Division Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
J Occup Rehabil. 2019 Mar;29(1):175-193. doi: 10.1007/s10926-018-9777-7.
Purpose The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes. Methods We searched Medline, Cochrane Library, Scopus, Web of Science, Academic Search Premier, Africa-Wide Information, CINAHL, OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Results Initial search located 1071 articles, of which 80 were full text reviewed. Twenty-eight articles were included, reporting on various outcomes relating to a total of seventeen studies. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n = 3), ergonomic training and workstation adjustments (n = 4), exercise and resistance training (n = 6), clinic-based versus workplace-based work hardening (n = 1), nurse case manager training (n = 1), physiotherapy versus Feldenkrais (n = 1), and ambulant myofeedback training (n = 1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusion While there is substantial evidence for workplace exercise programs, other workplace-based interventions require further high quality research. Systematic review registration PROSPERO CRD42017059708.
目的 本系统评价旨在识别、整理和分析当前关于上肢疾病患者在工作场所进行康复干预的有效性的证据，评估这些干预措施对工作绩效、疼痛、缺勤、生产力和其他结果的影响。
方法 我们在 Medline、Cochrane 图书馆、Scopus、Web of Science、Academic Search Premier、Africa-Wide Information、CINAHL、OTSeeker 和 PEDro 等数据库中，使用了四个方面的检索词进行检索：上肢、干预、工作场所和临床试验（无时间限制）。仅包括颈部疼痛或其他部位肌肉骨骼疼痛的研究不被纳入。
结果 初步检索共找到 1071 篇文章，其中 80 篇进行了全文审查。最终纳入了 28 篇文章，报道了与 17 项研究相关的各种结果。其中 9 项研究的方法学质量较高，7 项研究的质量中等，1 项研究的质量较低。研究按照干预措施的类别进行分类：人体工程学控制（n=3）、人体工程学培训和工作站调整（n=4）、运动和抗阻训练（n=6）、基于诊所的与基于工作场所的强化治疗（n=1）、护士病例管理培训（n=1）、物理治疗与费登奎斯（n=1）和可移动肌电反馈训练（n=1）。最大的证据体支持工作场所运动方案，其中人体工程学培训和工作站调整具有积极影响，人体工程学控制则具有混合影响。可移动肌电反馈训练则没有效果。其余三种干预措施在各自的单篇研究中都具有积极效果。
结论 虽然有大量证据支持工作场所运动方案，但其他基于工作场所的干预措施需要进一步进行高质量的研究。系统评价注册 PROSPERO CRD42017059708。
