u003cp\u003eDuring the months following recovery, 75% of participants in the control group experienced a recurrence of NP and LBP. Our findings align with previous studies, which consistently demonstrate that a history of previous episodes of NP and LBP strongly predicts the recurrence of pain [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In our RCT study, we specifically focused on high-risk office workers with a history of NP and LBP. This targeted approach revealed a heightened recurrence of pain among the present study\u0026rsquo;s population. Additionally, the 1-year incidence of recurrence of NP and LBP varied from 33\u0026ndash;69% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This large variation may be attributable to differences in population studied and the criteria for defining recurrence. We specifically focused on office workers and defined the recurrence of NP and LBP as pain lasting at least 24 hours with an intensity over 30 mm on a 100-mm VAS, following a minimum of 30 days without pain, in accordance with the definition provided by Stanton et al. (2011) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Contrastingly, de Silva et al. (2019) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and Machado et al. (2017) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] studied the general population. Da Silva et al. (2019) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] defined recurrence of LBP as an episode lasting at least 24 hours with a pain intensity greater than 2 on an 11-point numerical rating scale (NRS), following a period of at least 30 days without pain. Machado et al. (2017) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] defined a recurrence as an episode of LBP that persisted for at least 24 hours after the onset of symptoms, with at least mild pain intensity, and followed a period of at least 30 days without pain (pain intensity of 0 or 1). When reviewing these definitions, we note that all studies agree on the criterion of pain returning for at least 24 hours after at least 30 days pain-free. The crucial difference lies in the threshold for pain intensity deemed to constitute a recurrence.\u003c/p\u003e \u003cp\u003eOur findings indicate that among participants using dynamic seat cushions, only 27% experienced a recurrence of NP and LBP. While these results are potentially relevant, caution is warranted in their interpretation due to the lack of statistical significance. Therefore, the observed 50% reduction compared to the control group over a 6-month follow-up might be occurred by chance. Our results contrast with Akkarakittichoke et al.'s (2021) findings, who reported that a smart seat cushion, providing postural shifts, resulted in a notable 65% reduction in NP and LBP recurrence rates over the 12-month follow-up [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The observed differences might be attributed to variations in baseline characteristics and the nature of the postural shift intervention. In Akkarakittichoke et al.'s (2021) study, participants were younger and had a habitual tendency to exercise occasionally, while our study involved older participants who almost never engaged in physical exercise in their daily lives. Both of these factors pose a risk of recurrence for NP and LBP [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Moreover, in the previous study, postural shifts were induced by an external processor that calculated and automatically facilitated these shifts if the participant remained in a static posture for an prolonged period [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In contrast, participants in our study were required to initiate the postural shifts by themselves, as we did not employ a system to facilitate the movement. Moderate-quality evidence in systematic reviews indicates that targeted muscle exercise, such as strengthening the abdominal and pelvic regions, is effective for preventing recurrence of LBP [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], representing a form of direct prevention treatment. In contrast, the present study involves cushions that encourage postural shifts during sitting, resembling light exercise, which may serve as an indirect way to prevent the occurrence of NP and LBP, but may not directly prevent their recurrence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Strengths and limitations\u003c/h2\u003e \u003cp\u003eStrengths of the present study are that it used data from a cluster RCT and that double-blinding occurred for both participants and assessors. However, it is crucial to consider several limitations when interpreting its results. First, the RCT study focused on high-risk healthy, primarily female office workers in the metropolitan area, which may limit the generalizability of the findings to other populations. Future studies should consider evaluating the effects of a dynamic seat cushion that encourages postural shift intervention on the recovery duration and recurrence of NP and LBP in different occupational settings and among patients with NP and LBP. Second, we performed a secondary analysis to investigate the effects of this intervention on the recovery duration and recurrence of NP and LBP for the 6-month follow-up. Although this is relatively long, it may not capture potential long-term effects or changes in the recurrence of NP and LBP beyond that period. Thus, future studies should investigate over a prolonged period, such as a 1-year follow-up or even longer than that. Last, although the recurrence rate was 27% in the intervention group and 75% in the control group, the difference did not reach statistical significance. Thus, further study with an expanded sample size may enhance proper statistical power and facilitate a more precise evaluation of the intervention's impact on recurrence rates.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe present study showed that sitting on a dynamic seat cushion that encourages postural shifts improved recovery rate and duration of NP and LBP among office workers. Due to small numbers, however, a potentially relevant reduction of recurrence of NP and LBP could not be statistically confirmed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study obtained approval from the research ethics review committee at Chulalongkorn University (COA No.015/2023) and is registered in the Thai Clinical Trials Registry (TCTR20230623002) at June 23\u003csup\u003eth\u003c/sup\u003e 2023. All participants signed informed consent forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study contains no identifiable data of participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author (PJ) on reasonable request and after ethical permission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper. The Research and Researchers for Industry Program (NRCT5-RRI63001-P01) and the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) provided financial support for this study. It is important to note that these sponsors did not interfere with the methodology, data collection, or data analysis of the study. However, it is worth mentioning that the cushion being studied is currently in the process of obtaining a patent. The patent ownership belongs to the National Research Council of Thailand (NRCT) and Chulalongkorn University. It is essential to clarify that the research team did and will not derive any benefits from this patent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funding sources of this research: Research and Researchers for Industry Program (NRCT5-RRI63001-P01), the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) and Huachiew Chalermprakiet University Fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have contributed in the following ways: SC provided the concept/research design, data collection, data analysis and manuscript writing. AJvdB, ES and PJ contributed to the concept/research design, data analysis and manuscript writing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the funding source of this research: Research and Researchers for Industry Program (NRCT5-RRI63001-P01), the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) and Huachiew Chalermprakiet University Fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eDepartment of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u0026nbsp;\u003c/sup\u003eArbo Unie, Occupational Health Service, Nieuwegein, The Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u0026nbsp;\u003c/sup\u003eDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGBD 2021 Other Musculoskeletal Disorders Collaborators: Global, regional, and national burden of other musculoskeletal disorders, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023, 5(11):e670-e682. https://doi.org/10.1016/S2665-9913(23)00232-1. \u003c/li\u003e\n\u003cli\u003eGBD 2021 Other Musculoskeletal Disorders Collaborators: Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. 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Spine 2014, 39(15):1243-1253. https://dx.doi.org/ 10.1097/brs.0000000000000387. \u003c/li\u003e\n\u003cli\u003eda Silva T, Mills K, Brown BT, Pocovi N, de Campos T, Maher C, Hancock MJ: Recurrence of low back pain is common: a prospective inception cohort study. J Physiother 2019, 65(3):159-165. https://dx.doi.org/ 10.1016/j.jphys.2019.04.010.\u003c/li\u003e\n\u003cli\u003eCohen SP: Epidemiology, diagnosis, and treatment of neck pain. In: Mayo Clinic Proceedings: 2015: Elsevier; 2015: 284-299. https://dx.doi.org/ 10.1016/j.mayocp.2014.09.008.\u003c/li\u003e\n\u003cli\u003eDiana N\u0026oslash;rregaard Rasmussen C, Karstad K, S\u0026oslash;gaard K, Rugulies R, Burdorf A, Holtermann A: Patterns in the Occurrence and Duration of Musculoskeletal Pain and Interference with Work among Eldercare Workers-A One-Year Longitudinal Study with Measurements Every Four Weeks. 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Phys Ther 2016, 96(6):797-807. https://dx.doi.org/ 10.2522/ptj.20150229.\u003c/li\u003e\n\u003cli\u003eKamper SJ, Stanton TR, Williams CM, Maher CG, Hush JM: How is recovery from low back pain measured? A systematic review of the literature. Eur Spine J 2011, 20(1):9-18. https://dx.doi.org/ 10.1007/s00586-010-1477-8.\u003c/li\u003e\n\u003cli\u003eHadgraft NT, Healy GN, Owen N, Winkler EA, Lynch BM, Sethi P, Eakin EG, Moodie M, LaMontagne AD, Wiesner G et al: Office workers\u0026apos; objectively assessed total and prolonged sitting time: Individual-level correlates and worksite variations. Prev Med Rep 2016, 4:184-191. https://dx.doi.org/10.1016/j.pmedr.2016.06.011.\u003c/li\u003e\n\u003cli\u003eEhsani F, Mosallanezhad Z, Vahedi G: The Prevalence, Risk Factors and Consequences of Neck Pain in Office Employees. 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J Manipulative Physiol Ther 2023, 46(2):76-85. https://dx.doi.org/10.1016/j.jmpt.2023.06.003.\u003c/li\u003e\n\u003cli\u003ePaksaichol A, Janwantanakul P, Lawsirirat C: Development of a neck pain risk score for predicting nonspecific neck pain with disability in office workers: a 1-year prospective cohort study. J Manipulative Physiol Ther 2014, 37(7):468-475. https://dx.doi.org/10.1016/j.jmpt.2014.07.004.\u003c/li\u003e\n\u003cli\u003eJanwantanakul P, Sihawong R, Sitthipornvorakul E, Paksaichol A: A screening tool for non-specific low back pain with disability in office workers: a 1-year prospective cohort study. BMC musculoskeletal disorders 2015, 16:298-298. https://dx.doi.org/10.1186/s12891-015-0768-y.\u003c/li\u003e\n\u003cli\u003eBhuanantanondh P, Buchholz B, Arphorn S, Kongtip P, Woskie S: The Prevalence of and Risk Factors Associated with Musculoskeletal Disorders in Thai Oil Palm Harvesting Workers: A Cross-Sectional Study. Int J Environ Res Public Health 2021, 18(10). https://dx.doi.org/\u003c/li\u003e\n\u003cli\u003ePhakthongsuk P: Construct validity of the Thai version of the job content questionnaire in a large population of heterogeneous occupations. J Med Assoc Thai 2009, 92(4):564-572. https://dx.doi.org/10.3390/ijerph18105474.\u003c/li\u003e\n\u003cli\u003eUthaikhup S, Paungmali A, Pirunsan U: Validation of Thai versions of the Neck Disability Index and Neck Pain and Disability Scale in patients with neck pain. Spine (Phila Pa 1976) 2011, 36(21):E1415-1421. https://dx.doi.org/10.1097/BRS.0b013e31820e68ac.\u003c/li\u003e\n\u003cli\u003eWiangkham T, Phungwattanakul N, Thongbai N, Situy N, Polchaika T, Kongmee I, Thongnoi D, Chaisang R, Suwanmongkhon W: Translation, cross-cultural adaptation and psychometric validation of the Thai version of the STarT Back Screening Tool in patients with non-specific low back pain. 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Int Stat Rev 2010, 78(1):40-64. https://dx.doi.org/\u003c/li\u003e\n\u003cli\u003eDudley WN, Wickham R, Coombs N: An introduction to survival statistics: Kaplan-Meier analysis. Journal of the advanced practitioner in oncology 2016, 7(1):91. https://dx.doi.org/10.1093/ptj/pzx067.\u003c/li\u003e\n\u003cli\u003eAreerak K, van der Beek AJ, Janwantanakul P: Recovery from nonspecific neck pain in office workers. J Back Musculoskelet Rehabil 2018, 31(4):727-734. https://dx.doi.org/10.3233/bmr-170958.\u003c/li\u003e\n\u003cli\u003eVerwoerd M, Wittink H, Maissan F, de Raaij E, Smeets RJEM: Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review. Musculoskeletal Science and Practice 2019, 42:13-37. https://doi.org/10.1016/j.msksp.2019.03.009.\u003c/li\u003e\n\u003cli\u003ePalml\u0026ouml;f L, Holm LW, Alfredsson L, Magnusson C, Ving\u0026aring;rd E, Skillgate E: The impact of work related physical activity and leisure physical activity on the risk and prognosis of neck pain - a population based cohort study on workers. BMC Musculoskelet Disord 2016, 17:219. https://dx.doi.org/10.1186/s12891-016-1080-1.\u003c/li\u003e\n\u003cli\u003eBlanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK: Neck Pain: Revision 2017. Journal of Orthopaedic \u0026amp; Sports Physical Therapy 2017, 47(7):A1-A83. https://dx.doi.org/10.2519/jospt.2017.0302.\u003c/li\u003e\n\u003cli\u003eRojas-Galleguillos F, Clark-Hormaz\u0026aacute;bal C, M\u0026eacute;ndez-Fuentes E, Guede-Rojas F, Mendoza C, Riveros Vald\u0026eacute;s A, Carvajal-Parodi C: Exercise-induced hypoalgesia in chronic neck pain: A narrative review. Sports Medicine and Health Science 2024, 6(1):37-47. https://doi.org/10.1016/j.smhs.2023.09.011.\u003c/li\u003e\n\u003cli\u003eda Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ: Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther 2017, 47(5):305-313. https://dx.doi.org/10.2519/jospt.2017.7415.\u003c/li\u003e\n\u003cli\u003eLangenfeld A, Humphreys BK, Swanenburg J, Peterson CK: Prognostic factors for recurrences in neck pain patients up to 1 year after chiropractic care. J Manipulative Physiol Ther 2015, 38(7):458-464. https://dx.doi.org/10.1016/j.jmpt.2015.06.014.\u003c/li\u003e\n\u003cli\u003eBaradaran Mahdavi S, Riahi R, Vahdatpour B, Kelishadi R: Association between sedentary behavior and low back pain; A systematic review and meta-analysis. Health Promot Perspect 2021, 11(4):393-410. https://dx.doi.org/10.34172/hpp.2021.50.\u003c/li\u003e\n\u003cli\u003eCampos-Fumero A, Delclos GL, Douphrate DI, Felknor SA, Vargas-Prada S, Serra C, Coggon D, Gimeno Ruiz de Porras D: Low back pain among office workers in three Spanish-speaking countries: findings from the CUPID study. Inj Prev 2017, 23(3):158-164. https://dx.doi.org/10.1136/injuryprev-2016-042091.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"dynamic sitting, postural shift, office worker","lastPublishedDoi":"10.21203/rs.3.rs-4324521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4324521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eNeck and low back pain are prevalent issues among office workers due to prolonged sitting, necessitating effective interventions. Dynamic seat cushion, designed to promote postural shifts have emerged as promising solutions to address these concern. This study aims to evaluate the effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study used 6-month follow-up data of a randomized controlled trial, involving 66 office workers who reported pain in the trial. At baseline, participants were cluster-randomized into an intervention group, which received a dynamic seat cushion designed to encourage postural shifts, or a control group, which received a placebo seat pad. Health outcomes included recovery duration and recurrence of pain. Analyses utilized log rank test and Cox proportional hazard models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In the intervention group, the recovery rate from neck and low back pain was 100%, which was 86% for the control group. The median recovery duration in the intervention group (1 month) was two months shorter than in the control group (3 months). The intervention group had a higher probability of recovery compared to the control group (HR\u003csub\u003eadj\u003c/sub\u003e 4.35, 95% CI 1.87 – 10.11; p \u0026lt; 0.01). The recurrence rate of neck and low back pain was 27% in the intervention group, which was 75% in the control group. The Hazard Ratio, after adjustment, for the intervention group compared to the control group was 0.50 (95% CI = 0.11 – 2.12).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eA dynamic seat cushion that encourages postural shifts shortened recovery duration of neck and low back pain among office workers. Due to small numbers, however, a potentially relevant reduction of recurrence of neck and low back pain could not be statistically confirmed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThai Clinical Trials Registry: \u003c/strong\u003eTCTR20230623002 (23/06/2023).\u003c/p\u003e","manuscriptTitle":"Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-29 02:24:50","doi":"10.21203/rs.3.rs-4324521/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-15T10:10:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-14T04:03:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-14T04:03:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-04-25T13:38:00+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":"37ad4d65-a2f0-41ec-8494-13ed4270e246","owner":[],"postedDate":"May 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:13:02+00:00","versionOfRecord":{"articleIdentity":"rs-4324521","link":"https://doi.org/10.1186/s12891-024-07947-4","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2024-10-25 15:57:18","publishedOnDateReadable":"October 25th, 2024"},"versionCreatedAt":"2024-05-29 02:24:50","video":"","vorDoi":"10.1186/s12891-024-07947-4","vorDoiUrl":"https://doi.org/10.1186/s12891-024-07947-4","workflowStages":[]},"version":"v1","identity":"rs-4324521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4324521","identity":"rs-4324521","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}