Journal of Occupational Rehabilitation

, Volume 20, Issue 2, pp 127–162 | Cite as

Systematic Review of the Role of Occupational Health and Safety Interventions in the Prevention of Upper Extremity Musculoskeletal Symptoms, Signs, Disorders, Injuries, Claims and Lost Time

  • Carol A. KennedyEmail author
  • Benjamin C. Amick III
  • Jack T. Dennerlein
  • Shelley Brewer
  • Starly Catli
  • Renee Williams
  • Consol Serra
  • Fred Gerr
  • Emma Irvin
  • Quenby Mahood
  • Al Franzblau
  • Dwayne Van Eerd
  • Bradley Evanoff
  • David Rempel


Background Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries. Methods A systematic review used a best evidence synthesis approach to address the question: “do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?” Results The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with “no effect” were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with “negative effects”. Conclusion It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.


Upper extremity musculoskeletal disorders Occupational health and safety interventions Systematic review 



The authors wish to thank: Rachel Couban and Dan Shannon for obtaining bibliographic information and other materials; Kiera Keown and Katherine Russo for their editorial advice; and Shanti Raktoe for administrative support. Shelley Brewer was supported by an Occupational Injury Prevention Training Grant (T42 OH008421) from the National Institute for Occupational Safety and Health. This research was supported by funds provided by the Workplace Safety and Insurance Board of Ontario.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Carol A. Kennedy
    • 1
    • 2
    Email author
  • Benjamin C. Amick III
    • 1
    • 3
  • Jack T. Dennerlein
    • 4
  • Shelley Brewer
    • 5
  • Starly Catli
    • 6
  • Renee Williams
    • 7
  • Consol Serra
    • 8
    • 9
  • Fred Gerr
    • 10
  • Emma Irvin
    • 1
  • Quenby Mahood
    • 1
  • Al Franzblau
    • 11
  • Dwayne Van Eerd
    • 1
  • Bradley Evanoff
    • 12
  • David Rempel
    • 13
  1. 1.The Institute for Work & HealthTorontoCanada
  2. 2.Department of Physical TherapyUniversity of TorontoTorontoCanada
  3. 3.Southwest Center for Occupational and Environmental Health, School of Public HealthThe University of TexasHoustonUSA
  4. 4.Department of Environmental HealthHarvard UniversityBostonUSA
  5. 5.Chemplan, Inc.SarasotaUSA
  6. 6.Workplace Safety & Insurance BoardTorontoCanada
  7. 7.School of Rehabilitation ScienceMcMaster UniversityHamiltonCanada
  8. 8.CISAL Center of Research in Occupational HealthUniversitat Pompeu FabraBarcelonaSpain
  9. 9.Department of Occupational HealthInstitut Municipal de la SalutBarcelonaSpain
  10. 10.Department of Environmental and Occupational Health, School of Public HealthUniversity of IowaIowa CityUSA
  11. 11.University of MichiganAnn ArborUSA
  12. 12.School of MedicineWashington University at St. LouisSt. LouisUSA
  13. 13.Division of Occupational and Environmental Medicine, School of MedicineUniversity of California - San FranciscoSan FranciscoUSA

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