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Research Plus: February/March 2010

OH interventions should target at-risk workers

A targeted OH intervention based on personal assessment, OH consultation, referral where necessary and action plans drawn up by the OH nurse or physician has the greatest impact on those workers who perceive that they are unlikely to be able to continue working1. The study is a follow-up of a previously published randomised controlled trial that demonstrated the effectiveness of a targeted intervention on workers with a high-risk of sickness absence2. The high-risk group included workers with poor future work ability, pain, musculoskeletal problems, fatigue, stress and high depression score. Workers with poor health status were randomised to the targeted OH intervention or ‘usual care’, with their absence followed for 12 months. The usual care group could consult the OH professional on request, but they did not get feedback on their health survey results; nor were they invited for an OH consultation. The sub-group analysis found that the intervention was most effective in workers with self-rated future work inability (p = 0.00003), severity of physical impairment (p = 0.009) and comorbidity (p = 0.01).

Assessing biomechanical exposure

This systematic review analyses 30 different observational methods for assessing biomechanical exposure to physical risk factors at work. The tools range from simple checklists to video technology and computer systems and measure various risk factors, such as working posture, workload, vibrating-tool use, work stress, repetitive work and lifting. No single tool is superior to the others and the authors recommend that users choose an assessment method after thoroughly considering their needs (such as for general screening, analysis of specific problematic tasks, or detailed data analysis). Observers will report consistent results if they have received sufficient training.

Vocational interventions

A systematic review found only weak evidence to support the use of vocational interventions to help unemployed people re-enter work, and limited evidence that such interventions improve mental health. Six papers covering five studies met inclusion criteria and all looked at group training interventions to promote re-employment and/or improve mental health. Only one intervention, the US Jobs II programme – which focuses on active learning, problem solving, job searching and preparing for setbacks – resulted in improved re-employment. Two studies reduced psychological distress.

Weight loss reduces apnoea

People with obstructive sleep apnoea are at raised risk of cardiovascular disease, sudden death during sleep and of having an accident while driving. A weight-loss programme based on a very low energy diet reduced the severity of the condition, as measured using the apnoea-hypopnoea index (AHI – rate of apnoea and hypopnoea per hour of sleep). Sixty-three men with BMI 30–40 and aged 30–65 years were included in the nine-week randomised controlled trial. Mean weight loss in the intervention group was 19kg, with a mean BMI reduction of 5.7. By the end of the trial, average AHI in the intervention group was 12, against 35 in the control group.

Shiftwork adds to risk of metabolic syndrome

Middle-aged male manufacturing workers are at greatest risk of metabolic syndrome if they have elevated serum alanine aminotransferase (ALT) and work to rotating shifts. A total of 996 workers were divided into four subgroups, depending on their exposure to rotating shiftwork and elevated serum ALT. Male workers with elevated baseline ALT and five-year exposures to shiftwork had significantly raised hyperglycaemia (+15%), hypertriglyceridaemia (+21%) and blood pressure (+31%). They also had the highest rate of metabolic syndrome: 37% prevalence, compared with 11% in the lowest exposure risk group.

Eye injuries

A Cochrane review of literature found no reliable evidence that educational interventions are effective in preventing eye injuries. It covered interventions to reduce eye injuries in workplace, sports and school settings. Educational approaches included short films, behaviour modification, warning information, and individual and group training alongside the provision of protective equipment. Two randomised controlled and three controlled before-and-after studies were included. Although two studies did show a reduction in injuries associated with the intervention, the evidence quality was poor.

Upper extremity disorders, work and productivity

A randomised controlled trial found improvements in productivity for people with upper extremity disorders if they received an ergonomic assessment and intervention on top of medical care. A total of 177, largely female, workers with an upper extremity disorder were randomised into a control or intervention group. All participants were given ‘best current treatment’, with the intervention group also receiving a workplace assessment and intervention from an occupational physiotherapist. Interventions included modification of adverse work styles (posture, tool use, work pace and work organisation) and self-care advice. Self-reported productivity loss was significantly lower in the intervention group after 12 weeks.

Workplace health promotion

There is considerable interest in workplace health promotion initiatives to address unhealthy lifestyles and improve overall health – but do they work? This systematic review of evidence found 31 randomised controlled trials (18 high quality) of interventions to increase physical activity and/or improve the diet of workers. Most of the 1,200 studies in the initial literature trawl were rejected ‘due to a lack of a control group or because the study did not describe the outcome measures sought’. The study found no evidence that workplace lifestyle interventions have a positive effect on cholesterol (total, HDL or LDL), blood glucose, body weight/BMI or blood pressure. However, there is strong evidence that they have a beneficial effect on overall body fat – a major risk factor for CVD. There is strong evidence that programmes targeted at workers at higher risk of CVD have a positive impact on body weight. At-risk populations benefit more from the interventions than mixed ones.

Small business interventions

A systematic review found limited to moderate evidence to support the implementation of multi-component occupational health and safety (OHS) programmes in small businesses. Only five papers met the full inclusion criteria for evidence synthesis: two of high quality and three of medium quality. There is moderate evidence that attitudes and beliefs are influenced by multifaceted interventions involving training, audits and recommendations. There is limited evidence that a multifaceted approach combining engineering controls along with training, audit and motivational components (financial incentives) have a positive effect on attitudes and beliefs, but no significant effect on workplace exposures. There is no evidence for any deleterious effects of the studied interventions. A shortage of well-controlled studies evaluating small business interventions limits the extent to which evidence-based recommendations can be made.

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.

 

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