title: Evaluation of the efficacy of a short-course, personalized self-management and intensive spa therapy intervention as active prevention of musculoskeletal disorders of the upper extremities (Muska): a research protocol for a randomized controlled trial.
abstract: Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population, substantially impacting the quality of life of employees. They also cause considerable economic cost to the healthcare system, with, notably, the reimbursement of treatments and compensation for lost income. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although prevalence varies depending on the region considered and the method of assessment, a prevalence of 30% is found in different epidemiological studies. The disease needs to be prevented, not only for medical and economic reasons, but also for legal reasons, owing to the requirement of assessing occupational risks. The strategy envisaged may thus revolve around active, multimodal prevention that has employees fully involved at the heart of their care. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders.
  
  
  
  A prospective, multicenter, comparative (intervention arm vs. control arm), randomized (immediate vs. later treatment) study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities (UE-MSDs). Participants are workers aged between 18 and 65 years with latent or symptomatic MSDS, with any type of job or workstation, with or without an history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over usual care in the management of MSDs in terms of employee functional capacity in personal and professional daily life. Secondary aims are to assess the benefit of the intervention in terms of pain, quality of life, and accumulated duration of sick leave.
  
  
  
  This randomized controlled trial is the first that will aim to evaluate multidisciplinary management of UE-MSDs using nonpharmacological treatment combining exercise, self-management, and spa therapy. The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial has the potential to demonstrate, with a good level of evidence, the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity, pain, and quality of life of employees in their daily life.
  
  
  
  Clinical trial.gov NCT02702466 retrospectively registered.
  
  
  
  Version 4 of 9/10/2015.
authors.affiliation: Physical Medicine and Rehabilitation, University Hospital of Clermont-Ferrand (CHU), 58, rue de Montalembert, 63000, Clermont-Ferrand, France. lanhers.charlotte@gmail.com.|University of Clermont-Ferrand Auvergne, Auvergne University, 28, Place Henri-Dunant, 63000, Clermont-Ferrand, France. lanhers.charlotte@gmail.com.|Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France. lanhers.charlotte@gmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lanhers
authors.affiliation: Clinical Research and Innovation Direction, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Physical Medicine and Rehabilitation, University Hospital of Clermont-Ferrand (CHU), 58, rue de Montalembert, 63000, Clermont-Ferrand, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Gay
authors.affiliation: Physical Medicine and Rehabilitation, University of Montpellier 1, Hopital of Lapeyronie, CHRU Montpellier, 371 Av. du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Hérisson
authors.affiliation: Research and Development, Thermal Cure Center de Royat, 1 place Allard, CS 20053 Royat, 63408, Chamalières Cedex, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Levyckyj
authors.affiliation: Physical Medicine and Rehabilitation, Hospital of Caremeau, University of Montpellier 1, 30029 Cedex 09, Nîmes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dupeyron
authors.affiliation: Physical Medicine and Rehabilitation, University Hospital of Clermont-Ferrand (CHU), 58, rue de Montalembert, 63000, Clermont-Ferrand, France.|University of Clermont-Ferrand Auvergne, Auvergne University, 28, Place Henri-Dunant, 63000, Clermont-Ferrand, France.|INRA, Unity of Human Nutrition (UNH, UMR 1019), CRNH Auvergne, Clermont-Ferrand, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coudeyre
mesh_terms: D001452:Balneology / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D009784:Occupational Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D016272:Occupational Health / Q000191:economics; D057285:Precision Medicine / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design; D012648:Self Care / Q000379:methods*; D018582:Sick Leave / Q000706:statistics & numerical data; D013997:Time Factors; D034941:Upper Extremity
keywords: Exercise; Musculoskeletal disorders; Prevention; Spa therapy