title: Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. A Cochrane systematic review.
abstract: BACKGROUND
  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 controlled trials and concurrent 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.
  
  
  RESULTS
  For this update we included six additional studies; twenty-one trials in total. Seventeen trials included people with chronic nonspecific neck or shoulder complaints, or nonspecific upper extremity disorders. Over twenty-five interventions were evaluated; six main subgroups of interventions could be determined: exercises, manual therapy, massage, ergonomics, energised splint and individual treatment versus group therapy. 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.
  
  
  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.
authors.affiliation: Erasmus MC, University Mediacal Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands. a.verhagen@erasmusmc.nl
authors.forename: A P
authors.initials: AP
authors.lastname: Verhagen
authors.forename: C
authors.initials: C
authors.lastname: Karels
authors.forename: S M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: A
authors.initials: A
authors.lastname: Feleus
authors.forename: S
authors.initials: S
authors.lastname: Dahaghin
authors.forename: A
authors.initials: A
authors.lastname: Burdorf
authors.forename: H C W
authors.initials: HC
authors.lastname: De Vet
authors.forename: B W
authors.initials: BW
authors.lastname: Koes
mesh_terms: D000328:Adult; D001132:Arm; D012090:Cumulative Trauma Disorders / Q000534:rehabilitation*; D006804:Ergonomics; D006801:Humans; D009333:Neck; D009784:Occupational Diseases / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D012782:Shoulder; D016896:Treatment Outcome