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

Abstract

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.

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Acknowledgments

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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Correspondence to Carol A. Kennedy.

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Kennedy, C.A., Amick III, B.C., Dennerlein, J.T. et al. 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. J Occup Rehabil 20, 127–162 (2010). https://doi.org/10.1007/s10926-009-9211-2

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Keywords

  • Upper extremity musculoskeletal disorders
  • Occupational health and safety interventions
  • Systematic review