Workplace management of upper limb disorders: a systematic review.
BACKGROUND
Upper limb pain is common among working-aged adults and a frequent cause of absenteeism.


OBJECTIVE
To systematically review the evidence for workplace interventions in four common upper limb disorders.


METHODS
Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology.


RESULTS
1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis.


CONCLUSIONS
Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.
Environmental and Occupational Medicine, Population Health Section, Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZP, UK. f.dick@abdn.ac.uk
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Dick
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Graveling
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Munro
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Walker-Bone
D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000534:rehabilitation*; D016287:Computer Peripherals; D006804:Ergonomics; D006801:Humans; D009784:Occupational Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D016272:Occupational Health; D009787:Occupational Medicine / Q000379:methods; D010146:Pain / Q000209:etiology / Q000534:rehabilitation*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013716:Tennis Elbow / Q000534:rehabilitation*; D013717:Tenosynovitis / Q000534:rehabilitation*; D034941:Upper Extremity; D017132:Workplace / Q000458:organization & administration