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PubMed2001

Clinical tools to facilitate workplace accommodation after treatment for an upper extremity disorder.

Failure to implement work site accommodations for work-related upper extremity disorders (WRUEDs) may be a factor contributing to delayed functional recovery and relapse. The present study describes the use of the 38-item Job Requirements and Physical Demands (JRPD) scale, a self-report measure of ergonomic exposure, and other case management tools to improve accommodation efforts for 101 workers (75 women, 26 men) returning to work after lost time related to a WRUED. Items were categorized into five subscales based on item content: administrative, computer-related, workstation design, environmental, and equipment. Administrative risk factors were elevated among office clerks, whereas postal clerks and letter carriers reported more workstation design risk factors, and letter carriers and electrical/mechanical workers cited more equipment-related risk factors (p < 0.05). All occupational categories rated computer-related risk factors highest. The Integrated Case Management (ICM) approach, which relies on the JRPD scale to guide recommendations, was used with a subgroup of these workers (n = 53), resulting in 1.4 times more workplace accommodations per worker than with a non-ICM approach. Clinical use of the self-reported exposure measure within the overall workplace accommodation process may have been a factor contributing to more frequent accommodation in the ICM group. This study of a subgroup of workers' compensation cases highlights the need for additional investigation of tools to integrate ergonomic approaches within the workplace accommodation process.

Arm Injuries↗
PubMed1997

Arm motion speed and risk of neck pain. A preliminary communication.

STUDY DESIGN: A sample of 486 Helsinki City Council workers, 35 to 54 years of age, was examined twice at a 1-year interval. OBJECTIVES: To investigate the speed of repetitive arm motion for its ability to predict neck pain. SUMMARY OF BACKGROUND DATA: Psychomotor factors have been suggested to play a role in the etiology of spinal disorders. It was hypothesized that motor skills, as reflected by arm motion speed, could provide protection against neck pain. METHODS: Both the baseline and follow-up examinations consisted of a questionnaire on the history of neck pain and of a number of tests, including arm motion speed and static and dynamic strength of the upper extremities. RESULTS: Of the 124 men and women who reported not having had neck pain during the 1 year before the baseline examination, 23 (19%) reported neck pain on reexamination. The incidence of neck pain was significantly higher both in the least and most rapid quintiles of arm motion speed than in the medium quintiles. This association was not confounded by age, sex, smoking, physical activity at work or at leisure, psychological distress score, or strength measures of the upper extremities, although these factors were significant covariates of the arm motion speed at baseline. When adjusted for these factors, the odds ratios of neck pain in the most and least rapid quintiles of arm motion speed were 8.68 (95% confidence interval 1.85-40.75) and 9.57 (95% confidence interval 2.21-41.52) respectively, compared with the medium quintiles. CONCLUSIONS: These results suggest that people with either very slow or very rapid arm motion speed may have an increased risk of neck pain. The etiology of neck pain is probably different on these two occasions.

Adult↗
PubMed2002

Biomechanical models for the pathogenesis of specific distal upper extremity disorders.

BACKGROUND: Knowledge of the pathogenesis of most disorders that occur in the distal upper extremity is generally lacking. The individual roles of postulated etiologic factors, such as biomechanical or psychosocial exposures, are poorly understood and their potential interactions even less so. This article proposes biomechanical or physiological models of pathogenesis for specific distal upper extremity disorders. METHODS: Tendon entrapment of the dorsal wrist compartments (tenosynovitis), peritendinitis, lateral epicondylitis, and carpal tunnel syndrome are common specific neuromusculoskeletal disorders of the upper extremities observed among workers. The normal anatomy and function of the targeted structures is considered the initial state; their pathology is considered the final state. Using biomechanical or physiological principles combined with clinical observations and experimental studies, pathways leading from the initial state to the final state are proposed. Each model defined a critical biomechanical or physiological attribute that was considered to best characterize 'dose.' Two temporal patterns of exposure (duration vs. repetition) were used to characterize 'dosage.' The roles of long-term exposure vs. unaccustomed work were mentioned, but not incorporated into the models. RESULTS: Compressive force transmitted to the extensor retinaculum was considered the critical factor in the model for tendon entrapment at the dorsal wrist compartments. Two models were proposed for lateral epicondylitis. One emphasized the role of eccentric exertions; the other emphasized contact pressure from the radial head. The model for peritendinitis relied on localized muscle fatigue. Seven plausible models were presented for carpal tunnel syndrome. CONCLUSIONS: It is possible to propose biologically plausible models of pathogenesis that are both coherent with current knowledge of tissue responses and consistent with clinical observations; however, more than one model was plausible for some conditions. Additional research is needed to determine which, if any, of the proposed models might be correct. Such models may be useful to health care providers and ergonomists in the context of primary, secondary, or tertiary prevention.

Biomechanical Phenomena↗
PubMed2006

Quantifying repetitive hand activity for epidemiological research on musculoskeletal disorders--part II: comparison of different methods of measuring force level and repetitiveness.

This paper focuses on comparisons between the different methods of assessing repetitive hand activities. Various methods were used to measure hand force and repetitiveness of hand activities on 733 subjects in the study described by Bao et al. (2006). Two definitions of repetitiveness were used in analysis of detailed time studies of repetitive hand activities and four parameters of the American Conference of Governmental Industrial Hygienists (ACGIH) hand activity level (HAL) and the Strain Index methods were estimated by ergonomists and used to quantify repetitiveness. Hand forces were measured or estimated using three different methods: 1) measured with a force gauge or mimicked on a force gauge (force matching); 2) estimated by ergonomists using rating scales; 3) self-reports by subjects. The jobs were also evaluated using the ACGIH HAL and Strain Index methods when different repetitiveness quantification methods were used. Results showed that different definitions of repetitive exertion might lead to measuring different physical exposure phenomena and produce very different results. There were poor correlations between the measures of repetitiveness estimated by the different methods. Correlations between force quantifications using different methods were also poor. This suggests that parameters measured by different methods might not be interchangeable. Both the ACGIH HAL and Strain Index methods identified more 'hazardous' jobs when repetitiveness was estimated by ergonomists than when it was calculated by detailed time studies of forceful hand exertions. The Strain Index method identified more 'hazardous' jobs than the ACGIH HAL method. Overall, the between-methods agreements were found to be moderate to substantial.

Adolescent↗
PubMed2005

Predictors of persistent elbow tendonitis among auto assembly workers.

INTRODUCTION: Lateral and medial epicondylitis associated with work activity is a common upper extremity musculoskeletal disorder with a prevalence of 4-30% depending upon the work setting and diagnostic criteria. The influence of treatment, ergonomic factors, medical history, psychosocial variables, and aging on the improvement of symptoms has not been well defined. METHODS: This was a prospective cohort study of a cohort of 45 workers with active elbow tendonitis for an average of 13 months. Complete resolution of symptoms was the defined outcome measure. RESULTS: The predictive factors for persistent elbow tendonitis included older age (OR = 1.1, 95% CI: 0.99, 1.33), higher hand repetition level for their job(s) (OR = 2.5, 95% CI: 1.00, 6.25), more deviation from a neutral wrist position during the work activity (OR = 2.0, 95% CI: 0.80, 5.56), and lower perceived decision authority on the job (OR = 0.9, 95% CI: 0.79, 0.98). Other ergonomic, psychosocial, and electrophysiologic measures were not predictive. The models had relatively high sensitivity and specificity. Treatment effects could not be evaluated due to incomplete data available. CONCLUSIONS: Older workers with jobs requiring more repetition and awkward wrist postures, and less decision authority were less likely to have resolution of their elbow tendonitis. IMPLICATIONS: Workers at highest risk for persistent elbow tendonitis should be placed at jobs with lower repetition levels and that use more neutral wrist postures. Effective interventions must address both the ergonomic and psychosocial risk factors in a multifaceted approach to this problem.

Adult↗
PubMed2003

Effects of software programs stimulating regular breaks and exercises on work-related neck and upper-limb disorders.

OBJECTIVES: This study evaluated the effects on work-related neck and upper-limb disorders among computer workers stimulated (by a software program) to take regular breaks and perform physical exercises. Possible effects on sick leave and productivity were studied as well. A randomized controlled design was used with cluster randomization. Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were randomized into a control group, one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod. Questionnaires were administered before andafter the intervention, and questions were generated by the software during the intervention period. Computer usage was recorded online. RESULTS: The data on self-reported recovery suggested a favorable effect; more subjects in the intervention groups than in the control group reported recovery (55% versus 34%) from their complaints and fewer reported deterioration (4% versus 20%). However, a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups. No effects on sick leave were observed. The subjects in the intervention groups showed higher productivity. CONCLUSIONS: The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints. There seems to be no additional effects from performing physical exercises during these breaks.

Analysis of Variance↗
PubMedDate not supplied

[The application of the concise exposure index to repetitive movement tasks of the upper limbs in various production settings: preliminary experience and validation].

A summary of eight investigations is presented, which were carried out using standardised methods, for the purpose of quantifying exposure to tasks involving repetitive movements of the upper limbs, as well as quantifying the prevalence of Work Related Musculo Skeletal Disorders of the upper limbs in groups of exposed workers. A total of 462 exposed workers were examined, and the study also took into account the data pertaining to a matched control group comprising 749 workers not exposed to any specific occupational risk. Regarding the quantification of exposure to increased risk, use was made of a Concise Index (OCRA), proposed by the Authors in a previous publication. The data resulting from the eight investigations were used for the study of measurements and models of association among the exposure variables (mainly represented by the OCRA index), as well as the effect variables represented by the prevalence of the various WMSDs of the upper limbs taken both individually and jointly. Significant associations were reported between the OCRA index and an effect indicator represented by the prevalence of all the WSMDs of the upper limbs, calculated on the number of upper limbs at risk. When a logarithmic conversion of the relative exposure (OCRA) and injury indices was carried out, a simple linear regression model resulted which seems to provide a satisfactory predictive performance of the risk of WMSDs of the upper limbs, based on the exposure index. The study confirmed the efficacy of various other models designed to predict effects based on multiple linear regression functions, in which the independent variables are represented by both the OCRA exposure index and by parameters relative to the breakdown by sex and age of the groups of exposed workers.

Adult↗
PubMed2006

Keyboard use and musculoskeletal outcomes among computer users.

BACKGROUND: In this review, the epidemiological evidence examining associations between upper extremity musculoskeletal symptoms and disorders and keyboard use intensity (hours of computer use-per day or per-week) and computer user posture was explored. METHODS: An OVID Medline literature search was conducted to identify papers published in the peer-reviewed medical literature between 1966 and November, 2005. A total of 558 citations were found and reviewed. Those papers in which associations between musculoskeletal outcomes and (1) posture (ascertained by a study investigator) or (2) computer use, in units of hours-per-day, hours-per-week, or as a percent of work-time, were included in the review. RESULTS: Thirty-nine epidemiological studies examining associations between computer use and MSD outcomes were identified. While the observational epidemiological literature was heterogeneous, some trends did emerge. It appears that the most consistent finding was the association observed between hours keying and hand/arm outcomes. Associations between some postural effects and musculoskeletal outcomes may also be inferred from the literature. In particular, placing the keyboard below the elbow, limiting head rotation, and resting the arms appears to result in reduced risk of neck/shoulder outcomes. Minimizing ulnar deviation and keyboard thickness appears to result in reduced risk of hand/arm outcomes. CONCLUSIONS: Several methodological limitations, including non-representative samples, imprecise or biased measures of exposure and health outcome, incomplete control of confounding, and reversal of cause and effect, may contribute to the heterogeneity of observed results. Suggestions are made for improving the validity of future investigations.

Computer Peripherals↗
PubMed2004

A multi-method approach to assessing deadlines and workload variation among newspaper workers.

OBJECTIVES: Working under frequent deadlines was previously found to be associated with upper limb work-related musculoskeletal disorders (WMSDs) in newspaper workers. Further investigation was required so that concrete recommendations for change could be offered to the workplace parties (labour and management of a large metropolitan newspaper). STUDY DESIGN: The assessment was based on three methods. A questionnaire was used to clarify time-related aspects of work on deadlines for a larger group of workers. Experience sampling was used to document temporal variation in various aspects of physical and psychological demands over work shifts and deadline cycles. Focus groups were also conducted. RESULTS: Differences were found between the "High" and "Low" deadline groups: Those working with frequent deadlines more frequently were required: to work together with others, to perform tasks on a specific schedule and specific order, to work at a fast paced, to perceive their work as hectic and "hard". Experience sampling showed differential trends in workload across daily, weekly, and no deadline days. The lack of breaks for extended periods of time leading up to a deadline was noticeable. The focus groups were useful in highlighting issues not addressed by the other two methods and to understand the feasibility of various possible interventions. CONCLUSIONS: The integration of results from all methods lead to recommendations for issues upon which to focus prevention related activities where deadlines are present: delays in work flow from others, interruptions from technology related problems, excessive work, insufficient staff/insufficient time, extra/unexpected work, compromising of work quality for speed, and lack of time for breaks.

Cumulative Trauma Disorders↗
PubMed2005

Course of symptoms and median nerve conduction values in workers performing repetitive jobs at risk for carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common occupational disorder associated with repetitive manual work. Little information exists about the possible relation between the variation of biomechanical hand/wrist exposure and the development of symptoms and median nerve conduction values. AIMS: To investigate the prevalence of CTS in a group of workers exposed to intensive use of the hands and the course of symptoms and median nerve conduction values after a period of reduced exposure to biomechanical risk factors. METHODS: CTS was assessed in assembly and non-assembly line workers by means of clinical examinations and nerve conduction studies (NCS). Ergonomic analysis was conducted for each assembly line workstation. RESULTS: Prevalence of CTS was significantly higher in assembly line workers compared to non-assembly line workers but there was a high prevalence of median nerve conduction abnormalities in both groups (60/102 hands and 40/110 hands, respectively). In a sizable proportion of both groups there was no relationship between symptoms and electrodiagnostic findings (45 hands and 48 hands in assembly and non-assembly line workers, respectively). When assembly line workers were re-examined after 2 years following a period of reduced work schedule, a significant proportion reported resolution of symptoms or had reverted to having normal NCS. CONCLUSIONS: In our study, repetitive work was associated with a higher level of CTS and abnormal NCS. These findings appeared to be reversible following a period of less repetitive work. Overall, there was generally poor correlation between symptoms and electrodiagnostic findings.

Adult↗
PubMed2005

Physical load exposure at construction sites.

OBJECTIVES: This field study analyzed work-related causes of musculoskeletal disorders to investigate the structure of physical workload in different occupations in the construction industry and rank different tasks with respect to the load on the lumber spine. METHODS: An observation instrument (Arbeitswissenschaftliches Erhebungsverfahren für Bauarbeiten) and a specially devised data retrieval system (Allgemeines Datenerfassungs- und Analysesystem für Bauarbeit) provided material for a large database which allowed a differentiated analysis of load exposures. The study was comprised of data from 340 construction workers (bricklayers, scaffolders, carpenters, plumbers, and painters). On the basis of a regular daily worktime of 8 hours, specific statistical aspects were studied concerning manual materials handling, biomechanical pressure on lumbar disc L5/S1, and posture constraints during kneeling, squatting, bending and overhead positions. RESULTS: The scaffolders (13.7% of the regular daily worktime), bricklayers using bricks requiring two hands (7.1%), and carpenters (6.7%) handled weights of > 10 kg. With respect to lumbar disc L5/S1, the scaffolders and bricklayers often showed pressures in excess of 3.4 kN. Bricklaying required bent postures for 20.7-35.6% of the daily worktime. The painters (23.8%), plumbers (16.7%), and carpenters (7.2%) often worked in kneeling postures. The painters often used overhead positions (18.3%). The bricklayers and scaffolders had high frequencies of materials handling. The recovery time for this repetitive work was longer than threefold the load time. CONCLUSIONS: This study showed that it is possible to rank different construction tasks with respect to load exposure. In addition it was shown that preventive measures such as improved ergonomic design, organizational structure, training, and medical health care are needed.

Cumulative Trauma Disorders↗
PubMedDate not supplied

[Guidelines for redesigning jobs with repetitive tasks].

Preventive measures aimed at minimising the occurrence of work-related musculo-skeletal disorders of the upper limbs (WMSDs) associated with repetitive tasks can be divided into 3 categories: structural, organisational and educational. Whenever specific risk and injury assessments have shown the need for preventive action, this is most often implemented within the framework of a range of assorted measures. In particular, structural measures pertain to optimising the layout of the work area and furnishings, and the "ergonomic" properties of work tools and equipment. Such measures serve to alleviate the problems caused by the use of excessive force and improper postures. The authors refer to the principles guiding such structural measures, in the light of the extensive literature that has been published on the subject. Organisational (or re-organisational) measures essentially relate to job design (i.e. distribution of tasks, speeds and pauses). They serve to alleviate problems connected with highly repetitive and frequent actions, excessively lengthy tasks and inadequate recovery periods. Very few relevant findings are available: the authors therefore illustrate in some detail a practical trial conducted in a major engineering firm. The objective was to lower to acceptable limits the frequency of certain repetitive tasks performed by workers using their upper limbs. The trial made it possible to identify a suitable plan and schedule of measures taking into due consideration the impact of the plan on production levels (and costs). The fundamental principles guiding the adoption of specific educational and training programmes for the workers and their supervisors are presented and discussed.

Arm↗
PubMed1996

A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys.

In this study we tested a neuroplasticity/learning origins hypothesis for repetitive strain injuries (RSIs), including occupationally induced focal dystonia. Repetitive movements produced in a specific form and in an appropriate behavioral context cause a degradation of the sensory feedback information controlling fine motor movements, resulting in the "learned" genesis of RSIs. Two adult New World owl monkeys were trained at a behavioral task that required them to maintain an attended grasp on a hand grip that repetitively and rapidly (20 msec) opened and closed over short distances. The monkeys completed 300 behavioral trials per day (1,100 to 3,000 movement events) with an accuracy of 80 to 90%. A movement control disorder was recorded in both monkeys. Training was continued until the performance accuracy dropped to below 50%. We subsequently conducted an electrophysiologic mapping study of the representations of the hand within the primary somatosensory (SI) cortical zone. The hand representation in the true primary somatosensory cortical field, SI area 3b, was found to be markedly degraded in these monkeys, as characterized by (1) a dedifferentiation of cortical representations of the skin of the hand manifested by receptive fields that were 10 to 20 times larger than normal, (2) the emergence of many receptive fields that covered the entire glabrous surface of individual digits or that extended across the surfaces of two or more digits, (3) a breakdown of the normally sharply segregated area 3b representations of volar glabrous and dorsal hairy skin of the hand, and (4) a breakdown of the local shifted-overlap receptive field topography of area 3b, with many digital receptive fields overlapping the fields of neurons sampled in cortical penetrations up to more than four times farther apart than normal. Thus, rapid, repetitive, highly stereotypic movements applied in a learning context can actively degrade cortical representations of sensory information guiding fine motor hand movements. This cortical plasticity/learning-based dedifferentiation of sensory feedback information from the hand contributes to the genesis of occupationally derived repetitive strain injuries, including focal dystonia of the hand. Successful treatment of patients with RSI will plausibly require learning-based restoration of differentiated representations of sensory feedback information from the hand.

Animals↗
PubMed2002

Forearm EMG response activity during motor performance in individuals prone to increased stress reactivity.

BACKGROUND: Work-related Upper Extremity Disorders (WRUEDs) are conceived of as a multifactorial syndrome caused by the effects of excessive repetitive motions, sustained static postures, and muscular stiffness. Our aim is to test an etiological model derived from a theory by Van Galen and Van Huygevoort [2000] Biol Psychol 51:151-171. The theory holds that physical, emotional, and psychosocial stressors enhance muscular stiffness as a compensatory filtering of impoverished signal-to-noise ratios in the motor system. High individual levels of arousal, as measured by Spielberger et al. [1970], State and Trait Anxiety Test would further enhance a subject's predisposition to react with stiffness responses in conditions of stress. METHODS: Ten participants with a high- and 10 with a low trait-anxiety score performed a computer task involving series of fast but well-dosed accelerations of the forearm along the surface of a digitizer. To induce cognitive stress a tone had to be remembered simultaneously with the aiming task. Pen-tip displacements and surface electromyographic (EMG) signals were recorded from four forearm muscles. RESULTS: Memory load did not affect error rates but produced shorter reaction times and prolonged movement times. EMG data show that under stress overall levels of neuromotor activation were enhanced. High-anxious participants exhibited higher cocontraction levels than low-anxious participants. CONCLUSIONS: The findings support the view that stress and muscular tension are closely related and may provide a clue to the origin of WRUEDs.

Adult↗
PubMed1996

Adjusting for the healthy worker selection effect in cross-sectional studies.

BACKGROUND: In a cross-sectional study of musculoskeletal disorders, women employed in highly repetitive manual work (garment assembly) were found to have approximately double the risk observed in a population with more varied tasks (hospital work). It was suspected that this estimate might be biased if garment workers with musculoskeletal pain were more likely than others to leave employment. METHODS: Retrospective information on date of first onset of symptoms and years employed to date of pain onset, or to survey date (whichever was earlier), was used to calculate age and calendar period-specific rates of onset, conditional on remaining employed until the survey. RESULTS: These rates, and the relative risk for garment work, increased over the 20-year period preceding the year of the survey. The trend was not explained by age or length of employment, or by any known changes in work demands that might have caused a true increase in incidence density. CONCLUSIONS: In the absence of longitudinal cohort data, alternative explanations for these results cannot be excluded. However, with specified assumptions, the most plausible appears to be a healthy worker selection effect acting differentially between high and low exposure groups. This effect would have caused the smallest bias in the prevalence in the year immediately before the survey, and a better estimate of the true relative risk would be approximately five. Where date of onset has been obtained, this method may be used in other cross-sectional studies to estimate and reduce the magnitude of selection bias in a survivor population, if longitudinal data cannot be collected.

Bias↗
PubMed2001

Physical exposure assessment in monotonous repetitive work--the PRIM study.

OBJECTIVES: A program called the Project on Research and Intervention in Monotonous Work (PRIM) was initiated in 1994 as a prospective cohort study of work-related musculoskeletal disorders. The group-based exposure assessment strategy, focusing on task-related exposure and used to obtain baseline measures of physical exposures, is reported in this paper. METHODS: Monotonous, repetitive worktasks were evaluated at 19 factories. Tasks with an estimated similarity in physical exposure were aggregated before 103 exposure groups were formed. Subjects from the exposure groups were randomly sampled for measurements, and task-related exposure levels were quantified by 43 single exposure items using a real-time video-based observation method that allowed computerized estimates of repetitiveness, body postures, force, and velocity. In combination with questionnaire-based data on task distribution, the duration of exposure was calculated at the individual level. RESULTS: The video-based observational method and the large number of exposure variables enabled the establishment of detailed quantitative exposure profiles in 103 task-based exposure groups. However, methodological problems associated with the use of grouped exposure assessment were revealed. Despite efforts to optimize group homogeneity, the within-group variance was larger than the between-group variance for several shoulder postural variables. CONCLUSIONS: A task-based exposure-assessment strategy can be successful in solving some of the main problems associated with the assessment of physical workplace exposures. The large within-group variance in exposure to nonneutral shoulder postures may eventually require individual assessment or the inclusion of groups with maximal contrast in exposure or both.

Adult↗
PubMed2007

Inflammatory biomarkers increase with severity of upper-extremity overuse disorders.

MSDs (musculoskeletal disorders) from overuse are common occupational health problems that cause pain, functional loss and loss of work time. The aim of the present study was to determine whether a relationship exists between the severity of early-onset overuse-related MSDs of the upper extremity and serum levels of IL-1beta (interleukin-1beta), TNF-alpha (tumour necrosis factor-alpha), IL-6 (interleukin-6) and CRP (C-reactive protein). Twenty-two subjects with upper-extremity MSDs due to overuse for no longer that 12 weeks were stratified according to the severity of upper-extremity signs and symptoms as determined by a UBMA (upper-body musculoskeletal assessment). Nine asymptomatic subjects also participated. Serum cytokines were analysed using ELISA, and CRP was analysed using a laser nephelometry technique. CRP was strongly correlated, and TNF-alpha, IL-1beta and IL-6 were moderately correlated, with UBMA scores. Only CRP and TNFalpha were significantly associated with UBMA scores in an ordinal logistic regression analysis in which age and BMI (body mass index) were covariates. These results are of clinical importance as they suggest that early-onset overuse-related MSDs may have an inflammatory component. The possibility of using a combination of serum biomarkers to follow the progression of overuse-related MSDs or their response to therapeutic intervention may be of interest to clinical practitioners and should be the focus of future research.

Adult↗
PubMed2000

Biopsychosocial rehabilitation for upper limb repetitive strain injuries in working age adults.

BACKGROUND: Upper limb repetitive strain injury is a common problem in western countries, causing human suffering and huge economical losses. Patients with prolonged pain associated with repetitive tasks in the work place can face both psychological and physical difficulties. Different treatment programmes, physical, psychological, behavioural, social and occupational treatments have been developed and used to help these patients. OBJECTIVES: The objective of this systematic review is to determine the effectiveness of biopsychosocial rehabilitation for upper limb repetitive strain injuries among working age adults. SEARCH STRATEGY: The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for a more broad area of musculoskeletal disorders. Trials on repetitive strain injuries were separated afterwards. SELECTION CRITERIA: Randomised controlled trials and controlled trials comparing biopsychosocial measures for the treatment of repetitive upper limb strain injury in working age adults DATA COLLECTION AND ANALYSIS: Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of biopsychosocial rehabilitation. MAIN RESULTS: We found only two relevant studies that satisfied our criteria. They assessed the effectiveness of two specific interventions and were both considered as low quality trials. The clinical relevance of the included studies was also unsatisfactory. The level of scientific evidence for the effectiveness of biopsychosocial rehabilitation for repetitive strain injuries was limited. One small trial found that hypnosis supplementary to comprehensive treatment can decrease the intensity of pain for acute RSI in six weeks follow-up. REVIEWER'S CONCLUSIONS: We conclude that presently there appears to be little scientific evidence for the effectiveness of biopsychosocial rehabilitation on repetitive strain injuries. As RCTs on more intensive and comprehensive biopsychosocial treatment programmes for RSI are lacking, there does not seem to be reliable data for these interventions. There is a need for high quality trials in this field.

Adult↗