Many conservative methods used to treat work-related complaints of the upper body have only limited effectiveness, according to an updated systematic review by Arianne Verhagen, Ph.D., and her colleagues in the Netherlands. Exercise, however, emerged as "a very good thing to do," she said.
Yet, "conservative interventions such as physiotherapy and ergonomic adjustments play a major role in the treatment of most work-related complaints of the arm, neck or shoulder," said Verhagen, a physical therapist and epidemiologist at the Erasmus University Medical Center, Rotterdam.
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The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
Verhagen updated a review published in 2003, which had included 15 trials. She added six new trials for a total of 2,110 adult participants. Most were industrial workers or hospital staff who suffered with chronic complaints varying between three and 12 months. Workers with inflammatory or neurological diseases were not included.
The randomized and nonrandomized controlled trials evaluated more than 25 conservative interventions including exercises, relaxation, ultrasound, biofeedback, myofeedback and workplace adjustments.
Verhagen said she is not surprised that exercise appeared most helpful to people suffering from chronic complaints of the arm, neck or shoulder.
"I am an evidence-based person, and exercise seems to be the best intervention from this review," said Verhagen. "That's what I do. When I treat patients, I know that they almost always get better."
Orthopedic surgeon Nicholas A. DiNubile, M.D., a clinical assistant professor at the University of Pennsylvania, agrees that there is limited scientific proof that conservative interventions are effective for these injuries.
"It's not that they are not effective though," he said. "There is an important difference." An orthopedic consultant for the Philadelphia 76ers and the Pennsylvania Ballet, DiNubile said that he is a great believer in physiotherapy interventions such as exercise and stretching as well as ergonomic workplace adjustments and taking breaks.
"One must be very careful, however, when interpreting interventions done in a workers' compensation environment and trying to apply those findings to non-workers' comp issues," DiNubile said. He added that it is important for researchers to ask themselves whether they are really measuring that intervention — or if social or psychosocial issues might be involved.
"What applies in work-related injuries may not always be applicable to the average person who gets an injury," DiNubile said.
Participants in the Cochrane review come primarily from the United States and Europe, where workers typically receive compensation when out of work because of work-related injuries. Verhagen said that she does not believe that workers with chronic pain would report that a particular intervention was not effective if, in fact, it worked. These factors were not considered in her study.
"I think normally, people would like to go back to work," she said.
The quality of these studies were poor, Verhagen said, making it difficult to draw more conclusions about the effectiveness of many of these interventions. One limitation centered on varied and vague definitions of "work-relatedness." In the Netherlands, "work-related" means that people have complaints that get worse when they are working, yet decrease or diminish on the weekend or when they are on holiday.
Verhagen said that with a rapidly increasing incidence in work-related disorders, the need arises "to determine whether these interventions have a significant impact on short-term and long-term outcomes."
In particular, research is needed to look at the effectiveness of ergonomic adjustments in the workplace, with studies concerning how a chair or a monitor is placed, how a mouse is used and whether an ergonomic keyboard is effective, said Verhagen. She knows of no such current studies.
"We have ongoing workplace adjustments in The Netherlands, for example, that are very expensive," she says. "Most of these have not been evaluated regarding their effect."
"The costs associated with these disorders are high — more than $2 billion of direct and indirect costs estimated annually in the United States alone," Verhagen said.
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