Hoe Victor C W, Urquhart Donna M, Kelsall Helen L, Sim Malcolm R
Centre for Occupational and Environmental Health, University of Malaya, Kuala Lumpur, Malaysia.
Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD008570. doi: 10.1002/14651858.CD008570.pub2.
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.
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.
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.
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%.
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.
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.
与工作相关的上肢和颈部肌肉骨骼疾病（MSDs）是全球最常见的职业疾病之一。尽管人体工程学设计和培训可能会降低工人患上与工作相关的上肢和颈部MSDs的风险，但证据并不明确。
评估工作场所人体工程学设计或培训干预措施，或两者结合，对预防成年人与工作相关的上肢和颈部MSDs的效果。
我们检索了截至2010年7月的MEDLINE、EMBASE、Cochrane对照试验中心注册库（CENTRAL）、CINAHL、AMED、科学网（科学引文索引）、SPORTDiscus、Cochrane职业安全与健康综述组数据库以及Cochrane骨、关节和肌肉创伤组专业注册库，并检索了截至2010年11月的物理治疗证据数据库、美国疾病控制与预防中心、美国国家职业安全与健康研究所数据库以及国际职业安全与健康信息中心数据库。
我们纳入了关于预防与工作相关的上肢和颈部MSDs的人体工程学工作场所干预措施的随机对照试验（RCTs）。我们仅纳入上肢或颈部或两者的MSDs基线患病率低于25%的研究。
两位综述作者独立提取数据并评估偏倚风险。我们纳入了在干预措施和结局方面我们认为足够同质的具有相关数据的研究进行荟萃分析。我们使用GRADE方法评估每个比较的证据总体质量。
我们纳入了13项RCTs（2397名工人）。11项研究在办公环境中进行，2项在医疗环境中进行。我们判定一项研究的偏倚风险较低。这13项研究评估了人体工程学设备、补充休息或减少工作时间、人体工程学培训、人体工程学培训与设备的组合以及患者搬运干预措施对预防成年人与工作相关的上肢和颈部MSDs的有效性。总体而言，有中等质量的证据表明使用带辅助鼠标的手臂支撑可降低颈部/肩部疾病的发生率（风险比（RR）0.52；95%置信区间（CI）0.27至0.99），但不能降低右上肢MSDs的发生率（RR 0.73；95% CI 0.32至1.66）；有低质量的证据表明该干预措施可减轻颈部/肩部不适（标准化均数差（SMD）-0.41；95% CI -0.69至-0.12）和右上肢不适（SMD -0.34；95% CI -0.63至-0.06）。也有中等质量的证据表明，比较辅助鼠标和传统鼠标时，颈部/肩部和右上肢疾病的发生率未降低（颈部/肩部RR 0.62；95% CI 0.19至2.00；右上肢RR 0.91；95% CI 0.48至1.72），比较使用传统鼠标时带手臂支撑和不带手臂支撑时，颈部/肩部和右上肢疾病的发生率未降低（颈部/肩部RR 0.67；95% CI 0.36至1.24；右上肢RR 1.09；95% CI 0.51至2.29），以及比较带手臂支撑的辅助鼠标和带手臂支撑的传统鼠标时，颈部/肩部和右上肢疾病的发生率未降低（颈部/肩部RR 0.58；95% CI 0.30至1.12；右上肢RR 0.92；95% CI 0.36至2.36）。有低质量的证据表明，与带手臂支撑的传统鼠标相比，使用带手臂支撑的辅助鼠标可减轻颈部/肩部不适（SMD -0.39；95% CI -0.67至-0.10）。有低至极低质量的证据表明其他干预措施对降低成年人与工作相关的上肢和颈部MSDs无效。
我们发现中等质量的证据表明，使用带辅助鼠标的手臂支撑可能会降低颈部/肩部MSDs的发生率，但不能降低右上肢MSDs的发生率。此外，我们发现中等质量的证据表明，比较带与不带手臂支撑的辅助鼠标和传统鼠标时，颈部/肩部和右上肢MSDs的发生率未降低。然而，鉴于涉及多种干预措施和结局进行了多次比较，需要高质量的证据来明确确定这些干预措施的有效性。虽然我们发现极低至低质量的证据表明其他人体工程学干预措施不能预防与工作相关的上肢和颈部MSDs，但这受到现有研究的稀缺性和异质性的限制。本综述强调了开展高质量RCTs以研究上肢和颈部MSDs预防的必要性。
