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Meta-Analysis
. 2012 Aug 15;2012(8):CD008570.
doi: 10.1002/14651858.CD008570.pub2.

Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults

Victor C W Hoe  1 , Donna M Urquhart, Helen L Kelsall, Malcolm R Sim
Affiliations
Meta-Analysis

Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults

Victor C W Hoe et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Work-related upper limb and neck musculoskeletal disorders (MSDs) are one of the most common occupational disorders around the world. Although ergonomic design and training are likely to reduce the risk of workers developing work-related upper limb and neck MSDs, the evidence is unclear.

Objectives: To assess the effects of workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck MSDs in adults.

Search methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED, Web of Science (Science Citation Index), SPORTDiscus, Cochrane Occupational Safety and Health Review Group Database and Cochrane Bone, Joint and Muscle Trauma Group Specialised Register to July 2010, and Physiotherapy Evidence Database, US Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health database, and International Occupational Safety and Health Information Centre database to November 2010.

Selection criteria: We included randomised controlled trials (RCTs) of ergonomic workplace interventions for preventing work-related upper limb and neck MSDs. We included only studies with a baseline prevalence of MSDs of the upper limb or neck, or both, of less than 25%.

Data collection and analysis: Two review authors independently extracted data and assessed risk of bias. We included studies with relevant data that we judged to be sufficiently homogeneous regarding the intervention and outcome in the meta-analysis. We assessed the overall quality of the evidence for each comparison using the GRADE approach.

Main results: We included 13 RCTs (2397 workers). Eleven studies were conducted in an office environment and two in a healthcare setting. We judged one study to have a low risk of bias. The 13 studies evaluated effectiveness of ergonomic equipment, supplementary breaks or reduced work hours, ergonomic training, a combination of ergonomic training and equipment, and patient lifting interventions for preventing work-related MSDs of the upper limb and neck in adults.Overall, there was moderate-quality evidence that arm support with alternative mouse reduced the incidence of neck/shoulder disorders (risk ratio (RR) 0.52; 95% confidence interval (CI) 0.27 to 0.99) but not the incidence of right upper limb MSDs (RR 0.73; 95% CI 0.32 to 1.66); and low-quality evidence that this intervention reduced neck/shoulder discomfort (standardised mean difference (SMD) -0.41; 95% CI -0.69 to -0.12) and right upper limb discomfort (SMD -0.34; 95% CI -0.63 to -0.06).There was also moderate-quality evidence that the incidence of neck/shoulder and right upper limb disorders were not reduced when comparing alternative mouse and conventional mouse (neck/shoulder RR 0.62; 95% CI 0.19 to 2.00; right upper limb RR 0.91; 95% CI 0.48 to 1.72), arm support and no arm support with conventional mouse (neck/shoulder RR 0.67; 95% CI 0.36 to 1.24; right upper limb RR 1.09; 95% CI 0.51 to 2.29), and alternative mouse with arm support and conventional mouse with arm support (neck/shoulder RR 0.58; 95% CI 0.30 to 1.12; right upper limb RR 0.92; 95% CI 0.36 to 2.36).There was low-quality evidence that using an alternative mouse with arm support compared to conventional mouse with arm support reduced neck/shoulder discomfort (SMD -0.39; 95% CI -0.67 to -0.10). There was low- to very low-quality evidence that other interventions were not effective in reducing work-related upper limb and neck MSDs in adults.

Authors' conclusions: We found moderate-quality evidence to suggest that the use of arm support with alternative mouse may reduce the incidence of neck/shoulder MSDs, but not right upper limb MSDs. Moreover, we found moderate-quality evidence to suggest that the incidence of neck/shoulder and right upper limb MSDs is not reduced when comparing alternative and conventional mouse with and without arm support. However, given there were multiple comparisons made involving a number of interventions and outcomes, high-quality evidence is needed to determine the effectiveness of these interventions clearly. While we found very-low- to low-quality evidence to suggest that other ergonomic interventions do not prevent work-related MSDs of the upper limb and neck, this was limited by the paucity and heterogeneity of available studies. This review highlights the need for high-quality RCTs examining the prevention of MSDs of the upper limb and neck.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
Figure 2
Figure 2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 An arm support together with an alternative mouse versus a conventional mouse alone, Outcome 1 Incidence of neck/shoulder disorder.
Analysis 1.2
Analysis 1.2
Comparison 1 An arm support together with an alternative mouse versus a conventional mouse alone, Outcome 2 Incidence of right upper limb disorder.
Analysis 1.3
Analysis 1.3
Comparison 1 An arm support together with an alternative mouse versus a conventional mouse alone, Outcome 3 Incidence of upper body disorders (neck, shoulder, and upper limb).
Analysis 1.4
Analysis 1.4
Comparison 1 An arm support together with an alternative mouse versus a conventional mouse alone, Outcome 4 Neck/shoulder discomfort score.
Analysis 1.5
Analysis 1.5
Comparison 1 An arm support together with an alternative mouse versus a conventional mouse alone, Outcome 5 Right upper extremity discomfort score.
Analysis 2.1
Analysis 2.1
Comparison 2 An alternative mouse alone versus a conventional mouse alone, Outcome 1 Incidence of neck/shoulder disorder.
Analysis 2.2
Analysis 2.2
Comparison 2 An alternative mouse alone versus a conventional mouse alone, Outcome 2 Incidence of right upper extremity disorder.
Analysis 2.3
Analysis 2.3
Comparison 2 An alternative mouse alone versus a conventional mouse alone, Outcome 3 Incidence of upper body disorder (neck, shoulder, and upper extremity).
Analysis 2.4
Analysis 2.4
Comparison 2 An alternative mouse alone versus a conventional mouse alone, Outcome 4 Neck/shoulder discomfort score.
Analysis 2.5
Analysis 2.5
Comparison 2 An alternative mouse alone versus a conventional mouse alone, Outcome 5 Right upper extremity discomfort score.
Analysis 3.1
Analysis 3.1
Comparison 3 An arm support together with a conventional mouse versus a conventional mouse alone, Outcome 1 Incidence of neck/shoulder disorder.
Analysis 3.2
Analysis 3.2
Comparison 3 An arm support together with a conventional mouse versus a conventional mouse alone, Outcome 2 Incidence of right upper extremity disorders.
Analysis 3.3
Analysis 3.3
Comparison 3 An arm support together with a conventional mouse versus a conventional mouse alone, Outcome 3 Incidence of upper body disorders.
Analysis 3.4
Analysis 3.4
Comparison 3 An arm support together with a conventional mouse versus a conventional mouse alone, Outcome 4 Neck/shoulder discomfort score.
Analysis 3.5
Analysis 3.5
Comparison 3 An arm support together with a conventional mouse versus a conventional mouse alone, Outcome 5 Right upper extremity discomfort score.
Analysis 4.1
Analysis 4.1
Comparison 4 An alternative mouse with an arm support versus a conventional mouse with an arm support, Outcome 1 Incidence of neck/shoulder disorder.
Analysis 4.2
Analysis 4.2
Comparison 4 An alternative mouse with an arm support versus a conventional mouse with an arm support, Outcome 2 Incidence of right upper limb disorder.
Analysis 4.3
Analysis 4.3
Comparison 4 An alternative mouse with an arm support versus a conventional mouse with an arm support, Outcome 3 Incidence of upper body disorders (neck, shoulder, and upper limb).
Analysis 4.4
Analysis 4.4
Comparison 4 An alternative mouse with an arm support versus a conventional mouse with an arm support, Outcome 4 Neck/shoulder discomfort score.
Analysis 4.5
Analysis 4.5
Comparison 4 An alternative mouse with an arm support versus a conventional mouse with an arm support, Outcome 5 Right upper extremity discomfort score.
Analysis 5.1
Analysis 5.1
Comparison 5 Supplementary breaks versus normal breaks, Outcome 1 After shifts discomfort rating for neck (4‐8 weeks).
Analysis 5.2
Analysis 5.2
Comparison 5 Supplementary breaks versus normal breaks, Outcome 2 After shifts discomfort ratings for right shoulder/upper arm (4‐8 weeks).
Analysis 5.3
Analysis 5.3
Comparison 5 Supplementary breaks versus normal breaks, Outcome 3 After shifts discomfort ratings for right forearm/wrist/hand (4‐8 weeks).
Analysis 6.1
Analysis 6.1
Comparison 6 Reduce work hours versus normal work hours, Outcome 1 Upper extremity disorder (6 months).
Analysis 6.2
Analysis 6.2
Comparison 6 Reduce work hours versus normal work hours, Outcome 2 Upper extremity disorder (12 months).
Analysis 6.3
Analysis 6.3
Comparison 6 Reduce work hours versus normal work hours, Outcome 3 Work ability (6 months).
Analysis 6.4
Analysis 6.4
Comparison 6 Reduce work hours versus normal work hours, Outcome 4 Work ability (12 months).
Analysis 7.1
Analysis 7.1
Comparison 7 Ergonomic training versus no intervention, Outcome 1 Neck/shoulder musculoskeletal symptoms by medical examination.
Analysis 7.2
Analysis 7.2
Comparison 7 Ergonomic training versus no intervention, Outcome 2 Hand/wrist symptoms by medical examination.
Analysis 7.3
Analysis 7.3
Comparison 7 Ergonomic training versus no intervention, Outcome 3 Intensity of upper extremity pain.
Analysis 7.4
Analysis 7.4
Comparison 7 Ergonomic training versus no intervention, Outcome 4 Frequency of upper extremity pain.
Analysis 7.5
Analysis 7.5
Comparison 7 Ergonomic training versus no intervention, Outcome 5 Duration of upper extremity pain.
Analysis 8.1
Analysis 8.1
Comparison 8 Work injury prevention programme versus no intervention, Outcome 1 Frequency of neck ache or pain.
Analysis 8.2
Analysis 8.2
Comparison 8 Work injury prevention programme versus no intervention, Outcome 2 Frequency of shoulder ache or pain.
Analysis 8.3
Analysis 8.3
Comparison 8 Work injury prevention programme versus no intervention, Outcome 3 Frequency of wrist/hand ache or pain.
Analysis 8.4
Analysis 8.4
Comparison 8 Work injury prevention programme versus no intervention, Outcome 4 Intensity of neck ache or pain.
Analysis 8.5
Analysis 8.5
Comparison 8 Work injury prevention programme versus no intervention, Outcome 5 Intensity of shoulder ache or pain.
Analysis 8.6
Analysis 8.6
Comparison 8 Work injury prevention programme versus no intervention, Outcome 6 Intensity of wrist/hand ache or pain.
Analysis 9.1
Analysis 9.1
Comparison 9 Patient lifting/transfer intervention versus normal practice, Outcome 1 Shoulder pain (safe lifting versus usual practice).
Analysis 9.2
Analysis 9.2
Comparison 9 Patient lifting/transfer intervention versus normal practice, Outcome 2 Shoulder pain (no strenuous lifting versus usual practice).
Analysis 9.3
Analysis 9.3
Comparison 9 Patient lifting/transfer intervention versus normal practice, Outcome 3 DASH (no lifting versus usual practice).
Analysis 9.4
Analysis 9.4
Comparison 9 Patient lifting/transfer intervention versus normal practice, Outcome 4 DASH (no strenuous lifting).
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