Preventing upper extremity MSDs: What works and what doesn’t

The strongest evidence to come out of a new systematic review from the Institute for Work & Health is that workstation adjustments alone have no effect in preventing upper extremity musculoskeletal disorders. However, there are indications that adding ergonomics training to the mix may make a difference.

Health and safety professionals have long been aware of the problem of work-related musculoskeletal injuries, especially pain disorders of the muscles, tendons and nerves. The upper extremity – including the neck, shoulders, arms, wrists and hands – has proven particularly vulnerable. In 2006, musculoskeletal disorders (MSDs) and traumatic injuries of the upper extremity accounted for about 30 per cent of lost-time claims in Ontario. The burden to individuals, workplaces and economies is significant.

Workplaces seeking to prevent upper extremity MSDs certainly have options. Approaches to prevention range from ergonomics training to new equipment. The difficulty is in knowing which intervention technique will supply the greatest benefit.

A new systematic review from the Institute for Work & Health (IWH) aimed to provide workplaces with evidence to make informed choices about such programs. It looked at the effectiveness of different workplace interventions for preventing and managing upper extremity MSDs and traumatic injuries.

“The use of workplace interventions is quite widespread, not to mention costly,” confirms Carol Kennedy, a research associate at the Institute who coordinated the review. “Still, no research review has looked at all types of upper extremity disorders, from acute injuries to chronic pain, or across all industries and sectors. This is what
drove the review.”

Led by IWH Scientific Director Dr. Benjamin Amick, an international review team of 14 researchers evaluated existing studies of workplace interventions. From an initial pool of more than 15,000 articles, the team identified 36 high or medium quality studies.

There were 19 categories of workplace interventions – everything from job stress management training to the physical adjustment of computer workstations.Taken together, the studies provide a “mixed” level of evidence that occupational health and safety (OHS) interventions prevent upper extremity MSDs. A “mixed” level means the evidence is inconsistent. In this review, inconsistencies arose because some interventions showed a positive effect and some showed no effect on upper extremity health. None of the interventions showed an adverse or negative effect.

Arm supports prove beneficial

Some interventions fared better than others. For example, there is moderate evidence that adding arm supports to computer workstations carries some benefit for upper extremity health.

Yet other interventions appeared to have no effect. Researchers found strong evidence that workstation adjustments alone are ineffective. There is moderate evidence that job stress management training and biofeedback training (in which monitoring instruments are used to provide information about increased muscle tension) are also ineffective.

Still, the review team cautions that additional research is needed. “In many cases, there just weren’t enough higher quality studies to provide a good evidence base,” says Kennedy. “The review team believes that policy recommendations should be based on strong levels of evidence, and this requires consistent findings from a reasonable number of high quality studies. We found strong evidence with only one type of intervention – that workstation adjustments are ineffective when implemented in isolation. As a result, we’re recommending that worksites not engage in health and safety activities that include only workstation adjustments.”

The review team was surprised and somewhat frustrated by the lack of intervention studies evaluating upper extremity injuries in non-office based sectors. Although the office sector is known for having frequent upper extremity disorders, it is not necessarily known for having traumatic injuries, such as crush injuries or lacerations. “We were disappointed not to find a single higher quality study that addressed the prevention of these types of injuries in non-office settings,” says Kennedy.

To access the review, visit: www.iwh.on.ca/systematic-reviews

EVIDENCE-BSED SUGGESTIONS FOR PREVENTING UPPER EXTREMITY MSDs IN THE WORKPLACE

In this systematic review, researchers looked at previous studies to find those of sufficient quality to help answer the question: Do OHS workplace interventions prevent upper extremity MSDs and injuries? Based on their findings, they offer the following advice.

Recommendation (a strong level of research evidence makes this a recommended workplace practice):

• Worksites should not make workstation adjustments to computing workstations their only solution to upper extremity MSDs. When implemented in isolation in office environments, they have no effect. (However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial for upper extremity musculoskeletal health.)

Practice considerations (a moderate level of evidence makes the application of these practices in the workplace worth considering):

• Workplaces should consider using arm supports to alleviate upper extremity MSDs. Arm supports should be consid- ered a practical design in a range of work environments to reduce muscle loading in the upper extremity.
• Workplaces should not consider using biofeedback and job stress management in their training programs to reduce upper extremity MSDs. These training programs appear to have no effect.

Source: At Work, Issue 55, Winter 2009: Institute for Work & Health, Toronto