Aas Randi Wågø, Tuntland Hanne, Holte Kari Anne, Røe Cecilie, Lund Thomas, Marklund Staffan, Moller Anders
International Research Institute of Stavanger (IRIS), Box 8046, Stavanger, Norway, 4068.
Cochrane Database Syst Rev. 2011 Apr 13;2011(4):CD008160. doi: 10.1002/14651858.CD008160.pub2.
Musculoskeletal disorders are the most common cause of disability in many industrial countries. Recurrent and chronic pain accounts for a substantial portion of workers' absenteeism. Neck pain seems to be more prominent in the general population than previously known.
To determine the effectiveness of workplace interventions (WIs) in adult workers with neck pain.
We searched: CENTRAL (The Cochrane Library 2009, issue 3), and MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, OTseeker, PEDro to July 2009, with no language limitations;screened reference lists; and contacted experts in the field.
We included randomised controlled trials (RCT), in which at least 50% of the participants had neck pain at baseline and received interventions conducted at the workplace.
Two review authors independently extracted data and assessed risk of bias. Authors were contacted for missing information. Since the interventions varied to a large extend, International Classification of Functioning, Disability and Health (ICF) terminology was used to classify the intervention components. This heterogeneity restricted pooling of data to only one meta-analysis of two studies.
We identified 1995 references and included10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (N = 8) examined office workers. Few workers were sick-listed. Thus, WIs were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56, 95% CI 0.33 to 0.95), but not in the short- (OR 0.83, 95% CI 0.52 to 1.34) or long-term (OR 1.28, 95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed.
AUTHORS' CONCLUSIONS: Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs.
在许多工业化国家，肌肉骨骼疾病是导致残疾的最常见原因。反复出现的慢性疼痛占工人旷工的很大一部分。颈部疼痛在普通人群中似乎比以前认为的更为突出。
确定工作场所干预措施（WIs）对成年颈部疼痛工人的有效性。
我们检索了以下数据库：CENTRAL（《考克兰图书馆》2009年第3期）、MEDLINE、EMBASE、CINAHL、PsycINFO、ISI科学网、OTseeker、PEDro，检索截至2009年7月，无语言限制；筛选参考文献列表；并联系该领域的专家。
我们纳入了随机对照试验（RCT），其中至少50%的参与者在基线时患有颈部疼痛，并接受了在工作场所进行的干预措施。
两位综述作者独立提取数据并评估偏倚风险。就缺失信息与作者进行了联系。由于干预措施差异很大，因此使用国际功能、残疾和健康分类（ICF）术语对干预成分进行分类。这种异质性限制了数据合并，仅对两项研究进行了一项荟萃分析。
我们识别出1995篇参考文献，纳入了10项随机对照试验（2745名工人）。两项研究的偏倚风险评估为低。大多数试验（N = 8）研究的是办公室工作人员。很少有工人被列入病假名单。因此，工作场所干预措施很少旨在改善复工情况。总体而言，证据质量低，表明工作场所干预措施与不进行干预在疼痛患病率或严重程度方面无显著差异。如果有显著结果，支持工作场所干预措施的结果在随访期间并未持续。有中等质量证据（1项研究，415名工人）表明，一项包含四个组成部分的工作场所干预措施在中期显著更有效地减少病假（比值比0.56，95%置信区间0.33至0.95），但在短期（比值比0.83，95%置信区间0.52至1.34）或长期（比值比1.28，95%置信区间0.73至2.26）并非如此。这些发现可能是因为只有一小部分工人被列入病假名单。
总体而言，本综述发现证据质量低，既不支持也不反驳任何特定工作场所干预措施对缓解疼痛的益处；有中等质量证据表明多成分干预措施在中期减少了病假，但随着时间推移这种效果并未持续。进一步的研究很可能会对我们对效应估计的信心产生重要影响，并可能改变估计结果。迫切需要设计良好的工作场所干预措施的高质量随机对照试验。
