title: Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time.
abstract: BACKGROUND
  Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries.
  
  
  METHODS
  A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?"
  
  
  RESULTS
  The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects".
  
  
  CONCLUSIONS
  It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.
authors.affiliation: The Institute for Work & Health, 481 University Avenue, Toronto, Ontario, Canada. ckennedy@iwh.on.ca
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kennedy
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Amick
authors.forename: Jack T
authors.initials: JT
authors.lastname: Dennerlein
authors.forename: Shelley
authors.initials: S
authors.lastname: Brewer
authors.forename: Starly
authors.initials: S
authors.lastname: Catli
authors.forename: Renee
authors.initials: R
authors.lastname: Williams
authors.forename: Consol
authors.initials: C
authors.lastname: Serra
authors.forename: Fred
authors.initials: F
authors.lastname: Gerr
authors.forename: Emma
authors.initials: E
authors.lastname: Irvin
authors.forename: Quenby
authors.initials: Q
authors.lastname: Mahood
authors.forename: Al
authors.initials: A
authors.lastname: Franzblau
authors.forename: Dwayne
authors.initials: D
authors.lastname: Van Eerd
authors.forename: Bradley
authors.initials: B
authors.lastname: Evanoff
authors.forename: David
authors.initials: D
authors.lastname: Rempel
mesh_terms: D006801:Humans; D009140:Musculoskeletal Diseases / Q000517:prevention & control*; D009784:Occupational Diseases / Q000517:prevention & control*; D016272:Occupational Health; D016032:Randomized Controlled Trials as Topic; D034941:Upper Extremity; D014942:Workers' Compensation; D017132:Workplace