Werknemers met musculoskeletale pijn versterken door digitale gezondheidszorg

Musculoskeletal pain is a leading cause of work disability, affecting employees across various occupational sectors. While physical and psychosocial stressors at work are well-established risk factors, they do not fully explain why some employees develop persistent pain and take sick leave while others continue working. Maladaptive pain perceptions, such as fear-avoidance beliefs and pain catastrophizing, may play a key role, yet their interaction with workplace conditions remains poorly understood. Understanding these interactions is essential for identifying employees at risk of long-term disability and guiding the development of targeted interventions. At the same time, structural barriers limit access to timely and effective care. European legislation mandates periodic occupational health examinations based on risk exposure rather than individual health status, leading to gaps in monitoring and early intervention. Additionally, a growing shortage of healthcare providers further restricts access to specialized care, delaying necessary support for employees with musculoskeletal pain. In this context, mobile health (mHealth) technologies offer a scalable solution by providing convenient access to information, self-monitoring, and treatment options. However, few mHealth interventions are tailored to the unique challenges of employees, such as integrating pain management strategies into daily work routines. Research is needed to explore the potential benefits and requirements of mHealth interventions for working populations to ensure their effective adoption in practice. This dissertation addresses these gaps through two primary objectives. The first objective was to investigate the interaction between work-related factors and pain perceptions in identifying employees at risk of developing musculoskeletal pain and related sickness absence. Two cross-sectional studies demonstrated that maladaptive pain perceptions are independent predictors of musculoskeletal pain and work ability, interacting with workplace conditions to influence disability risk. Notably, job autonomy mitigated pain risk in employees with high fear of movement but increased pain risk in those with low fear. Similarly, workload negatively impacted work ability only in employees with high fear-avoidance beliefs, while social support did not improve work ability in these employees. A third cross-sectional study revealed distinct subgroups of employees, demonstrating that those with maladaptive pain perceptions exhibited the poorest work expectations, indicating heightened disability risk. The second objective focused on empowering employees with musculoskeletal pain through mHealth. An app-based pain management intervention was developed in collaboration with employees and healthcare professionals, and its feasibility and effectiveness were evaluated in a longitudinal pilot study. The intervention successfully reduced pain catastrophizing. However, its effects on fear-avoidance beliefs, pain intensity, and physical activity were limited. Key barriers to effectiveness included restrictive app features, non-personalized content, cognitive biases in user engagement, and non-supportive workplace environments. In summary, this dissertation highlights the critical role of maladaptive pain perceptions in musculoskeletal pain and work disability, demonstrating how these psychological factors interact with workplace conditions. Given the dynamic nature of these interactions, traditional one-time occupational health assessments may be insufficient. Instead, continuous monitoring through mHealth solutions offers a promising approach for detecting changes in pain perceptions and workplace support, enabling timely intervention before work disability occurs. Similarly, occupational interventions should integrate strategies that address maladaptive pain perceptions, as focusing solely on workplace conditions may be ineffective or even counterproductive. While mHealth solutions can support multidimensional treatment by helping employees reframe pain and increase awareness of activity habits, digital interventions alone are unlikely to sustain long-term work participation. Blended interventions that integrate digital tools with professional guidance and workplace policies appear to be the most promising direction for future development.