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.


OBJECTIVE
The objective of this systematic review is to determine the effectiveness of biopsychosocial rehabilitation for upper limb repetitive strain injuries among working age adults.


METHODS
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.


METHODS
Randomised controlled trials and controlled trials comparing biopsychosocial measures for the treatment of repetitive upper limb strain injury in working age adults


METHODS
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.


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.


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.
Karjalainen
K
K
Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, Helsinki, Finland. Kaija.Karjalainen@occuphealth.fi
Malmivaara
A
A
van Tulder
M
M
Roine
R
R
Jauhiainen
M
M
Hurri
H
H
Koes
B
B
D000328:Adult; D000368:Aged; D001132:Arm; D018849:Controlled Clinical Trials as Topic; D012090:Cumulative Trauma Disorders / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D012944:Social Support