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


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.

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We would like to acknowledge and thank all of the individuals who have made important contributions to this review: Arthur Ameis, Carlo Ammendolia, Poonam Cardoso, Douglas Gross, Gail Lindsay, Margareta Nordin, Mike Paulden, Roger Salhany, John Stapleton, Maja Stupar, and Angela Verven. We would also like to thank Trish Johns-Wilson at the University of Ontario Institute of Technology for her review of the search strategy. Ontario Ministry of Finance; the study sponsor had no involvement in the study design, collection, analysis, interpretation of data, writing of the manuscript or decision to submit the manuscript for publication.

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No conflicts of interest to disclose for all authors.

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Correspondence to Sharanya Varatharajan.

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Systematic Review Registration Number: CRD42012003390.

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Varatharajan, S., Côté, P., Shearer, H.M. et al. 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. J Occup Rehabil 24, 692–708 (2014).

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  • Neck pain and associated disorders
  • Whiplash-associated disorders
  • Upper extremity disorders
  • Work disability prevention interventions
  • Treatment
  • Systematic review