Research Plus: December/January 2009/2010

Hospital workers’ pregnancy outcomes

Danish research findings are generally reassuring on the risks to hospital workers who continue to work during pregnancy. A cohort of 5,976 pregnant female hospital workers was compared to a reference group of 60,890 pregnant women in other occupations. No significant associations were found between hospital work and either foetal loss, preterm birth, infant gender or small-for-gestational-age infants. There were slightly raised prevalences of congenital abnormalities in some hospital subgroups, potentially due to exposure to hazardous chemicals, shiftwork or physically demanding work.

International Journal of Occupational and Environmental Health 2009; 15(4): 402–409.

Age and experience predict delayed RTW

While younger and inexperienced workers are at greater risk of a lost-time back injury, their older (over 45 years) and more experienced colleagues (working at least four years) are more likely to have a delayed return to work, according to a 15-year nested case-control study of work-related back claims made by US carpenters. Those injured in acute events (eg falls, being struck, vehicle crashes) are also more likely to have a delayed return.

American Journal of Industrial Medicine 2009; 52: 821–830.

Do OH interventions reduce MSDs?

A lack of high-quality research makes it ‘difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity musculoskeletal disorders’, concludes a systematic review. It found strong evidence that workplace adjustments alone have no effect on outcomes, but limited evidence that they are beneficial when combined with ergonomics training. There is moderate evidence that arm supports have a positive impact, and that neither biofeedback training nor job stress management training are beneficial. There is limited evidence that using alternative keyboards, providing a new chair and taking rest breaks are beneficial.

Journal of Occupational Rehabilitation 2009: online first: 10.1007/s10926-009-9211-2

Economic case?

Is there an economic case for investing in OH interventions? A systematic review (67 papers) examined evidence from various sectors. Within the healthcare sector, there is moderate evidence that ergonomic and musculoskeletal disorder (MSD) prevention programmes, including patient-lifting aids, techniques and training, are worth undertaking on economic grounds, and moderate to limited evidence for the economic benefits of occupational disease prevention programmes, including needlestick prevention and the use of powder-free gloves. There is strong evidence in various sectors for the economic benefits of disability management programmes and, in manufacturing and warehousing, for interventions to prevent MSDs.

Journal of Occupational and Environmental Medicine 2009; 51(9): 1004–1023.

Massage for back pain

An updated Cochrane review finds some evidence to support the use of massage therapy in the management of low back pain (LBP). Two studies showed massage to be superior to ‘sham’ (placebo) treatment in both the short and long term. When compared to active interventions, massage was found to be similar to exercises, but superior to joint mobilisation, relaxation therapy, physiotherapy, acupuncture, and self-care education.

Spine 2009; 34(16): 1669–1684.

Business case

A systematic review of health and safety business cases (18 papers covering 26 studies) finds that most studies lack randomisation or controls and tend to attribute any after-the-event positive effect to the intervention. Most evidence came from North America though four studies were from Sweden and two from the UK. Nineteen of the studies assessed ergonomic interventions to prevent musculoskeletal disorders. Eighteen were simply before-and-after comparisons, with no control groups, and calculations rarely included estimates of statistical uncertainty.

Scandinavian Journal of Work, Environment & Health 2009; 35(6): 403–413.

Returning to work after brain injury

A systematic review found little evidence of what should be considered ‘best practice’ in supporting patients back to work after a traumatic brain injury. There is weak evidence that ‘supported employment’ is helpful, and that patients are more likely to gain paid work after completing a specialist vocational brain injury programme. There is moderate evidence that a vocational case-coordination approach enhances employment and productivity outcomes, and weak evidence that those who receive such an intervention in the first year after injury are placed in employment more quickly than those who do not.

Journal of Head Trauma Rehabilitation 2009; 24(3): 195–212.

Surgical masks and flu

Standard surgical masks are no worse than more expensive NIOSH-approved N95 respirators in protecting healthcare workers against influenza viruses. A total of 446 nurses in eight hospitals were randomly assigned either a standard surgical mask or a fit-tested N95 respirator (30% of each group had received seasonal flu vaccine). Between January and April 2009, there were 50 confirmed influenza cases (23.6%) in the surgical mask group and 48 (22.9%) in the N95 group, with no significant difference in the absolute risk between the two groups (it was impossible to tell whether infections were due to community or hospital exposure).

Journal of the American Medical Association 2009; 302(17): 1865–1871.

Shouldering the burden

Shoulder impingement syndrome is a painful condition that limits function, particularly in overhead activities. This systematic review of 18 papers (including one workplace study) found moderate evidence that physiotherapist-led exercises and surgery are equally effective, especially in the longer-term, and moderate evidence to support the use of manual therapy combined with physiotherapist-led exercises. Home-based exercises, including isometric strengthening, are as effective as mixed physiotherapy. Ultrasound is not effective.

Journal of Rehabilitation Medicine 2009; 41: 870–880.

Chronic shoulder pain

A supervised exercise programme is more effective than shockwave treatment in relieving chronic shoulder pain and improving return to work, according to a single blinded randomised controlled trial. After 18 weeks, 64% of patients in the exercise group achieved a reduction in shoulder pain and disability scores compared with 36% in the shockwave treatment group. More patients in the exercise group returned to work (p = 0.016).

British Medical Journal 2009; 339: b3360.

Post disc surgery rehab

There is low to moderate evidence that exercise programmes starting four to six weeks after lumbar disc surgery are effective in reducing pain and disability, an updated Cochrane review finds. There is low quality evidence that high-intensity exercise programmes are slightly more effective than low intensity ones, but no difference between supervised and home-based exercises, for delivering short-term pain relief.

Spine 2009; 34 (17): 1839–1848.