Verhagen Arianne P, Bierma-Zeinstra Sita M A, Burdorf Alex, Stynes Siobhán M, de Vet Henrica C W, Koes Bart W
Department of General Practice, Erasmus Medical Center, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
Cochrane Database Syst Rev. 2013 Dec 12;2013(12):CD008742. doi: 10.1002/14651858.CD008742.pub2.
Work-related upper limb disorder (WRULD), repetitive strain injury (RSI), occupational overuse syndrome (OOS) and work-related complaints of the arm, neck or shoulder (CANS) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements, awkward postures and impact of external forces such as those associated with operating vibrating tools. Work-related CANS, which is the term we use in this review, severely hampers the working population.
To assess the effects of conservative interventions for work-related complaints of the arm, neck or shoulder (CANS) in adults on pain, function and work-related outcomes.
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 31 May 2013), MEDLINE (1950 to 31 May 2013), EMBASE (1988 to 31 May 2013), CINAHL (1982 to 31 May 2013), AMED (1985 to 31 May 2013), PsycINFO (1806 to 31 May 2013), the Physiotherapy Evidence Database (PEDro; inception to 31 May 2013) and the Occupational Therapy Systematic Evaluation of Evidence Database (OTseeker; inception to 31 May 2013). We did not apply any language restrictions.
We included randomised controlled trials (RCTs) and quasi-randomised controlled trials evaluating conservative interventions for work-related complaints of the arm, neck or shoulder in adults. We excluded trials undertaken to test injections and surgery. We included studies that evaluated effects on pain, functional status or work ability.
Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of the included studies. When studies were sufficiently similar, we performed statistical pooling of reported results.
We included 44 studies (62 publications) with 6,580 participants that evaluated 25 different interventions. We categorised these interventions according to their working mechanisms into exercises, ergonomics, behavioural and other interventions.Overall, we judged 35 studies as having a high risk of bias mainly because of an unknown randomisation procedure, lack of a concealed allocation procedure, unblinded trial participants or lack of an intention-to-treat analysis.We found very low-quality evidence showing that exercises did not improve pain in comparison with no treatment (five studies, standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -1.08 to 0.03), or minor intervention controls (three studies, SMD -0.25, 95% CI -0.87 to 0.37) or when provided as additional treatment (two studies, inconsistent results) at short-term follow-up or at long-term follow-up. Results were similar for recovery, disability and sick leave. Specific exercises led to increased pain at short-term follow-up when compared with general exercises (four studies, SMD 0.45, 95% CI 0.14 to 0.75)We found very low-quality evidence indicating that ergonomic interventions did not lead to a decrease in pain when compared with no intervention at short-term follow-up (three studies, SMD -0.07, 95% CI -0.36 to 0.22) but did decrease pain at long-term follow-up (four studies, SMD -0.76, 95% CI -1.35 to -0.16). There was no effect on disability but sick leave decreased in two studies (risk ratio (RR) 0.48, 95% CI 0.32 to 0.76). None of the ergonomic interventions was more beneficial for any outcome measures when compared with another treatment or with no treatment or with placebo.Behavioural interventions had inconsistent effects on pain and disability, with some subgroups showing benefit and others showing no significant improvement when compared with no treatment, minor intervention controls or other behavioural interventions.In the eight studies that evaluated various other interventions, there was no evidence of a clear beneficial effect of any of the interventions provided.
AUTHORS' CONCLUSIONS: We found very low-quality evidence indicating that pain, recovery, disability and sick leave are similar after exercises when compared with no treatment, with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm, neck or shoulder. Low-quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up. There was no evidence of an effect on other outcomes. For behavioural and other interventions, there was no evidence of a consistent effect on any of the outcomes.Studies are needed that include more participants, that are clear about the diagnosis of work-relatedness and that report findings according to current guidelines.
工作相关上肢疾病（WRULD）、重复性劳损（RSI）、职业性过度使用综合征（OOS）以及手臂、颈部或肩部的工作相关不适（CANS）是因重复动作、不良姿势以及诸如操作振动工具等外力影响而引发的疾病最常用的统称。工作相关CANS（本综述所采用的术语）严重影响劳动人口。
评估针对成人手臂、颈部或肩部工作相关不适（CANS）的保守干预措施对疼痛、功能及工作相关结局的影响。
我们检索了Cochrane对照试验中心注册库（《Cochrane图书馆》，2013年5月31日）、MEDLINE（1950年至2013年5月31日）、EMBASE（1988年至2013年5月31日）、CINAHL（1982年至2013年5月31日）、AMED（1985年至2013年5月31日）、PsycINFO（1806年至2013年5月31日）、物理治疗证据数据库（PEDro；建库至2013年5月31日）以及职业治疗系统证据评估数据库（OTseeker；建库至2013年5月31日）。我们未设置任何语言限制。
我们纳入了评估针对成人手臂、颈部或肩部工作相关不适的保守干预措施的随机对照试验（RCT）和半随机对照试验。我们排除了旨在测试注射和手术的试验。我们纳入了评估对疼痛、功能状态或工作能力影响的研究。
两位综述作者独立选择纳入试验、提取数据并评估纳入研究的偏倚风险。当研究足够相似时，我们对报告的结果进行统计合并。
我们纳入了44项研究（62篇出版物），共6580名参与者，评估了25种不同的干预措施。我们根据其作用机制将这些干预措施分为运动、人体工程学、行为及其他干预措施。总体而言，我们判定35项研究存在高偏倚风险，主要原因是随机化程序不明、缺乏分配隐藏程序、试验参与者未设盲或缺乏意向性分析。我们发现质量极低的证据表明，与不治疗相比（五项研究，标准化均数差（SMD）-0.52，95%置信区间（CI）-1.08至0.03），或与小干预对照相比（三项研究，SMD -0.25，95%CI -0.
