Institut national de santé publique du Québec, 190 Crémazie E. Montreal, QC, H2P 1E2, Canada.
Scand J Work Environ Health. 2018 Mar 1;44(2):113-133. doi: 10.5271/sjweh.3696. Epub 2017 Nov 30.
Objectives We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work. Methods We systematically reviewed the 2000-2015 English- and French-language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented the interpretation of results. Results We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low-to-very-low quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated. Conclusions Targeting work-rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.
目的
我们旨在确定针对工作组织或心理社会工作环境的干预措施与常规工作相比，在预防或减少与工作相关的肌肉骨骼疾病（WMSD）方面是否更有效。
方法
我们系统地回顾了 2000-2015 年的英语和法语科学文献，包括评估组织或心理社会工作干预对非病假工人颈部、肩部、上肢和/或背部与工作相关的肌肉骨骼疼痛或疾病的发生率、患病率或强度，或因这些问题导致的工作缺勤的有效性的研究。我们排除了康复和个体层面的行为干预以及超过 50%失访率的研究。我们分析了中高质量研究，并使用推荐评估、制定与评估（GRADE）方法综合证据。对关键工作场所干预要素的分析补充了结果的解释。
结果
我们确定了 884 篇文章；28 篇符合选择标准，产生了 2 篇高质量、10 篇中质量和 16 篇低质量研究。有中等质量证据表明，与常规休息时间表相比，补充休息可以有效降低各种身体部位的症状强度。其他干预措施的证据质量较低至极低，主要是由于研究设计、高失访率、共同干预和不敏感指标的偏倚风险。大多数干预措施缺乏关键的干预要素，如工作活动分析和实施过程中的人体工程学指导，但这些要素与干预效果或无效性之间的关系仍有待证明。
结论
针对工作-休息周期可能会减少 WMSD。需要进行更高质量的研究，以便对其他预防或减少 WMSD 的工作组织或心理社会干预措施的有效性得出明确的结论。
