Thursday, August 23, 2012 New in the Literature: Preventing Work-related Musculoskeletal Disorders (Cochrane Database Syst Rev. 2012 August 15) The level of evidence supporting workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck musculoskeletal disorders (MSDs) ranges from moderate to very low quality, according to authors of a meta-analysis published online in Cochrane Database of Systematic Reviews. However, given there were multiple comparisons made involving a number of interventions and outcomes, the authors say that high-quality evidence is needed to determine the effectiveness of these interventions clearly. The authors searched 13 databases for randomized controlled trials (RCTs) of ergonomic workplace interventions for preventing work-related upper limb and neck MSDs. They included only studies with a baseline prevalence of MSDs of the upper limb or neck, or both, of less than 25%. Two review authors independently extracted data and assessed risk of bias. They included studies with relevant data that they judged to be sufficiently homogeneous regarding the intervention and outcome in the meta-analysis. They assessed the overall quality of the evidence for each comparison using the GRADE approach. Thirteen RCTs (2,397 workers) were included in the analysis. Eleven studies were conducted in an office environment and 2 in a health care setting. The authors judged 1 study to have a low risk of bias. The 13 studies evaluated effectiveness of ergonomic equipment, supplementary breaks or reduced work hours, ergonomic training, a combination of ergonomic training and equipment, and patient lifting interventions for preventing work-related MSDs of the upper limb and neck in adults. Overall, there was moderate-quality evidence that arm support with an alternative mouse reduced the incidence of neck/shoulder disorders (risk ratio [RR] 0.52) but not the incidence of right upper limb MSDs (RR 0.73), and low-quality evidence that this intervention reduced neck/shoulder discomfort (standardized mean difference (SMD) -0.41) and right upper limb discomfort (SMD -0.34). There also was moderate-quality evidence that the incidence of neck/shoulder and right upper limb disorders were not reduced when comparing alternative mouse and conventional mouse (neck/shoulder RR 0.62; right upper limb RR 0.91), arm support and no arm support with conventional mouse (neck/shoulder RR 0.67; right upper limb RR 1.09), and alternative mouse with arm support and conventional mouse with arm support (neck/shoulder RR 0.58; right upper limb RR 0.92). There was low-quality evidence that using an alternative mouse with arm support compared with conventional mouse with arm support reduced neck/shoulder discomfort (SMD -0.39). There was low- to very low-quality evidence that other interventions were not effective in reducing work-related upper limb and neck MSDs in adults.