Hoozemans M J M, Knelange E B, Frings-Dresen M H W, Veeger H E J, Kuijer P P F M
MOVE Research Institute, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands CORAL - Centre for Orthopaedic Research Alkmaar, Orthopaedic Outpatient Department, Medical Centre Alkmaar, Alkmaar, The Netherlands.
MOVE Research Institute, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Occup Environ Med. 2014 Nov;71(11):788-95. doi: 10.1136/oemed-2013-101837. Epub 2014 Jul 17.
Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of) upper arm, elbow, forearm, wrist or hand symptoms.
系统回顾关于从事推/拉活动的工人与不从事推/拉活动的工人相比，是否有更高的上肢症状风险这一问题的观察性研究。通过PubMed和EMBASE在MEDLINE中进行检索，使用与工作相关的检索词并结合推/推/拉/拉。研究必须考察推/拉暴露与上肢症状的关系。两位作者独立进行文献筛选和研究偏倚风险评估。采用最佳证据综合法，根据有力、中等或矛盾/不足的证据得出结论。检索结果有4764项研究。纳入了7项研究，其中3项偏倚风险较低，总共包括8279名参与者。在所有4项前瞻性队列研究中均观察到与上肢症状呈显著正相关，效应大小在1.5至4.9之间。其余3项研究中的2项也报告了与上肢症状呈正相关。此外，在2项前瞻性队列研究中发现与颈部/肩部症状呈显著正相关，效应大小分别为1.5和1.6，在2项横断面研究中的1项中发现与肩部症状呈正相关，效应大小为2.1。有强有力的证据表明推/拉与上肢症状有关，特别是肩部症状。关于推/拉与上臂、肘部、前臂、手腕或手部症状（的组合）之间的关系，证据不足或相互矛盾。
