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Överskrift Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults
Upplaga Issue 3
Sidor CD003471
Överskrift Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults
Beskrivning Conservative interventions such as physiotherapy and ergonomic adjustments (such as keyboard adjustments or ergonomic advice) play a major role in the treatment of most work-related complaints of the arm, neck or shoulder (CANS). OBJECTIVES: This systematic review aims to determine whether conservative interventions have a significant impact on outcomes for work-related CANS in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2005) and Cochrane Rehabilitation and Related Therapies Field Specialised Register (March 2005), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2005), PubMed, EMBASE, CINAHL, AMED and reference lists of articles. The date of the last search was March 2005. No language restrictions were applied. SELECTION CRITERIA: We included randomised and non-randomised controlled trials studying conservative interventions (e.g. exercises, relaxation, physical applications, biofeedback, myofeedback and work-place adjustments) for adults suffering CANS. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials from the search yield, assessed the methodological quality using the Delphi list, and extracted relevant data. We pooled data or, in the event of clinical heterogeneity or lack of data, we used a rating system to assess levels of evidence. MAIN RESULTS: For this update we included six additional studies; 21 trials in total. Seventeen trials included people with chronic non-specific neck or shoulder complaints, or non-specific upper extremity disorders. Over 25 interventions were evaluated; five main subgroups of interventions could be determined: exercises, manual therapy, massage, ergonomics, and energised splint. Overall, the quality of the studies was poor.In 14 studies a form of exercise was evaluated, and contrary to the previous review we now found limited evidence about the effectiveness of exercises when compared to massage and conflicting evidence when exercises are compared to no treatment. In this update there is limited evidence for adding breaks during computer work; massage as add-on treatment on manual therapy, manual therapy as add-on treatment on exercises; and some keyboard designs when compared to other keyboards or placebo in participants with carpal tunnel syndrome. AUTHORS' CONCLUSIONS: There is limited evidence for the effectiveness of keyboards with an alternative force-displacement of the keys or an alternative geometry, and limited evidence for the effectiveness of exercises compared to massage; breaks during computer work compared to no breaks; massage as an add-on treatment to manual therapy; and manual therapy as an add-on treatment to exercises. PLAIN LANGUAGE SUMMARY: Are physiotherapy or ergonomic workplace adjustments helpful in participants with work-related arm, neck or shoulder complaints?In the USA, cumulative trauma disorders account for between 56 and 65% of all occupational injuries. Overall, the estimated prevalence of these injuries is approximately 30% and the incidence is rapidly increasing. Conservative interventions such as physiotherapy and ergonomic work-place adjustments play a major role in the treatment. There is a need to determine whether these interventions have a significant impact on short-term and long-term outcomes. This review shows that there is limited evidence about the positive effect of exercise when compared to massage (one study); adding breaks during computer work (one study); massage as add-on treatment on manual therapy (one study), manual therapy as add-on treatment on exercises (one study); and some keyboards in people with carpal tunnel syndrome when compared to placebo (one study). There is conflicting evidence concerning the efficacy of exercises over no treatment (eight studies) or as add-on treatment (three studies), and no differences between strength and endurance exercises can be found yet (four studies). At the moment there is also conflicting evidence about the effectiveness of ergonomic programs over no treatment (two studies). No adverse effects were mentioned in the studies. The most important limitations of the included studies are the heterogeneity of the participants, interventions and outcome measures used. No clear definition of 'work-relatedness' could be found in the majority of the studies. Methodological flaws and low power in many of the studies may have influenced the results.
Källa Cochrane Database of Systematic Reviews
Publicerad 2006
Författare Bierma-Zeinstra SMA, Burdorf L, Dahaghin S, de Vet HCW, Feleus A, Goriunova AV., Karels C, Koes BW, Verhagen AP

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