Musculoskeletal Science and Practice 45 (2020) 102062

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Musculoskeletal Science and Practice

journal homepage: www.elsevier.com/locate/msksp

Cochrane review summary

Are ergonomic interventions effective for prevention of upper extremity T

work-related musculoskeletal disorders among office workers? A Cochrane
Review summary with commentary☆,☆☆
Sina Esmaeilzadeh Arman
Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

The aim of this commentary is to discuss in a rehabilitation per-
spective the published Cochrane Review “Ergonomic interventions for
preventing work-related musculoskeletal disorders of the upper limb
and neck among office workers” by Hoe, Urquhart, Kelsall, Zamri, Sim1
(Hoe et al., 2018), under the direct supervision of the Cochrane Work
Group. This Cochrane Corner is produced in agreement with Muscu-
loskeletal Science and Practice by Cochrane Rehabilitation.
Background: In the last decades, the use of computers in office en-
vironments has increased dramatically which consequently is accom-
panied by a number of health problems such as work-related muscu-
loskeletal disorders (WMSDs), mostly in the neck and upper extremities
(Juul-Kristensen et al., 2006). WMSDs continue to be the most im-
portant cause of sick leave and work-related disability (Woods, 2005).
The aetiology of WMSDs is multifactorial (Hush et al., 2006). Many
studies have established the relationship between WMSDs and in-
dividual, physical, psychosocial, and organizational risk factors at office
environments (Karlqvista et al., 2002). Although many studies have
emphasized that multi-component participatory ergonomic interven-
tions addressing musculoskeletal risk factors at workplace might be
effective in reducing WMSDs, the impact of ergonomic interventions on
prevention still remains controversial (Esmaeilzadeh et al., 2014). A
Cochrane Review searched evidence regarding their effectiveness.
among office workers.
1.2. What was studied in the cochrane review?
The population addressed in this review was people who work at an
office environment and whose main tasks were to perform professional,
managerial or administrative tasks and the majority of whom (> 75%)
did not have WMSDs of the upper limb or neck or both. The interven-
tions studied were ergonomic interventions targeting physical, organi-
zational, and/or cognitive risk factors among office workers. Physical,
organisational, and cognitive ergonomic intervention were compared to
no intervention, placebo, or alternative intervention; ergonomic
training was compared to no training in ergonomic principles or al-
ternative training; and multifaceted interventions were compared to a
single intervention or a different combination of interventions. The
studied primary outcomes were: incidence of the upper extremity
WMSDs (number of office workers with newly diagnosed WMSDs),
presence or intensity of complaints or symptoms in the neck or upper
extremities, and work-related functioning (including workday loss, job
loss or change, work disability, and functioning level).
1.3. Search methodology and up-to-datedness of the cochrane review?

1. Ergonomic interventions for preventing work-related
musculoskeletal disorders of the upper limb and neck among
office workers (Hoe et al., 2018)
1.1. What is the aim of this cochrane review?
The aim of this Cochrane Review was to assess the effects of phy-
sical, cognitive and organizational ergonomic interventions or their
combinations for preventing WMSDs of upper extremities and neck
The review authors searched for relevant randomised controlled
trials (RCTs), quasi-randomised trials, cluster-RCTs, and cross-over
trials in any language that had been published up to 10 October 2018.
The electronic searches were employed in the Cochrane Central
Register of Controlled Trials, Ovid MEDLINE, Embase, Web of Science,
CINAHL, SPORTDiscus, Scopus, NIOSHTIC-2, and the World Health
Organization International Clinical Trials Registry Platform.

DOI of original article: https://doi.org/10.1016/j.msksp.2019.07.005

☆
rehabilitation.cochrane.org.
☆☆
The views expressed in the summary with commentary are those of the Cochrane Corner author(s) and do not represent the Cochrane Library or Wiley.
E-mail address: sinabox@gmail.com.
1
This summary is based on a Cochrane Review previously published in the Cochrane Database of Systematic Reviews (2018), Issue 10. Art. No.: CD008570. DOI:
10.1002/14651858.CD008570.pub3 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in
response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

https://doi.org/10.1016/j.msksp.2019.102062

Available online 14 September 2019

2468-7812/ © 2019 Elsevier Ltd. All rights reserved.
S.E. Arman
1.4. What are the main results of the cochrane review?
The review included 15 RCTs involving 2165 office workers.
For physical ergonomic interventions, the review found:
• When comparing the use of an arm support with an alternative computer
mouse to a conventional mouse alone (2 trials)
o Moderate-quality evidence for reducing the incidence of neck or
shoulder WMSDs in favour of arm support with an alternative
computer mouse, but no effect on the incidence of right upper
limb WMSDs
o Low-quality evidence that an arm support with an alternative
computer mouse reduced both neck or shoulder and right upper
limb discomfort
o Inconsistent evidence for arm supports combined with alternative
computer mouse designs for reducing neck or shoulder or right
upper limb complaints
• When comparing the use of an alternative computer mouse to a con-
ventional mouse (2 trials)
o Moderate-quality evidence that the incidence of neck or shoulder
and right upper limb disorders were not considerably reduced
• When comparing the use of an arm support with a conventional mouse to
a conventional mouse alone (3 trials)
o Moderate-quality evidence that the incidence of neck or shoulder
and right upper limb disorders were not considerably reduced
• When comparing workstation adjustment to usual arrangement (1 trial)
o Workstation adjustment may not have an effect on upper limb
pain compared to no intervention
• When comparing sit-stand desks to sitting desks (1 trial)
o Sit-stand desks may not have an effect on upper limb pain com-
pared to no intervention
For organisational ergonomic interventions.
• When comparing supplementary breaks to conventional breaks (4 trials
one of which used a biofeedback mouse for regulating breaks to ensure
workers take breaks versus no intervention)
o Very low-quality evidence from two trials that supplementary
breaks may reduce neck, right shoulder or upper arm, and right
forearm or wrist or hand discomfort among data entry workers
For cognitive ergonomic interventions.
• The review found no studies specifically addressing the cognitive
domain
For training interventions.
• When comparing participatory ergonomic training intervention to no
intervention (2 trials), participatory education intervention to traditional
education (2 trials), and active ergonomic training to no intervention (1
trial)
o No effect on upper limb pain compared to no intervention. Low to
very low-quality evidence that participatory and active training
interventions may or may not prevent WMSDs of the neck or
upper limb or both
For multifaceted ergonomic interventions.
• When comparing combined physical and organisational ergonomic in-
tervention (work injury prevention program) to no intervention (1 trial)
o Very low-quality evidence of no effect on any of the upper limb
pain outcomes measured (neck, shoulder, wrist or hand)
2
Musculoskeletal Science and Practice 45 (2020) 102062
1.5. What did the authors conclude?
The authors concluded that they found inconsistent evidence re-
garding the effectiveness of an arm support or alternative mouse in the
prevention of upper extremity WMSDs where it is not clear whether
they may or may not reduce the incidence of neck or upper limb
WMSDs. The authors found no evidence of an effect of other physical
ergonomic interventions. Regarding organizational ergonomic inter-
ventions, there was very low quality evidence about the effects of
supplementary breaks to reduce neck and upper extremity discomfort.
There was no evidence of ergonomic training and multifaceted ergo-
nomic interventions having an effect on upper extremity discomfort or
pain. The authors indicated that further high-quality trials are required
to determine the impact of ergonomic interventions on upper extremity
WMSDs among office workers.
1.6. What are the implications of the cochrane evidence for practice in
rehabilitation?
The term upper extremity WMSD has been defined as a disorder of
the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels,
or spinal disks in the neck, shoulder, elbow, forearm, wrist, or hand that
is associated with exposure to risk factors (Barr and Barbe, 2002). There
is an important role for rehabilitation professionals in applying ergo-
nomic interventions for a variety of WMSDs (Oral et al., 2013) who
need reliable evidence for evidence-based decision making regarding
their application.
Generally, the authors of this Cochrane review found different levels
of evidence ranging from very low to moderate quality in terms of ef-
fectiveness or no effect of ergonomic interventions for preventing upper
extremity WMSDs. However, the number of effective interventions and
the quality of evidence are very limited which points to the need for
high quality future studies which have the high likelihood of changing
the evidence when the evidence is currently low or very low quality.
Another point for future research is the proper measurement of ergo-
nomic exposure, i.e. office worker's postures during computing and
equipment layouts such as monitor position and other physical, orga-
nisational, psychosocial, and individual risk factors. The review authors
found that none of the studies (except for one) assessed work postures,
improper positioning, or workstation layouts (e.g. when using compu-
ters) (Hoe et al., 2018). Moreover, the use of the International Classi-
fication of Functioning, Disability and Health (ICF) categories, parti-
cularly those relevant to environmental factors (Leyshon and Shaw,
2008) could also facilitate the elucidation of the effects of ergonomic
interventions as to which intervention would be effective for which
environmental factor to prevent WMSDs. Objective outcome measures
rather than self-reported measures for evaluating ergonomic exposure
might be helpful to better understand the effects of ergonomic inter-
ventions. Finally, it is also important to provide data on work-related
function as measured by the number of workdays lost, change of job,
loss of job, level of functioning, and work disability for which the data
were not available in any of the studies evaluated in the review even
though it was considered as the primary outcome (Hoe et al., 2018).
Disclosures
The author declares no conflicts of interest.
Acknowledgements
The author thanks Cochrane Rehabilitation and the Cochrane Work
Group for reviewing the contents of the Cochrane Corner. Additionally,
the author would like to appreciate Professor Aydan Oral for her
S.E. Arman
valuable comments and contributions.
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