Workplace-Based Rehabilitation of Upper Limb Conditions: A Systematic Review

Abstract

Purpose The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes. Methods We searched Medline, Cochrane Library, Scopus, Web of Science, Academic Search Premier, Africa-Wide Information, CINAHL, OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Results Initial search located 1071 articles, of which 80 were full text reviewed. Twenty-eight articles were included, reporting on various outcomes relating to a total of seventeen studies. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n = 3), ergonomic training and workstation adjustments (n = 4), exercise and resistance training (n = 6), clinic-based versus workplace-based work hardening (n = 1), nurse case manager training (n = 1), physiotherapy versus Feldenkrais (n = 1), and ambulant myofeedback training (n = 1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusion While there is substantial evidence for workplace exercise programs, other workplace-based interventions require further high quality research. Systematic review registration PROSPERO CRD42017059708.

A Systematic Review of Workplace Interventions to Rehabilitate Musculoskeletal Disorders Among Employees with Physical Demanding Work

“…3 of 3 interventions from high or medium quality studies showed no effect of stress management leading to a strong level of evidence for no benefit for this interventional domain. This is in line with previous reviews on upper limb and back pain among the general working population and among nurses [13,14,17]. For instance, Van Hoof et al [14] found that stress management in isolation was not effective in nurses with and without low back pain and Van Eerd et al [13] found moderate evidence for no effect of job stress management training for the prevention of upper extremity MSDs and symptoms.…”

“…Specifically, outcome characteristics such as pain intensity, the prevalence of pain, symptoms, and discomfort were too broad to be matched or pooled and therefore lacked the comparability for a meaningful meta-analysis. This is also coherent with other reviews within the field of work-related interventions to reduce MSDs [13,16,17,23]. Instead, we employed the pre-planned best evidence synthesis approach developed by IWH, with the opportunity to provide practitioners with the requested evidence-based approach to better identify and implement more relevant and effective workplace solutions.…”

“…16 of 23 interventions supported the domain of workplace physical exercise, resulting in a moderate level of evidence. Previous reviews have found evidence for the use of workplace exercise (not specified) for workers with upper limb, neck or back conditions/pain [17,78] whereas others have not [14,20,79]. Kennedy et al [20] found mixed evidence for exercise as an occupational health and safety intervention in the prevention of upper extremity MSDs among workers in general.…”

“…Previous reviews on the general working population have both reported an effect, no effect and conflicting results of workplace ergonomics on MSD. Hoosain et al [17] found positive effects for the use of ergonomic controls, ergonomic training and workstation adjustments, although these intervention categories had few high-quality studies. In opposition, Verbeek et al [15] found no evidence available from RCTs for the effectiveness of manual material handling advice and training or manual material handling assistive devices for treating back pain.…”

“…The review also reported moderate evidence for the effect of stretching, mouse use feedback and forearm supports and moderate evidence for no effect of EMG biofeedback, job stress management training, and office workstation adjustment. Further, Hossain et al (2019) investigated the evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper-limb conditions also by including RCTs and non-RCTs along with the review process developed by the IWH [17]. They found that the largest body of evidence supported workplace physical exercise programs, but also reported positive effects for ergonomic training and workstation adjustments, and mixed-effects for ergonomic controls.…”