van der Molen Henk F, Foresti Chiara, Daams Joost G, Frings-Dresen Monique H W, Kuijer P Paul F M
Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.
Occup Environ Med. 2017 Oct;74(10):745-755. doi: 10.1136/oemed-2017-104339. Epub 2017 Jul 29.
The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case-control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.
本系统评价和荟萃分析的目的是研究哪些与工作相关的风险因素与特定的肩部软组织疾病相关。我们检索了Medline和Embase电子数据库中2009年至2016年3月24日发表的文章，并纳入了2009年之前进行的一项系统评价的参考文献。当结局数据以临床评估的肩部软组织疾病描述，且提及至少两个水平的与工作相关的暴露（暴露组与较少暴露或未暴露组）时，纳入主要的横断面研究和纵向研究。两位作者独立选择研究、提取数据并评估研究质量。对于纵向研究，我们进行了荟萃分析，并使用GRADE（推荐分级、评估、制定和评价）来评估风险因素与肩部疾病发病之间关联的证据。27项研究符合纳入标准。在一项病例对照研究和六项前瞻性队列研究的荟萃分析中，总共纳入了来自丹麦、芬兰、法国、德国和波兰的2413722名工人中的16300例患有特定肩部软组织疾病的患者。该荟萃分析显示，肩部疾病与手臂抬高（比值比[OR]=1.9，95%置信区间[CI]为1.47至2.47）和肩部负荷（OR=2.0，95%CI为1.90至2.10）之间存在中度关联证据，而与手部用力（OR=1.5，95%CI为1.25至1.87）、手臂振动（OR=1.3，95%CI为1.01至1.77）、心理社会工作需求（OR=1.1，95%CI为1.01至1.25）以及与临时工一起工作（OR=2.2，95%CI为1.2至4.2）之间存在低至极低关联证据。未发现手臂重复、社会支持、决策自由度、工作控制和工作安全感与疾病无关联的低质量证据。发现有中度证据表明手臂抬高和肩部负荷会使特定肩部疾病的风险加倍。发现手部用力、手臂振动、心理社会工作需求以及与临时工一起工作与特定肩部疾病发病率之间存在低至极低质量的关联证据。
