| Mechanical exposure interventions |
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| Work environment/workstation adjustments & VDU workers |
Aaras et al (2001)16
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Prospective parallel group study Yes (without intervention)
150 VDU workers Visual discomfort, headache, neck, shoulder & forearm pain |
New lighting, new workplaces and optometric corrections (when required)
Primary |
Pain intensity and duration VAS,
Standardised Nordic musculoskeletal questionnaire |
Reduced shoulder pain No reduction in neck pain Unchanged forearm and hand pain |
11 Medium |
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Nevala‐Puranen et al (2003)17
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Pre‐/post‐cohort with parallel group randomised with respect to instruction No 20 VDU workers Neck, shoulder and upper limb pain |
Modifications of office layout and workstation +/− ergonomic advice and upper limb exercises Secondary |
VAS pain score Questionnaire: mental strain and physical exercise outside of work |
Reduced upper limb VAS scores Improved work posture (shoulder flexion)
Altered EMG activity during typing and the use of the mouse No differences between groups in work pace, change in mental strain at work or frequency of physical exercise |
10 Medium |
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Mekhora et al (2000)18
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Randomised prospective parallel group study Yes (delayed intervention; subjects as own controls)
85 VDU workers Tension neck syndrome |
Workstation adjustment using computer software application (IntelAd version 1.2)
Secondary |
Adapted Visual Analogue Discomfort Scale (VADS)
Standardised Nordic musculoskeletal questionnaire |
Reduced VADS No difference between workload and work duration throughout study and/or between companies |
9 Low |
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Ketola et al (2002)19
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Randomised controlled trial Yes (without intervention)
109 VDU workers Neck, shoulder and upper limb pain |
Workstation adjustment &/or redesign following intensive ergonomic education
Secondary |
Finnish education system ergonomic rating scale
Discomfort diary Modified Nordic musculoskeletal questionnaire |
Reductions in discomfort ratings at 2 months Improved ergonomic rating, intensive group greater than education or reference group |
12 Medium |
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| Workstation equipment & VDU workers |
Aaras et al (2001)20
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Prospective parallel group study Yes (without intervention)
67 VDU workers Neck, shoulder & forearm pain |
VDU work utilising the Anir computer mouse (intervention) versus a traditional mouse
Secondary |
VAS pain score Clinical examination |
Reduced number of tender points in the neck and shoulder Reduced neck, shoulder, forearm, wrist and hand pain scores, 6, 12 months Reduced sick leave Reduced pain with flexion and side‐flexion passive ROM in cervical spine |
9 Low |
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Rempel et al (1999)21
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Randomised controlled trial Yes (without intervention; subjects matched)
24 keyboard operators (administrative assistants or technical writer/editors)
Carpal Tunnel Syndrome (CTS) |
Use of keyboard where the keys differed in their force‐displacement characteristics. Keyboard ‘A'–Protouch (Key Tronic Corporation). Keyboard ‘B'–MacPro Plus with 2‐ounce rubber domes (Key Tronic Corporation)
Secondary/tertiary(?) |
Self‐administered medical history questionnaire Symptom survey (VAS pain score)
Questionnaire of hand‐function status Standardised physical examination Nerve conduction test |
Difference in pain levels between the keyboard groups, 12 weeks; not at 6 weeks.
Reduced pain at 12 weeks using keyboard ‘A'
No differences in mean palm‐wrist median sensory latencies between 0 and 12 weeks No differences between groups in hand‐function ratings, 6 and 12 weeks |
20 High |
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Tittiranonda et al (1999)22
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Randomised controlled trial
Yes (placebo intervention; subjects matched)
4 groups, 20 keyboard operators in each Carpal Tunnel Syndrome (CTS) and/or tendonitis |
4 computer keyboards: standard (placebo), Apple Adjustable Keyboard (kb1), Comfort Keyboard System (kb2) and Microsoft Natural Keyboard (kb3)
Secondary/tertiary(?) |
Physical examination Hand/arm discomfort and pain questionnaire VAS of stiffness, numbness or pain Job Content Instrument (JCI)
Work Interpersonal Relationships Inventory (WIRI) |
Significant reduction in overall pain severity in kb3 at 6 months Significant increase in functional status after 6 months in kb3 group compared to placebo.
No significant decrease in prevalence of clinical measures after 6 months |
18 Medium |
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| Ergonomic equipment & manufacturing workers |
Herbert et al (2001)23
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Cohort study No N = 56 female Hispanic and Indian spooling workers at sequin manufacturing company Upper extremity Musculoskeletal Disorders (MSDs) |
Ergonomic education and introduction of adjustable chair (including training in correct chair use)
Primary/secondary |
Symptoms portion of the 1993 NIOSH questionnaire Pre‐/Post video‐analysis of upper extremity postures using the Modified Exposure Assessment Method |
Reduced pain scores after introduction of adjustable chairs at most anatomic sites Reduced prevalence of pain in the right shoulder, left elbow, and left forearm after introduction of adjustable chair.
Improved upper limb posture following chair intervention |
8 Low |
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Aiba et al (1999)24
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Prospective longitudinal cohort No 383 manufacturing workers using impact wrenches Vibration White Finger (VWF) |
Introduction of vibration‐damped wrench Primary |
Stockholm Workshop Scale for VWF Questionnaires on work histories, medical histories and subjective symptoms, including VWF Medical doctor confirmed VWF by showing the subject a photograph of typical VWF conditions |
Prevalence of VWF eliminated |
3 Low |
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Jetzer et al (2003)25
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Cohort study No 165 manufacturers & installers of concrete roofing tiles Hand‐Arm Vibration Syndrome (HAVS) or CTS |
Introduction of new tools with decreased levels of Hand‐Arm vibration exposure and/or ISO 10 819 gloves Primary |
Questionnaire on medical and work history Clinical hand examination by occupational health nurses Vascular tests depending on responses to medical questionnaire and Stockholm Workshop Scale |
Trend toward decreasing prevalence of HAVS
Workers who used new low‐vibration tools and wore ISO 10 819 gloves showed most improvement and least decrement in symptoms |
6 Low |
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| Production systems/organisation culture interventions |
| Production systems/organisation culture intervention |
Christmansson et al (1999)26
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Pre‐/post‐case‐studies No 17 window and door assembly workers Upper extremity pain disorders |
Organisation alterations, control systems and work design (distribution of work tasks)
Primary |
Structured interviews
Video analyses using Hand‐Arm‐Movement‐Analysis (HAMA)
Psycho‐social questionnaires Medical examination |
No improvement in prevalence of upper extremity MSDs during study period Some psychosocial factors improved (eg “influence on and control of work”), some worsened (eg “relationship with fellow workers”) |
4 Low |
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Fernstrom & Aborg (1999)27
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Cohort No 22 female office workers performing data entry tasks Neck, shoulder, arm and hand pain |
Organisation alterations and different work tasks Primary/secondary |
Clinical examination by physiotherapist Diagnoses according to a documented screening method Subjects videotaped throughout test days |
No improvement in neck, shoulder and/or arm pain No difference in number or duration of rest periods between years Increased non‐computer work from 50 min in 1991 to 93 min in 1992 |
8 Low |
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| Modifier interventions |
| Exercise and upper extremity conditions |
Ludewig and Borstad (2003) 28
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Randomised controlled trial Yes (without intervention and without conditions)
92 male construction workers performing overhead work Shoulder Impingement Syndrome |
Stretching and progressive strength training programme Secondary/tertiary(?) |
Self‐reported Shoulder Rating Questionnaire (SRQ)
Modified Shoulder Pain and Disability Index (SPADI) Questionnaire |
Improvement in self‐reported Shoulder Rating Questionnaire (SRQ) and Shoulder Satisfaction Scores |
16 Medium |
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Hagberg et al (2000)29
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Randomised trial No 69 women industrial workers Cervico‐brachial syndrome ICD‐10 code M53.1 |
Isometric shoulder endurance versus strength 16 week training programme Tertiary |
VAS pain scores Sick leave & NSAID use Standarised physical examination Strength, range of motion and endurance tests |
Reduced pain, no difference by training type No reduction in sick leave Improved arm motion performance test Increased shoulder strength |
14 Medium |
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Waling et al (2002)30
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Prospective quasi‐randomised trial No 126 female administrative workers Trapezius Myalgia |
Group training programmes:
a) Strength group b) Endurance group c) Coordination group d) Stress management (non‐training) reference group Tertiary |
VAS pain scores Frequency of pain Pressure pain thresholds Degree of worry Use of analgesics Sick leave |
Reduced frequency of pain and VAS in all groups over time No change in pressure pain thresholds No differences between training groups and reference group on any variable |
12 Medium |
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| Exercise & Fibromyalgia |
Meiworm et al (2000)31
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Experimental trial Yes (without intervention)
39, mostly females Fibromyalgia (FM) |
12 week progressive aerobic endurance exercise programme including walking, jogging, cycling and/or swimming Secondary/tertiary |
Body diagram of pain VAS pain score Pressure pain thresholds |
Decreased painful body area
Reduced mean number of tender points Mean pain threshold unchanged VAS score unchanged No changes in control group |
10 Medium |
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Schachter et al (2003)32
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Randomised controlled trial Yes (without intervention)
143 females FM |
Differing exercise duration:
a) Long Bout of Exercise (LBE)
b) Short Bout of Exercise (SBE)
c) No exercise (NE) (control)
Tertiary |
Body pain diagrams AIMS2 Questionnaire Affect Scale Score Fibromyalgia Impact Questionnaire (FIQ)
VAS pain score CPSS |
Reduced disease severity and improved self‐efficacy within SBE group and compared to NE group Improvements in physical function, disease severity, symptoms, self‐efficacy and psychological well‐being in LBE group |
19 High |
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Valim et al (2003)33
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Randomised trial No 76 females FM |
Two exercise modalities:
a) Aerobic exercise (AE) walking programme,
b) Stretching exercise (SE)
Tertiary |
Sit and reach (flexibility) test Fibromyalgia Impact Questionnaire (FIQ)
Short Form–36 (SF‐36) Question‐naire Beck Depression Inventory (BDI)
Trace‐State Anxiety Inventory Pain score from tender points VAS pain score |
Improvements in AE group compared to SE group of total FIQ score and role emotional and mental health domains of FIQ, the mental component summary of SF‐36, BDI, VAS score and number of tender points No improvement in SE group in mental health or role emotional domains and the Mental Component Summary of the SF‐36 or BDI |
17 Medium |
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van Santen et al (2002)34
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Pre‐/post‐test trial Yes (without intervention)
143 Females FM |
Two intervention modalities:
a) Group supervised fitness programme, (aerobic exercise and isometric strengthening)
b) Biofeedback training for muscle relaxation Tertiary |
VAS pain score VAS fatigue scale Health status: Arthritis Impact Measurement Scale, Sickness Impact Profile (SIP)
Psychological distress: Symptom Checklist‐90‐Revised (SCL‐90)
Physical fitness ‐ bicycle ergometer |
No significant findings except physical fitness worsened for all groups over the study period.
Decrease was less in fitness group compared to control group |
14 Medium |
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| Multiple modifier interventions (including exercise) & upper extremity conditions |
de Greef et al (2003)35
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Randomised controlled trial
Yes (without intervention)
53 Symphony Orchestra Musicians PRMDs |
Specific mobilising, strengthening, and conditioning programme (the Groningen Exercise Therapy for Symphony Orchestra Musicians (GETSOM) programme)
Secondary/tertiary(?) |
Physical Competence Scale (PCS)
World Health Questionnaire for Musicians (WHQM) |
Musculoskeletal disorders decreased
Perceived physical competence increased |
9 Low |
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Chan et al (2000)36
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Pre‐/post‐test trial No 12 Work‐related lateral epicondylitis of elbow |
Education on pathology and ergonomics related to WRMDS, stretching & strengthening exercises to be performed at home and work hardening protocols Secondary/tertiary(?) |
VAS pain scores LLUMC (Loma Linda University Medical Centre) Activity Sort Baltimore Therapeutic Equipment (BTE) Primus measures Dexter Evaluation Computer System Satisfaction with Performance Scaled Questionnaire |
Reductions in pre/post VAS pain scores maintained at 4 and 12 week follow‐up Increased BTE Primus measures Increases in LLUMC Activity Sort Scores and Satisfaction with Performance Scaled Questionnaire Scores maintained at 4th and 12th weeks of follow‐up |
7 Low |
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Omer et al (2003/2004)37
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Randomised controlled trial No true control group 50 VDU workers Cumulative Trauma Disorders (CTDs) including Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS) |
Ergonomic and health education (‘control' group) versus an exercise programme (flexibility, RoM, relaxation, strengthening and postural exercises involving the neck shoulders and wrists performed 3 days per week at lunchtime) (treatment group)
Secondary/tertiary(?) |
Pain assessment using Numeric Rating Scale (NRS)
Pain Disability Index (PDI)
Tiredness Scale (TS)
Beck Depression Inventory BDI) Scale |
Improved NRS, PDI and BDI scores for treatment group |
9 Low |
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van den Heuvel et al (2003)38
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Randomised controlled trial Yes (without intervention)
268 VDU workers Work‐related upper limb repetitive strain injuries according to the Health Council of the Netherlands |
Microbreaks prompted by computer software and “natural” rest breaks versus microbreaks and natural rest breaks combined with the performance of regular exercises performed at the workstation also prompted by the software
Secondary/tertiary(?) |
Perceived overall recovery from complaints Frequency of complaints Severity of pain VAS scale Self‐reported sick leave Productivity |
Self‐reported recovery higher in intervention group No differences between the groups for sick leave Improved productivity in Group 1 (breaks and no exercises) compared to control group Improved accuracy rate in intervention groups compared to control group |
13 Medium |
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| Multiple modifier interventions (including exercise) & Fibromyalgia |
Bailey et al (1999)39
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Prospective pre‐/post‐cohort study No 106 FM |
Fibro‐Fit Programme: 12‐week out‐patient exercise and multidisciplinary programme Tertiary |
Fibro‐Fit self‐efficacy questionnaire Canadian Standardised Test of Fitness (CSTF)
Fibromyalgia Impact Questionnaire (FIQ)
Canadian Occupational Performance Measure (COPM)
Family Crisis Oriented Personal Evaluation Scales (F‐COPES) |
Improvements in all outcome measures
Relationship between smoking and pain. i.e. smokers had less improvement in pain Attendance rate of FM support group related to greater improvement in pain Patients who refused pain or anti‐depressant medications had poorer outcomes |
8 Low |
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Cedraschi et al (2004)40
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Pre‐/post‐test trial Yes (without intervention)
61
FM |
Group training programme. Consisted of pool exercise, relaxation, low impact land exercise, activities of daily living and education.
Tertiary |
Number of tender points and myalgic score Global rating by physician Questionnaires |
Improvement in Fibromyalgia Impact Questionnaire (FIQ) and Psychological General Well‐Being (PGWB) Index No change in objective physician measures |
14 Medium |
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Gowans et al (1999)41
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Randomised controlled trial Yes (delayed intervention; subjects as own controls)
41 FM |
6‐week exercise and education programme (two exercise and two multidisciplinary educational sessions per week)
Tertiary |
Fibromyalgia Impact Questionnaire (FIQ)
Arthritis Self‐Efficacy Scale (ASES)
Knowledge of FM management Questionnaire 6 min walk test |
Improvement in 6 min walk distance, well‐being, self‐efficacy, and FM knowledge
Reduced morning fatigue All gains maintained at follow‐up except morning fatigue and subjects' knowledge of FM management which resumed to baseline levels |
11 Medium |
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Mannerkorpi et al (2000)42
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Pre‐/post‐test trial No true control group used 69 females FM |
Two intervention modalities:
a) Group pool exercise programme b) Education programme Tertiary |
Fibromyalgia Impact Questionnaire (FIQ)
Short Form‐36 Questionnaire (SF‐36)
Swedish Multi‐dimensional Pain Inventory (MPI‐S)
Arthritis Self‐Efficacy Scale (ASES‐S)
Arthritis Impact Measurement Scales (AIMS)
Quality of Life Questionnaire (QOLS) |
Improved FIQ score and walk distance compared with education group
Improved FIQ physical functioning and anxiety scores in exercise compared with education group Improved Sf‐36 general health score, social functioning, pain severity and affective distress components of MPI‐S in exercise group Improved AIMS depression and QOLS in exercise compared to education group |
14 Medium |
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Redondo et al (2004)43
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Prospective, longitudinal, quasi‐randomised, parallel trial No 40 females FM |
Two intervention modalities:
a) Physical Exercise (PE) and cardiovascular fitness programme b) Cognitive‐behavioural therapy (CBT)
Tertiary |
Fibromyalgia Questionnaire (FIQ)
Short Form‐36 (SF‐36)
Beck Anxiety Inventory Chronic Pain Self‐Efficacy Scale (CPSS)
Chronic Pain Coping Inventory Range of Motion and Pain scale |
PE Group: Improvements in most items and total score of FIQ
Improvement in the bodily pain domain of SF‐36 At one year follow‐up none of clinical variables were significantly better than the initial assessment CBT Group: Improved items of FIQ (stiffness, total score) at 8 weeks At 6 month and one year changes not maintained, except improved general health domains of SF‐36 EDUC group: symptoms and pain improved 0–6 weeks; returned to baseline 6–32 weeks |
16 Medium |
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| Multiple modifier interventions (excluding exercise) & upper extremity conditions |
Faucett et al (2002)44
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Randomised controlled trial Yes (without intervention)
139 engineers and microscopic assembly workers of electronic manufacturing corporation Upper limb Work‐Related Musculoskeletal Disorders (WRMSDs) |
Muscle Learning Therapy (MLT) or educational group (EDUC) consisting of OHN‐delivered education and Cognitive Behavioural Training (CBT) that addressed symptom and stress management and problem solving Primary |
Symptom Diary Data VAS pain measures Surface Electromyography (EMG) |
MLT group: 0–6 weeks no change in symptoms and pain; 6–32 weeks worsened Control group: 0–6–32 weeks symptoms and pain steadily worsened Differences at 6 weeks significant, but not over all time periods |
10 Medium |
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Bohr (2000)45
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Randomised controlled trial No, comparison of two intervention groups 102 VDU workers Neck, shoulder and upper limb pain |
Traditional ergonomic education versus participatory ergonomic education Primary |
Paper and pencil surveys Observational checklists Standardised Nordic musculoskeletal questionnaire
Work AGPAR score |
No difference between two groups for observation data scores for the work area configuration, worker postures, or overall scores No difference between two groups for upper body pain/discomfort or APGAR scores |
9 Low |
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| Multiple modifier interventions (excluding exercise) & Fibromyalgia |
Oliver et al (2001)46
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Randomised controlled trial Yes (without intervention)
600 patients FM |
Social support versus social support combined with health and self‐help education Tertiary |
Health Care Costs Knowledge of FM
‘Guttman‐like' Group Cohesiveness Scale Adapted Arthritis Self‐Efficacy Scale |
Reduced helplessness for participants in all groups but more markedly in social support and education group |
12 Medium |
