Workplace-based rehabilitation of upper limb conditions : a systematic review

Hoosain, Munira Begum (2018-03)

Thesis (MOccTher)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Background: Upper limb conditions are a common and growing cause of work related ill health and disability. International and South African legislation support work rehabilitation and specifically workplace-based rehabilitation, but the availability of workplace-based rehabilitation services appears to be limited in South Africa, with more focus on once-off work evaluations. Evidence is needed on the effectiveness of workplace-based rehabilitation services, in order to inform future service delivery. Objective: The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes such as ergonomic risk and mental health. Methods: This systematic review was designed in accordance with PRISMA guidelines and registered with PROSPERO as number: PROSPERO CRD42017059708. We searched Medline (PubMed), Cochrane Library, Scopus, Web of Science, EBSCOhost (Academic Search Premier, Africa-Wide, CINAHL), OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Risk of bias in included studies was assessed using a question and rating system developed by the Institute for Work and Health (IWH). As meta-analysis was not possible, study results were analysed through a narrative synthesis. Results: The initial literature search located 1071 articles, of which 80 were full text reviewed. Seventeen studies were included, across 28 articles, reporting on various outcomes. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n=3), ergonomic training and workstation adjustments (n=4), exercise and resistance training (n=6), clinic-based versus workplace-based work hardening (n=1), nurse case manager training (n=1), physiotherapy versus Feldenkrais (n=1), and ambulant myofeedback training (n=1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusion and Recommendations: There is substantial evidence supporting workplace exercise programs. Further research needs to be conducted on the remaining intervention categories. Researchers are encouraged to collaborate with clinicians to enable more high quality research in “real-life” rehabilitation contexts, including individualised work rehabilitation. Clinicians should build partnerships with the Department of Labour and stakeholders at workplaces, in order to develop rehabilitation resources in work environments.

AFRIKAANSE OPSOMMING : Agtergrond: Boonste ledemaat toestande is ‘n algemene en toenemende oorsaak van werkverwante siektes en gestremdheid. Internasionale en Suid-Afrikaanse wetgewing ondersteun werkrehabilitasie, veral rehabilitasie wat by die werkplek plaasvind. In Suid-Afrika is rehabilitasie by die werkplek nog beperk, met meer fokus op eenmalige werk evaluerings. Inligting oor die doeltreffendheid van werkplek gebaseerde rehabilitasie dienste is nodig ten leiding aangaande toekomstige dienslewering. Doelwit: Die doelwit van hierdie sistematiese oorsig was om die huidige beskikbare navorsing oor die effektiwiteit van werkplek gebaseerde rehabilitasie dienste in werkers met boonste ledemaatstoestande op werkverrigting, pyn, afwesigheid, produktiwiteit en ander uitkomste soos ergonomiese risiko en geestesgesondheid, te identifiseer, saam te voeg en te analiseer. Metode: Hierdie sistematiese oorsig is volgens PRISMA riglyne ontwerp en by PROSPERO geregistreer: PROSPERO CRD42017059708. Ons het gesoek in Medline (PubMed), Cochrane Biblioteek, Scopus, Web of Science, EBSCOhost (Academic Search Premier, Africa-Wide, CINAHL), OTSeeker en PEDro met sleutelwoorde in die volgende vier areas: boonste ledemaat, intervensie, werkplek en kliniese proef (met geen datum limiete). Studies oor slegs nekpyn of muskuloskeletale pyn in ander gebiede, is nie ingesluit nie. Risiko van vooroordeel in ingeslote studies is beoordeel deur 'n vraag- en graderingstelsel wat deur die Instituut vir Werk en Gesondheid (Institute for Work and Health (IWH)) ontwikkel is. Aangesien ‘n meta-analise nie moontlik was nie, is studie-uitslae geanaliseer deur middel van 'n narratiewe sintese. Resultate: Die aanvanklike literatuursoektog het 1071 artikels opgetref, waarvan 80 volledige artikels ge-evalueer is. Sewentien studies is ingesluit, vanuit 28 artikels wat oor verskeie uitkomste verslag lewer. Nege studies was van hoë metodologiese gehalte, sewe van medium gehalte en een van lae gehalte. Studies is gesorteer in intervensie kategorieë: Ergonomiese kontrole (n=3), ergonomiese opleiding en werkstasie aanpassings (n=4), oefening en weerstandsopleiding (n=6), kliniek gebaseerde teenoor werkplek gebaseerde werkverharding (n=1), verpleegkundige bestuurder opleiding (n=1), fisioterapie teenoor Feldenkrais (n=1), en ambulante myoterugvoer opleiding (n=1). Werkplek oefenprogramme is deur die meeste navorsing ondersteun, met positiewe gevolge vir ergonomiese opleiding en werkstasie aanpassings, en gemengde effekte vir ergonomiese kontrole. Ambulante myoterugvoer opleiding het geen effek getoon nie. Die oorblywende drie kategorieë het positiewe effekte getoon in die enkele studie oor elke intervensie. Gevolgtrekking en Aanbevelings: Werkplek-oefenprogramme word goed deur navorsing ondersteun. Verdere navorsing moet gedoen word oor die oorblywende intervensie kategorieë. Navorsers word aangemoedig om met terapeute saam te werk, ten einde meer hoë kwaliteit navorsing in rehabilitasie omgewings te doen, insluitende geïndividualiseerde werkrehabilitasie. Terapeute moet met die Departement van Arbeid en belanghebbendes by werksplekke vennootskappe bou, om rehabilitasie hulpbronne in werksplekke te ontwikkel.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103897
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