Verhagen A P, Bierma-Zeinstra S M A, Feleus A, Karels C, Dahaghin S, Burdorf L, de Vet H C W, Koes B W
Department of General Practice, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, Netherlands.
Cochrane Database Syst Rev. 2004(1):CD003471. doi: 10.1002/14651858.CD003471.pub2.
Conservative interventions such as physiotherapy and ergonomic adjustments play a major part in the treatment of most work-related musculoskeletal disorders (WRMD).
The objective of this systematic review is to determine whether conservative interventions have a significant impact on short and long-term outcomes for upper extremity WRMD in adults.
We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002) and Cochrane Rehabilitation and Related Therapies Field specialised register (January 2002), the Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2001), PubMed (1966 to November 2001), EMBASE (1988 to November 2001), and CINAHL (1982 to November 2001). We also searched the Physiotherapy Index (1988 to November 2001) and reference lists of articles. No language restrictions were applied.
Only randomised controlled trials and concurrent controlled trials studying conservative interventions for adults suffering from upper extremity WRMD were included. Conservative interventions may include exercises, relaxation, physical applications, biofeedback, myofeedback and work place adjustments.
Two reviewers independently selected the trials from the search yield and assessed the clinical relevance and methodological quality using the Delphi list. In the event of clinical heterogeneity or lack of data we used a rating system to assess levels of evidence.
We included 15 trials involving 925 people. Twelve trials included people with chronic non-specific neck or shoulder complaints, or non-specific upper extremity disorders. Over 20 interventions were evaluated; seven main subgroups of interventions could be determined: exercises, manual therapy, massage, ergonomics, multidisciplinary treatment, energised splint and individual treatment versus group therapy. Overall, the quality of the studies appeared to be poor. In 10 studies a form of exercise was evaluated, and there is limited evidence about the effectiveness of exercises only when compared to no treatment. Concerning manual therapy (1 study), massage (4 studies), multidisciplinary treatment (1 study) and energised splint (1 study) no conclusions can be drawn. Limited evidence is found concerning the effectiveness of specific keyboards for patients with carpal tunnel syndrome.
REVIEWER'S CONCLUSIONS: This review shows limited evidence for the effectiveness of keyboards with an alternative force-displacement of the keys or an alternative geometry, and limited evidence for the effectiveness of individual exercises. The benefit of expensive ergonomic interventions (such as new chairs, new desks etc) in the workplace is not clearly demonstrated.
保守干预措施，如物理治疗和人体工程学调整，在大多数与工作相关的肌肉骨骼疾病（WRMD）的治疗中起着主要作用。
本系统评价的目的是确定保守干预措施对成人上肢WRMD的短期和长期疗效是否有显著影响。
我们检索了Cochrane肌肉骨骼损伤小组专门注册库（2002年1月）、Cochrane康复及相关疗法领域专门注册库（2002年1月）、Cochrane对照试验注册库（《Cochrane图书馆》2001年第3期）、PubMed（1966年至2001年11月）、EMBASE（1988年至2001年11月）和CINAHL（1982年至2001年11月）。我们还检索了物理治疗索引（1988年至2001年11月）以及文章的参考文献列表。未设语言限制。
仅纳入研究针对患有上肢WRMD的成人进行保守干预的随机对照试验和同期对照试验。保守干预措施可能包括锻炼、放松、物理治疗、生物反馈、肌反馈和工作场所调整。
两名评价员独立从检索结果中选择试验，并使用德尔菲列表评估临床相关性和方法学质量。若存在临床异质性或数据不足，我们使用评分系统评估证据水平。
我们纳入了15项试验，涉及925人。12项试验纳入了患有慢性非特异性颈部或肩部疾病或非特异性上肢疾病的患者。评估了20多种干预措施；可确定7个主要干预亚组：锻炼、手法治疗、按摩、人体工程学、多学科治疗、动力夹板以及个体治疗与团体治疗。总体而言，研究质量似乎较差。在10项研究中评估了某种形式的锻炼，仅与不治疗相比时，关于锻炼有效性的证据有限。关于手法治疗（1项研究）、按摩（4项研究）、多学科治疗（1项研究）和动力夹板（1项研究），无法得出结论。对于腕管综合征患者使用特定键盘的有效性，发现的证据有限。
本评价表明，对于按键力 - 位移或几何形状不同的键盘的有效性，证据有限；对于个体锻炼的有效性，证据也有限。工作场所中昂贵的人体工程学干预措施（如新椅子、新桌子等）的益处未得到明确证明。
