123 Eur Spine J (2008) 17 (Suppl 1): S60-S74 DOI 10.1007/s00586-008-0626-9 Reprinted with permission from Lippincott Williams & Wilkins, Côté P, van der Velde G, Cassidy JD, et al., The Burden and Determinants of Neck Pain in Workers, Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders, SPINE, Volume 33, Number 4S, pp S60–S74 The Burden and Determinants of Neck Pain in Workers Results of the Bone and Joint Decade 2000 –2010 Task Force on Neck Pain and Its Associated Disorders Pierre Co ˆte ´, DC, PhD,* Gabrielle van der Velde, DC,† J. David Cassidy, DC, PhD, DrMedSc,‡ Linda J. Carroll, PhD,§ Sheilah Hogg-Johnson, PhD,� Lena W. Holm, DrMedSc,** Eugene J. Carragee, MD, FACS,†† Scott Haldeman, DC, MD, PhD,‡‡ Margareta Nordin, PT, DrMedSc,§§ Eric L. Hurwitz, DC, PhD,�� Jaime Guzman, MD, MSc, FRCP(C),*** and Paul M. Peloso, MD, MSc, FRCP(C)††† Study Design. Systematic review and best evidence synthesis. Objectives. To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in workers; to propose an etiological diagram; and to make recommendations for future research. Summary of Background Data. Previous reviews of the etiology of neck pain in workers relied on cross-sec- tional evidence. Recently published cohorts and random- ized trials warrant a re-analysis of this body of research. Methods. We systematically searched Medline for liter- ature published from 1980 –2006. Retrieved articles were reviewed for relevance. Relevant articles were critically ap- praised. Articles judged to have adequate internal validity were included in our best evidence synthesis. Results. One hundred and nine papers on the burden and determinants of neck pain in workers were scientifi- cally admissible. The annual prevalence of neck pain var- ied from 27.1% in Norway to 47.8% in Que ´ bec, Canada. Each year, between 11% and 14.1% of workers were lim- ited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previ- ous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and pre- cision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor phys- ical work environment, and workers’ ethnicity may be associated with neck pain. There is evidence that inter- ventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers. Conclusion. Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors. No prevention strategies have been shown to reduce the incidence of neck pain in workers. Key words: neck pain, work, disability, sick leave, sys- tematic review, epidemiology, incidence, risk factors, eti- ology. For centuries the nature of work has influenced the health of populations. The economies of industrialized countries, which once depended on manufacturing and resource extraction jobs, now rely largely on the service sector for growth and prosperity. The shift from manu- facturing and resource-based jobs to the service industry has transformed the nature of work injuries and disabil- ity. The high rate of acute and fatal injuries observed in most countries at the beginning of the 20th century has been replaced by a sharp increase in the incidence of compensated musculoskeletal disorders such as back and neck pain. 1–4 This wave of musculoskeletal disorders has led workers, employers, unions, clinicians, insurers and policy-makers to ask 3 important questions: Is neck pain From the *Centre of Research Expertise in Improved Disability Out- comes (CREIDO), University Health Network Rehabilitation Solu- tions, Toronto Western Hospital, Toronto, Canada; Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada; Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Canada; Institute for Work & Health, Toronto, Canada; †Institute for Work & Health, Toronto, Canada; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Division of Health Care and Outcomes Research, Toronto Western Research In- stitute, Toronto, Canada; Centre of Research Excellence in Improved Disability Outcomes (CREIDO), University Health Network Rehabil- itation Solutions, Toronto Western Hospital, Toronto, Canada; ‡Cen- tre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada; Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada; Departments of Public Health Sciences and Health Policy, Manage- ment and Evaluation, University of Toronto, Canada; §Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Canada; �Institute for Work & Health, Toronto, Canada; Department of Public Health Sciences, University of Toronto, Canada; **Institute of Envi- ronmental Medicine, Karolinska Institutet, Stockholm, Sweden; ††De- partment of Orthopaedic Surgery, Stanford University School of Med- icine, USA; Orthopaedic Spine Center and Spinal Surgery Service, Stanford University Hospital and Clinics, USA; ‡‡Department of Neu- rology, University of California, Irvine, USA; Department of Epidemi- ology, School of Public Health, University of California, Los Angeles, CA; §§Departments of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, NY University, NY; Occupa- tional and Industrial Orthopaedic Center (OIOC), NY University Medical Center, NY; ��Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Ma � noa, Honolulu, HI, USA; ***Department of Medicine, University of British Columbia, Canada; Occupational Health and Safety Agency for Healthcare in BC, Canada; †††Endocrinology, Analgesia and Inflammation, Merck & Co. Rahway, NJ. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence to Pierre Co ˆ te ´, DC, PhD, Toronto Western Hospital, Fell Pavilion 4-124, 399 Bathurst Street, Toronto, ON M5T 2S8; E-mail: pcote@uhnresearch.ca