Table 2

 Summary of intervention studies

Intervention classificationAuthorDesignInterventionMeasuresFindingsQuality of evidence
Design typeTypeQuality score
Control groupPrimary/secondary/tertiaryQuality rating
Mechanical exposure interventions
Work environment/workstation adjustments & VDU workers Aaras et al (2001)16Prospective parallel group study Yes (without intervention)150 VDU workers Visual discomfort, headache, neck, shoulder & forearm painNew lighting, new workplaces and optometric corrections (when required)PrimaryPain intensity and duration VAS,Standardised Nordic musculoskeletal questionnaireReduced shoulder pain No reduction in neck pain Unchanged forearm and hand pain11 Medium
Nevala-Puranen et al (2003)17Pre-/post-cohort with parallel group randomised with respect to instruction No 20 VDU workers Neck, shoulder and upper limb painModifications of office layout and workstation +/− ergonomic advice and upper limb exercises SecondaryVAS pain score Questionnaire: mental strain and physical exercise outside of workReduced upper limb VAS scores Improved work posture (shoulder flexion)Altered EMG activity during typing and the use of the mouse No differences between groups in work pace, change in mental strain at work or frequency of physical exercise10 Medium
Mekhora et al (2000)18Randomised prospective parallel group study Yes (delayed intervention; subjects as own controls)85 VDU workers Tension neck syndromeWorkstation adjustment using computer software application (IntelAd version 1.2)SecondaryAdapted Visual Analogue Discomfort Scale (VADS)Standardised Nordic musculoskeletal questionnaireReduced VADS No difference between workload and work duration throughout study and/or between companies9 Low
Ketola et al (2002)19Randomised controlled trial Yes (without intervention)109 VDU workers Neck, shoulder and upper limb painWorkstation adjustment & / or redesign following intensive ergonomic education SecondaryFinnish education system ergonomic rating scale Discomfort diary Modified Nordic musculoskeletal questionnaireReductions in discomfort ratings at 2 months Improved ergonomic rating, intensive group greater than education or reference group12 Medium
Workstation equipment & VDU workers Aaras et al (2001)20Prospective parallel group study Yes (without intervention)67 VDU workers Neck, shoulder & forearm painVDU work utilising the Anir computer mouse (intervention) versus a traditional mouse SecondaryVAS pain score Clinical examinationReduced number of tender points in the neck and shoulder Reduced neck, shoulder, forearm, wrist and hand pain scores, 6, 12 months Reduced sick leave Reduced pain with flexion and side-flexion passive ROM in cervical spine9 Low
Rempel et al (1999)21Randomised controlled trial Yes (without intervention; subjects matched)24 keyboard operators (administrative assistants or technical writer/editors)Carpal Tunnel Syndrome (CTS)Use of keyboard where the keys differed in their force-displacement characteristics. Keyboard ‘A’–Protouch (Key Tronic Corporation). Keyboard ‘B’–MacPro Plus with 2-ounce rubber domes (Key Tronic Corporation)Secondary/tertiary(?)Self-administered medical history questionnaire Symptom survey (VAS pain score)Questionnaire of hand-function status Standardised physical examination Nerve conduction testDifference in pain levels between the keyboard groups, 12 weeks; not at 6 weeks.Reduced pain at 12 weeks using keyboard ‘A’No differences in mean palm-wrist median sensory latencies between 0 and 12 weeks No differences between groups in hand-function ratings, 6 and 12 weeks20 High
Tittiranonda et al (1999)22Randomised controlled trial Yes (placebo intervention; subjects matched)4 groups, 20 keyboard operators in each Carpal Tunnel Syndrome (CTS) and/or tendonitis4 computer keyboards: standard (placebo), Apple Adjustable Keyboard (kb1), Comfort Keyboard System (kb2) and Microsoft Natural Keyboard (kb3)Secondary/tertiary(?)Physical examination Hand/arm discomfort and pain questionnaire VAS of stiffness, numbness or pain Job Content Instrument (JCI)Work Interpersonal Relationships Inventory (WIRI)Significant reduction in overall pain severity in kb3 at 6 months Significant increase in functional status after 6 months in kb3 group compared to placebo.No significant decrease in prevalence of clinical measures after 6 months18 Medium
Ergonomic equipment & manufacturing workers Herbert et al (2001)23Cohort study No N = 56 female Hispanic and Indian spooling workers at sequin manufacturing company Upper extremity Musculoskeletal Disorders (MSDs)Ergonomic education and introduction of adjustable chair (including training in correct chair use)Primary/secondarySymptoms portion of the 1993 NIOSH questionnaire Pre-/Post video-analysis of upper extremity postures using the Modified Exposure Assessment MethodReduced pain scores after introduction of adjustable chairs at most anatomic sites Reduced prevalence of pain in the right shoulder, left elbow, and left forearm after introduction of adjustable chair.Improved upper limb posture following chair intervention8 Low
Aiba et al (1999)24Prospective longitudinal cohort No 383 manufacturing workers using impact wrenches Vibration White Finger (VWF)Introduction of vibration-damped wrench PrimaryStockholm Workshop Scale for VWF Questionnaires on work histories, medical histories and subjective symptoms, including VWF Medical doctor confirmed VWF by showing the subject a photograph of typical VWF conditionsPrevalence of VWF eliminated3 Low
Jetzer et al (2003)25Cohort study No 165 manufacturers & installers of concrete roofing tiles Hand-Arm Vibration Syndrome (HAVS) or CTSIntroduction of new tools with decreased levels of Hand-Arm vibration exposure and/or ISO 10 819 gloves PrimaryQuestionnaire on medical and work history Clinical hand examination by occupational health nurses Vascular tests depending on responses to medical questionnaire and Stockholm Workshop ScaleTrend toward decreasing prevalence of HAVS Workers who used new low-vibration tools and wore ISO 10 819 gloves showed most improvement and least decrement in symptoms6 Low
Production systems/organisation culture interventions
Production systems/organisation culture intervention Christmansson et al (1999)26Pre-/post-case-studies No 17 window and door assembly workers Upper extremity pain disordersOrganisation alterations, control systems and work design (distribution of work tasks)PrimaryStructured interviews Video analyses using Hand-Arm-Movement-Analysis (HAMA)Psycho-social questionnaires Medical examinationNo improvement in prevalence of upper extremity MSDs during study period Some psychosocial factors improved (eg “influence on and control of work”), some worsened (eg “relationship with fellow workers”)4 Low
Fernstrom & Aborg (1999)27Cohort No 22 female office workers performing data entry tasks Neck, shoulder, arm and hand painOrganisation alterations and different work tasks Primary/secondaryClinical examination by physiotherapist Diagnoses according to a documented screening method Subjects videotaped throughout test daysNo improvement in neck, shoulder and/or arm pain No difference in number or duration of rest periods between years Increased non-computer work from 50 min in 1991 to 93 min in 19928 Low
Modifier interventions
Exercise and upper extremity conditions Ludewig and Borstad (2003) 28Randomised controlled trial Yes (without intervention and without conditions)92 male construction workers performing overhead work Shoulder Impingement SyndromeStretching and progressive strength training programme Secondary/tertiary(?)Self-reported Shoulder Rating Questionnaire (SRQ)Modified Shoulder Pain and Disability Index (SPADI) QuestionnaireImprovement in self-reported Shoulder Rating Questionnaire (SRQ) and Shoulder Satisfaction Scores16 Medium
Hagberg et al (2000)29Randomised trial No 69 women industrial workers Cervico-brachial syndrome ICD-10 code M53.1Isometric shoulder endurance versus strength 16 week training programme TertiaryVAS pain scores Sick leave & NSAID use Standarised physical examination Strength, range of motion and endurance testsReduced pain, no difference by training type No reduction in sick leave Improved arm motion performance test Increased shoulder strength14 Medium
Waling et al (2002)30Prospective quasi-randomised trial No 126 female administrative workers Trapezius MyalgiaGroup training programmes:a) Strength group b) Endurance group c) Coordination group d) Stress management (non-training) reference group TertiaryVAS pain scores Frequency of pain Pressure pain thresholds Degree of worry Use of analgesics Sick leaveReduced frequency of pain and VAS in all groups over time No change in pressure pain thresholds No differences between training groups and reference group on any variable12 Medium
Exercise & Fibromyalgia Meiworm et al (2000)31Experimental trial Yes (without intervention)39, mostly females Fibromyalgia (FM)12 week progressive aerobic endurance exercise programme including walking, jogging, cycling and/or swimming Secondary/tertiaryBody diagram of pain VAS pain score Pressure pain thresholdsDecreased painful body area Reduced mean number of tender points Mean pain threshold unchanged VAS score unchanged No changes in control group10 Medium
Schachter et al (2003)32Randomised controlled trial Yes (without intervention)143 females FMDiffering exercise duration:a) Long Bout of Exercise (LBE)b) Short Bout of Exercise (SBE)c) No exercise (NE) (control)TertiaryBody pain diagrams AIMS2 Questionnaire Affect Scale Score Fibromyalgia Impact Questionnaire (FIQ)VAS pain score CPSSReduced disease severity and improved self-efficacy within SBE group and compared to NE group Improvements in physical function, disease severity, symptoms, self-efficacy and psychological well-being in LBE group19 High
Valim et al (2003)33Randomised trial No 76 females FMTwo exercise modalities:a) Aerobic exercise (AE) walking programme,b) Stretching exercise (SE)TertiarySit and reach (flexibility) test Fibromyalgia Impact Questionnaire (FIQ)Short Form–36 (SF-36) Question-naire Beck Depression Inventory (BDI)Trace-State Anxiety Inventory Pain score from tender points VAS pain scoreImprovements in AE group compared to SE group of total FIQ score and role emotional and mental health domains of FIQ, the mental component summary of SF-36, BDI, VAS score and number of tender points No improvement in SE group in mental health or role emotional domains and the Mental Component Summary of the SF-36 or BDI17 Medium
van Santen et al (2002)34Pre-/post-test trial Yes (without intervention)143 Females FMTwo intervention modalities:a) Group supervised fitness programme, (aerobic exercise and isometric strengthening)b) Biofeedback training for muscle relaxation TertiaryVAS pain score VAS fatigue scale Health status: Arthritis Impact Measurement Scale, Sickness Impact Profile (SIP)Psychological distress: Symptom Checklist-90-Revised (SCL-90)Physical fitness - bicycle ergometerNo significant findings except physical fitness worsened for all groups over the study period. Decrease was less in fitness group compared to control group14 Medium
Multiple modifier interventions (including exercise) & upper extremity conditions de Greef et al (2003)35Randomised controlled trial Yes (without intervention)53 Symphony Orchestra Musicians PRMDsSpecific mobilising, strengthening, and conditioning programme (the Groningen Exercise Therapy for Symphony Orchestra Musicians (GETSOM) programme)Secondary/tertiary(?)Physical Competence Scale (PCS) World Health Questionnaire for Musicians (WHQM)Musculoskeletal disorders decreased Perceived physical competence increased9 Low
Chan et al (2000)36Pre-/post-test trial No 12 Work-related lateral epicondylitis of elbowEducation on pathology and ergonomics related to WRMDS, stretching & strengthening exercises to be performed at home and work hardening protocols Secondary/tertiary(?)VAS pain scores LLUMC (Loma Linda University Medical Centre) Activity Sort Baltimore Therapeutic Equipment (BTE) Primus measures Dexter Evaluation Computer System Satisfaction with Performance Scaled QuestionnaireReductions in pre/post VAS pain scores maintained at 4 and 12 week follow-up Increased BTE Primus measures Increases in LLUMC Activity Sort Scores and Satisfaction with Performance Scaled Questionnaire Scores maintained at 4th and 12th weeks of follow-up7 Low
Omer et al (2003/2004)37Randomised controlled trial No true control group 50 VDU workers Cumulative Trauma Disorders (CTDs) including Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS)Ergonomic and health education (‘control’ group) versus an exercise programme (flexibility, RoM, relaxation, strengthening and postural exercises involving the neck shoulders and wrists performed 3 days per week at lunchtime) (treatment group)Secondary/tertiary(?)Pain assessment using Numeric Rating Scale (NRS)Pain Disability Index (PDI)Tiredness Scale (TS)Beck Depression Inventory BDI) ScaleImproved NRS, PDI and BDI scores for treatment group9 Low
van den Heuvel et al (2003)38Randomised controlled trial Yes (without intervention)268 VDU workers Work-related upper limb repetitive strain injuries according to the Health Council of the NetherlandsMicrobreaks prompted by computer software and “natural” rest breaks versus microbreaks and natural rest breaks combined with the performance of regular exercises performed at the workstation also prompted by the software Secondary/tertiary(?)Perceived overall recovery from complaints Frequency of complaints Severity of pain VAS scale Self-reported sick leave ProductivitySelf-reported recovery higher in intervention group No differences between the groups for sick leave Improved productivity in Group 1 (breaks and no exercises) compared to control group Improved accuracy rate in intervention groups compared to control group13 Medium
Multiple modifier interventions (including exercise) & Fibromyalgia Bailey et al (1999)39Prospective pre-/post-cohort study No 106 FMFibro-Fit Programme: 12-week out-patient exercise and multidisciplinary programme TertiaryFibro-Fit self-efficacy questionnaire Canadian Standardised Test of Fitness (CSTF)Fibromyalgia Impact Questionnaire (FIQ)Canadian Occupational Performance Measure (COPM)Family Crisis Oriented Personal Evaluation Scales (F-COPES)Improvements in all outcome measures Relationship between smoking and pain. i.e. smokers had less improvement in pain Attendance rate of FM support group related to greater improvement in pain Patients who refused pain or anti-depressant medications had poorer outcomes8 Low
Cedraschi et al (2004)40Pre-/post-test trial Yes (without intervention)61 FMGroup training programme. Consisted of pool exercise, relaxation, low impact land exercise, activities of daily living and education. TertiaryNumber of tender points and myalgic score Global rating by physician QuestionnairesImprovement in Fibromyalgia Impact Questionnaire (FIQ) and Psychological General Well-Being (PGWB) Index No change in objective physician measures14 Medium
Gowans et al (1999)41Randomised controlled trial Yes (delayed intervention; subjects as own controls)41 FM6-week exercise and education programme (two exercise and two multidisciplinary educational sessions per week)TertiaryFibromyalgia Impact Questionnaire (FIQ)Arthritis Self-Efficacy Scale (ASES)Knowledge of FM management Questionnaire 6 min walk testImprovement in 6 min walk distance, well-being, self-efficacy, and FM knowledge Reduced morning fatigue All gains maintained at follow-up except morning fatigue and subjects’ knowledge of FM management which resumed to baseline levels11 Medium
Mannerkorpi et al (2000)42Pre-/post-test trial No true control group used 69 females FMTwo intervention modalities:a) Group pool exercise programme b) Education programme TertiaryFibromyalgia Impact Questionnaire (FIQ)Short Form-36 Questionnaire (SF-36)Swedish Multi-dimensional Pain Inventory (MPI-S)Arthritis Self-Efficacy Scale (ASES-S)Arthritis Impact Measurement Scales (AIMS)Quality of Life Questionnaire (QOLS)Improved FIQ score and walk distance compared with education group Improved FIQ physical functioning and anxiety scores in exercise compared with education group Improved Sf-36 general health score, social functioning, pain severity and affective distress components of MPI-S in exercise group Improved AIMS depression and QOLS in exercise compared to education group14 Medium
Redondo et al (2004)43Prospective, longitudinal, quasi-randomised, parallel trial No 40 females FMTwo intervention modalities:a) Physical Exercise (PE) and cardiovascular fitness programme b) Cognitive-behavioural therapy (CBT)TertiaryFibromyalgia Questionnaire (FIQ)Short Form-36 (SF-36)Beck Anxiety Inventory Chronic Pain Self-Efficacy Scale (CPSS)Chronic Pain Coping Inventory Range of Motion and Pain scalePE Group: Improvements in most items and total score of FIQ Improvement in the bodily pain domain of SF-36 At one year follow-up none of clinical variables were significantly better than the initial assessment CBT Group: Improved items of FIQ (stiffness, total score) at 8 weeks At 6 month and one year changes not maintained, except improved general health domains of SF-36 EDUC group: symptoms and pain improved 0–6 weeks; returned to baseline 6–32 weeks16 Medium
Multiple modifier interventions (excluding exercise) & upper extremity conditions Faucett et al (2002)44Randomised controlled trial Yes (without intervention)139 engineers and microscopic assembly workers of electronic manufacturing corporation Upper limb Work-Related Musculoskeletal Disorders (WRMSDs)Muscle Learning Therapy (MLT) or educational group (EDUC) consisting of OHN-delivered education and Cognitive Behavioural Training (CBT) that addressed symptom and stress management and problem solving PrimarySymptom Diary Data VAS pain measures Surface Electromyography (EMG)MLT group: 0–6 weeks no change in symptoms and pain; 6–32 weeks worsened Control group: 0–6–32 weeks symptoms and pain steadily worsened Differences at 6 weeks significant, but not over all time periods10 Medium
Bohr (2000)45Randomised controlled trial No, comparison of two intervention groups 102 VDU workers Neck, shoulder and upper limb painTraditional ergonomic education versus participatory ergonomic education PrimaryPaper and pencil surveys Observational checklists Standardised Nordic musculoskeletal questionnaire Work AGPAR scoreNo difference between two groups for observation data scores for the work area configuration, worker postures, or overall scores No difference between two groups for upper body pain/discomfort or APGAR scores9 Low
Multiple modifier interventions (excluding exercise) & Fibromyalgia Oliver et al (2001)46Randomised controlled trial Yes (without intervention)600 patients FMSocial support versus social support combined with health and self-help education TertiaryHealth Care Costs Knowledge of FM‘Guttman-like’ Group Cohesiveness Scale Adapted Arthritis Self-Efficacy ScaleReduced helplessness for participants in all groups but more markedly in social support and education group12 Medium