Which workplace interventions are most effective in preventing upper extremity MSDs?

Upper extremity musculoskeletal disorders include pain, numbness or trauma to the neck, shoulder, arm, wrist and/or hand. MSDs are a problem for society and workplaces because they result in lost productivity, poor performance and lost-time claims. Approaches to prevention range from ergonomics training to new equipment. The difficulty is in knowing which intervention technique will supply the greatest benefit. This systematic review asks which occupational health and safety interventions are most effective in preventing upper extremity MSDs.

An international team of 14 researchers evaluated peer-reviewed studies of workplace interventions. Researchers looked at the effects of these interventions in reducing upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and time lost from work. The review team identified 36 medium or high quality studies from 15,000 articles. Stakeholders were valuable to the review process, providing comment on the research question, search terms and findings.

Taken together, the 36 studies provide a “mixed” level of evidence that occupational health and safety interventions prevent upper extremity MSDs. This means that the study findings were inconsistent (some studies showed a positive effect and some showed no effect; no studies showed negative or harmful effects).

The researchers found a strong level of evidence that workstation adjustment alone has no effect on upper extremity MSD outcomes.They found a moderate level of evidence that arm supports have a positive effect on upper extremity MSD outcomes, and that job stress management training and biofeedback training have no effect on these outcomes.

The researchers found a limited level of evidence that cognitive behavioural training has no effect on upper extremity MSD outcomes. They also found a limited level of evidence that training on ergonomics plus workstation adjustment, a new chair, and rest breaks have a positive effect on upper extremity MSD outcomes.

The researchers found a mixed level of evidence for:

• Training on ergonomics plus exercise programs;
• Alternative pointing device;
• Alternate keyboards; and
• Ergonomics training. 

Finally, the researchers found an insufficient level of evidence for:

• Miscellaneous work redesign programs;
• Rest breaks plus exercise programs;
• Participatory ergonomics;
• Broad-based MSK injury prevention programs;
• Prevention strategies plus physical therapy; and
• Multi-component patient handling.

This review benefitted from the different backgrounds and specializations of the team members and the engagement of stakeholders in the review process. The review was restricted to studies reported in peer-reviewed publications.