Systematic reviews including this primary study

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Systematic review

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Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Journal Journal of occupational rehabilitation
Year 2014
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Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention (WDP) interventions in workers with neck pain, whiplash-associated disorders (WAD), or upper extremity disorders. Methods We searched electronic databases from 1990 to 2012. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized and synthesized following best-evidence synthesis methodology. Results Of the 6,359 articles retrieved, 16 randomized controlled trials were eligible for critical appraisal and five were admissible. We found that a return-to-work coordination program (including workplace-based work hardening) was superior to clinic-based work hardening for persistent rotator cuff tendinitis. Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain. Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints. Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms. Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers’ recovery from recent work-related neck and upper extremity complaints. Conclusions At present, no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain, WAD, and upper extremity disorders. Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening. Also, adding computer-prompted breaks to ergonomic and workplace interventions benefits workers’ recovery. The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions. © 2014, Springer Science+Business Media New York.

Systematic review

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Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults

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Journal Cochrane Database of Systematic Reviews
Year 2013
Links Pubmed DOI PubMed Central
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Background: Work-related upper limb disorder (WRULD), repetitive strain injury (RSI), occupational overuse syndrome (OOS) and work-related complaints of the arm, neck or shoulder (CANS) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements, awkward postures and impact of external forces such as those associated with operating vibrating tools. Work-related CANS, which is the term we use in this review, severely hampers the working population. Objectives: To assess the effects of conservative interventions for work-related complaints of the arm, neck or shoulder (CANS) in adults on pain, function and work-related outcomes. Search methods: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 31 May 2013), MEDLINE (1950 to 31 May 2013), EMBASE (1988 to 31 May 2013), CINAHL (1982 to 31 May 2013), AMED (1985 to 31 May 2013), PsycINFO (1806 to 31 May 2013), the Physiotherapy Evidence Database (PEDro; inception to 31 May 2013) and the Occupational Therapy Systematic Evaluation of Evidence Database (OTseeker; inception to 31 May 2013). We did not apply any language restrictions. Selection criteria: We included randomised controlled trials (RCTs) and quasi-randomised controlled trials evaluating conservative interventions for work-related complaints of the arm, neck or shoulder in adults. We excluded trials undertaken to test injections and surgery. We included studies that evaluated effects on pain, functional status or work ability. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of the included studies. When studies were sufficiently similar, we performed statistical pooling of reported results. Main results: We included 44 studies (62 publications) with 6,580 participants that evaluated 25 different interventions. We categorised these interventions according to their working mechanisms into exercises, ergonomics, behavioural and other interventions. Overall, we judged 35 studies as having a high risk of bias mainly because of an unknown randomisation procedure, lack of a concealed allocation procedure, unblinded trial participants or lack of an intention-to-treat analysis. We found very low-quality evidence showing that exercises did not improve pain in comparison with no treatment (five studies, standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -1.08 to 0.03), or minor intervention controls (three studies, SMD -0.25, 95% CI -0.87 to 0.37) or when provided as additional treatment (two studies, inconsistent results) at short-term follow-up or at long-term follow-up. Results were similar for recovery, disability and sick leave. Specific exercises led to increased pain at short-term follow-up when compared with general exercises (four studies, SMD 0.45, 95% CI 0.14 to 0.75) We found very low-quality evidence indicating that ergonomic interventions did not lead to a decrease in pain when compared with no intervention at short-term follow-up (three studies, SMD -0.07, 95% CI -0.36 to 0.22) but did decrease pain at long-term follow-up (four studies, SMD -0.76, 95% CI -1.35 to -0.16). There was no effect on disability but sick leave decreased in two studies (risk ratio (RR) 0.48, 95% CI 0.32 to 0.76). None of the ergonomic interventions was more beneficial for any outcome measures when compared with another treatment or with no treatment or with placebo. Behavioural interventions had inconsistent effects on pain and disability, with some subgroups showing benefit and others showing no significant improvement when compared with no treatment, minor intervention controls or other behavioural interventions. In the eight studies that evaluated various other interventions, there was no evidence of a clear beneficial effect of any of the interventions provided. Authors' conclusions: We found very low-quality evidence indicating that pain, recovery, disability and sick leave are similar after exercises when compared with no treatment, with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm, neck or shoulder. Low-quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up. There was no evidence of an effect on other outcomes. For behavioural and other interventions, there was no evidence of a consistent effect on any of the outcomes. Studies are needed that include more participants, that are clear about the diagnosis of work-relatedness and that report findings according to current guidelines. © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Systematic review

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Best practices in the rehabilitation of acute musculoskeletal disorders in workers with injuries: an integrative review and analysis of evolving trends.

Authors Lysaght R , Donnelly C , Luong D
Journal Work (Reading, Mass.)
Year 2010
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OBJECTIVE: Strategies for the restoration of function and job performance in workers with musculoskeletal disorders have changed considerably since industrial rehabilitation became a distinct specialization in the 1980s. A rich body of research concerning approaches to medical and rehabilitative management of these disorders exists, resulting in a large number of hybrid approaches worldwide. METHODS: This integrative review examined the evidence base for best practices in the rehabilitation of acute musculoskeletal workplace injuries, and also mapped the evolution of approaches over the past thirty years. Contextual factors that may have contributed to change were assessed through analysis of changing practice trends and review of descriptive literature over time. RESULTS: A clear movement away from simplistic, unidimensional approaches towards comprehensive workplace interventions is evident. Economic concerns and growing government and insurance regulation of workplace safety and injury management were the likely drivers of change. While the contributions of various elements of disability management in the workplace were examined, many features of onsite interventions remain to be examined. CONCLUSIONS: A strong body of research has produced notable advances in management of acute musculoskeletal workplace injury. Research concerning the delivery of workplace-based interventions, the role of workplace environment factors and a range of worker outcomes will further advance knowledge in this field.