P. Paul F. M. Kuijer

Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review

Objectives To determine whether advice and training on working techniques and lifting equipment prevent back pain in jobs that involve heavy lifting. Data sources Medline, Embase, CENTRAL, Cochrane Back Group’s specialised register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT were searched up to September-November 2005. Review methods The primary search focused on randomised controlled trials and the secondary search on cohort studies with a concurrent control group. Interventions aimed to modify techniques for lifting and handling heavy objects or patients and including measurements for back pain, consequent disability, or sick leave as the main outcome were considered for the review. Two authors independently assessed eligibility of the studies and methodological quality of those included. For data synthesis, we summarised the results of studies comparing similar interventions. We used odds ratios and effect sizes to combine the results in a meta-analysis. Finally, we compared the conclusions of the primary and secondary analyses. Results Six randomised trials and five cohort studies met the inclusion criteria. Two randomised trials and all cohort studies were labelled as high quality. Eight studies looked at lifting and moving patients, and three studies were conducted among baggage handlers or postal workers. Those in control groups received no intervention or minimal training, physical exercise, or use of back belts. None of the comparisons in randomised trials (17u2009720 participants) yielded significant differences. In the secondary analysis, none of the cohort studies (772 participants) had significant results, which supports the results of the randomised trials. Conclusions There is no evidence to support use of advice or training in working techniques with or without lifting equipment for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.

Manual material handling advice and assistive devices for preventing and treating back pain in workers

BACKGROUNDnTraining and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH).nnnOBJECTIVESnTo determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain.nnnSEARCH STRATEGYnWe searched CENTRAL (The Cochrane Library 2011, issue 1), MEDLINE, EMBASE, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to February 2011.nnnSELECTION CRITERIAnWe included randomised controlled trials (RCT) and cohort studies with a concurrent control group that were aimed at changing human behaviour in MMH and measured back pain, back pain-related disability or sickness absence.nnnDATA COLLECTION AND ANALYSISnTwo authors independently extracted the data and assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group for RCTs and MINORS for the cohort studies.We based the results and conclusions on the analysis of RCTs only. We compared these with the results from cohort studies.nnnMAIN RESULTSnWe included nine RCTs (20,101 employees) and nine cohort studies (1280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.Six RCTs had a high risk of bias.None of the included studies showed evidence of a preventive effect of training on back pain.There was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.The results of the cohort studies were similar to those of the randomised studies.nnnAUTHORS CONCLUSIONSnThere is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty.

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: A systematic review

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland–Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

Effect of job rotation on need for recovery, musculoskeletal complaints, and sick leave due to musculoskeletal complaints: A prospective study among refuse collectors

BACKGROUNDnJob rotation might be an effective preventive measure to reduce the prevalence of musculoskeletal complaints, although its effect has not been yet established. The aim of the present study is to evaluate the effect of job rotation in refuse collecting on need for recovery, prevalence of musculoskeletal complaints, and sick leave due to musculoskeletal complaints.nnnMETHODSnA 1-year prospective study among refuse collectors was performed, using standardized questionnaires. Job rotation was performed between collecting two-wheeled containers and driving a refuse truck. The experimental groups of rotating refuse collectors at t(0) and t(1) (group R-R) and non-rotating refuse collectors at t(0) and rotating refuse collectors at t(1) (group NR-R) were compared with a reference group of non-rotating refuse collectors at t(0) and t(1) (group NR-NR).nnnRESULTSnThe adjusted need for recovery of group R-R was marginally significantly lower than need for recovery of the reference group. Groups R-R and NR-R had a more than two times higher risk for complaints of the low back than the reference group. No other significant results were found.nnnCONCLUSIONSnJob rotation seemed to coincide with a reduced need for recovery and was associated with an increased risk of low back complaints. No effects were found on sick leave due to musculoskeletal complaints. The results might be influenced by the healthy worker selection effect in the reference group and its inverse in the rotating groups.

Work-ability evaluation: a piece of cake or a hard nut to crack?

Purpose. To describe what aspects, categorized according to the ICF model, insurance physicians (IPs) take into account in assessing short- and long-term work-ability. Method. An interview study on a random sample of 60 IPs of the Dutch National Institute for Employee Benefit Schemes, stratified by region and years of experience. Results. In determining work-ability, a wide range of aspects were used. In the case of musculoskeletal disease, 75% of the IPs considered the ‘function and structures’ component important. With psychiatric and other diseases, however, the ‘participation factor’ component was considered important by 85 and 80%, respectively. Aspects relating to the ‘environmental factor’ and ‘personal factor’ components were mentioned as important by fewer than 25%. In assessing the short- and long-term prognosis of work-ability, the ‘disease or disorder’ component was primarily used with a rate of over 75%. Conclusions. In determining work-ability, insurance physicians predominantly consider aspects relating to the ‘functions and structures’ and ‘participation’ components of the ICF model important. The ‘environmental factor’ and ‘personal factor’ components were not often mentioned. In assessing the short- and long-term prognosis of work-ability, the ‘disease or disorder’ component was predominantly used. It can be argued that ‘environmental factors’ and ‘personal factors’ should also more often be used in assessing work-ability.

Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundPeople today are living longer and want to remain active. While obesity is becoming an epidemic, the number of patients suffering from osteoarthritis (OA) is expected to grow exponentially in the coming decades. Patients with OA of the knee are progressively being restricted in their activities. Since a knee arthroplasty (KA) is a well accepted, cost-effective intervention to relieve pain, restore function and improve health-related quality of life, indications are expanding to younger and more active patients. However, evidence concerning return to sports (RTS) and physical activity (PA) after KA is sparse.ObjectivesOur aim was to systematically summarise the available literature concerning the extent to which patients can RTS and be physically active after total (TKA) and unicondylar knee arthroplasty (UKA), as well as the time it takes.MethodsPRISMA guidelines were followed and our study protocol was published online at PROSPERO under registration number CRD42014009370. Based on the keywords (and synonyms of) ‘arthroplasty’, ‘sports’ and ‘recovery of function’, the databases MEDLINE, Embase and SPORTDiscus up to January 5, 2015 were searched. Articles concerning TKA or UKA patients who recovered their sporting capacity, or intended to, were included and were rated by outcomes of our interest. Methodological quality was assessed using Quality in Prognosis Studies (QUIPS) and data extraction was performed using a standardised extraction form, both conducted by two independent investigators.ResultsOut of 1115 hits, 18 original studies were included. According to QUIPS, three studies had a low risk of bias. Overall RTS varied from 36 to 89xa0% after TKA and from 75 to >100xa0% after UKA. The meta-analysis revealed that participation in sports seems more likely after UKA than after TKA, with mean numbers of sports per patient postoperatively of 1.1–4.6 after UKA and 0.2–1.0 after TKA. PA level was higher after UKA than after TKA, but a trend towards lower-impact sports was shown after both TKA and UKA. Mean time to RTS after TKA and UKA was 13 and 12 weeks, respectively, concerning low-impact types of sports in more than 90xa0% of cases.ConclusionsLow- and higher-impact sports after both TKA and UKA are possible, but it is clear that more patients RTS (including higher-impact types of sports) after UKA than after TKA. However, the overall quality of included studies was limited, mainly because confounding factors were inadequately taken into account in most studies.

Health and safety in waste collection: Towards evidence-based worker health surveillance.

BACKGROUNDnWaste collectors around the world are at risk for work-related disorders and injuries. The aim of this study was to assess work demands, acute physiologic responses, illnesses, and injuries as a starting point for worker health surveillance (WHS).nnnMETHODSnA systematic search was performed in PubMed and Embase on work demands, acute bodily responses, health, and injuries. A quality assessment and evidence synthesis was performed.nnnRESULTSnFrom a total of 379 retrieved studies, 50 studies fulfilled the inclusion criteria. Waste collecting varied from informal manual gathering to semi-automated systems. Most studies (number of studies) on work demands and/or acute bodily responses addressed bioaerosols (14). Studies of health effects addressed respiratory complaints (8), and those on injuries addressed acute musculoskeletal disorders (3). Strong evidence is available that exposure to bioaerosols exceeds recommendations. Moderate evidence is available for an increased risk of respiratory complaints and musculoskeletal injuries, with significant odds ratios reported varying between 1.9-4.1 and 1.5-3.3, respectively. Limited evidence exists for gastrointestinal disorders and hearing loss.nnnCONCLUSIONSnWHS in waste collection is warranted for early detection of respiratory, gastrointestinal, and musculoskeletal disorders, and hearing loss.

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

ObjectiveAssessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs?MethodsA systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed.ResultsOf the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12xa0months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies.ConclusionsStrong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Beneficial and Limiting Factors Affecting Return to Work After Total Knee and Hip Arthroplasty: A Systematic Review

Introduction A large number of patients undergoing total knee (TKA) and hip (THA) arthroplasties are of working age at the time these procedures are performed. The objective of this study was to systematically review literature on the beneficial and limiting factors affecting return to work in patients undergoing TKA or THA. Method Pubmed and Embase were systematically searched to find studies that described factors that influence return to work (RTW) after surgery. The following inclusion criteria had to be met: (1) inclusion of patients with primary or revision TKA or THA; (2) description of return to work after surgery or employment status; and (3) description of a beneficial or restricting factor affecting return to work. Results Only three studies were found that fulfilled the three inclusion criteria. Three factors were discussed: (1) the mini-posterior approach compared to the two-incision approach; (2) patient movement restrictions after surgery compared to no restrictions; and (3) patient discharge based on guidelines compared to discharge without guidelines. Conclusions This systematic review revealed that knowledge is sparse regarding beneficial or limiting factors affecting return to work after TKA or THA. Despite that, the results suggests that the two-incision approach is beneficial, patient movement restrictions are limiting, and patient discharge guidelines have no effect on the time patients take to RTW.

Working height, block mass and one- vs. two-handed block handling: the contribution to low back and shoulder loading during masonry work

The goal of this study was to compare the effects of the task variables block mass, working height and one- vs. two-handed block handling on low back and shoulder loading during masonry work. In a mock-up of a masonry work site, nine masonry workers performed one- and two-handed block-lifting and block-placing tasks at varying heights (ranging from floor to shoulder level) with blocks of varying mass (ranging from 6 to 16 kg). Kinematics and ground reaction forces were measured and used in a 3-D linked segment model to calculate low back and shoulder loading. Increasing lifting height appeared to be the most effective way to reduce low back loading. However, working at shoulder level resulted in relatively high shoulder loading. Therefore, it was recommended to organise masonry work in such a way that blocks are handled with the hands at about iliac crest height as much as possible.