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To assess the effectiveness of ergonomic interventions for work-related complaints of the arm, neck or shoulder (CANS) in adults, in terms of their effects on pain, functional status and work-related outcomes.
Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs that evaluated single or combined ergonomic interventions (e.g. office furniture, biomechanical or ergonomic education) compared to no treatment/usual care/placebo or another active intervention (exercise/another ergonomic intervention/other treatment), or as an add-on treatment.
Critical outcomes: pain, functional status (disability) and work-related outcomes (e.g. sickness absence, return to work, productivity loss at work, change of occupation). Important outcomes: global perceived effect (e.g. overall improvement), quality of life, healthcare consumption, and recurrence of injury, disorder or complaint. We prioritised outcomes in the short term (up to three months after the intervention) and were also interested in long-term results (over three months).
Two authors independently screened the search records, selected trials, extracted data and assessed risk of bias. When we judged studies to have sufficient clinical and statistical homogeneity, we performed meta-analysis. We assessed overall certainty of the evidence using GRADE for key outcomes at the short-term time point.
We brought forward 13 studies from the 2013 review. We identified two new articles relating to one of those 13 studies, along with seven new studies. Therefore, in total, we included 20 studies involving 2478 participants. In 16 studies, the participants had non-specific CANS; in four studies, the participants had specific CANS (e.g. carpal tunnel syndrome).
Results below are presented at the short-term time point. Ergonomic interventions versus no treatment, usual care or placebo in people with CANS Data were available only for trials that focused on non-specific CANS. Ergonomic interventions may result in little to no difference in pain compared to no treatment, usual care or placebo in people with CANS (SMD -0.23, 95% CI -0.54 to 0.08; 4 RCTs, 692 participants; low-certainty evidence). Ergonomic interventions probably result in little to no difference in functional status (disability) compared to being on a waiting list (RR 1.06, 95% CI 0.84 to 1.34; 1 RCT (2 comparisons), 383 participants; moderate-certainty evidence). Ergonomic interventions may result in little to no difference in sick leave compared to no treatment (MD for continuous data -0.32, 95% CI -0.73 to 0.09; 1 RCT, 98 participants; low-certainty evidence; RR for dichotomous data 0.87, 95% CI 0.63 to 1.21; 3 RCTs, 759 participants; moderate-certainty evidence). Ergonomic interventions probably result in little to no difference in recovery compared to no treatment (RR 1.32, 95% CI 0.89 to 1.97; 1 RCT (2 comparisons), 386 participants, moderate-certainty evidence). Ergonomic interventions may result in little to no difference in quality of life compared to no treatment (MD 0.10, 95% CI 0.00 to 0.20; 1 RCT, 68 participants; low-certainty evidence). Ergonomic interventions may result in little to no difference in healthcare consumption compared to no treatment when measured using continuous outcomes (MD -0.10. 95% CI -0.30 to 0.10; 1 RCT, 68 participants; low-certainty evidence), and may result in a reduction in healthcare consumption compared to usual care when measured using dichotomous outcomes (RR 0.49, 95% CI 0.31 to 0.78; 1 RCT, 210 participants; low-certainty evidence). No data were available for recurrence of injury, disorder or complaint. Ergonomic intervention versus active intervention (exercise or another type of ergonomic intervention or other treatment) in people with CANS Data were available from trials involving participants with specific CANS and with non-specific CANS. The evidence is very uncertain about the effects of ergonomic interventions on pain (SMD 0.41, 95% CI -0.02 to 0.84; 8 RCTs, 364 participants; very-low-certainty evidence) and on functional status (disability) (SMD -0.09, 95% CI -0.85 to 0.68; 3 RCTs, 180 participants; very-low-certainty evidence) compared to active intervention in people with specific or non-specific CANS. Intense ergonomic interventions may result in little to no difference in recovery (RR 1.29, 95% CI 0.85 to 1.94; 1 RCT, 257 participants; low-certainty evidence) or healthcare consumption (RR 0.86, 95% CI 0.50 to 1.47; 1 RCT, 217 participants; low-certainty evidence) compared to ergonomic education in people with non-specific CANS. Ergonomic interventions may improve quality of life compared to exercise in people with non-specific CANS (MD -10.10, 95% CI -19.87 to -0.33; 1 RCT, 61 participants; low-certainty evidence). No data were available for work-related outcomes or recurrence of injury, disorder or complaint. Ergonomic intervention plus another treatment versus the other treatment alone in people with CANS Data were available only from trials of participants with non-specific CANS. The evidence is very uncertain about the effects of ergonomic intervention as an add-on treatment to exercise on pain (SMD -0.50, 95% CI -1.64 to 0.63; 2 RCTs, 137 participants; very-low-certainty evidence). No data were available for our other outcomes of interest.
Overall, ergonomic interventions for work-related CANS may have no meaningful effects on pain, function, recovery, quality of life or work-related outcomes (sick leave) compared with no treatment or usual care. Findings are inconsistent for healthcare consumption. There may be a possible benefit for quality of life when ergonomic interventions are compared to exercise. The evidence for ergonomic interventions as an add-on treatment is very uncertain. High-quality, well-designed trials are needed to establish the role of ergonomic interventions in the management of CANS.
