Patient-friendly summary
If you read nothing else
Bottom line
Workplace-based resistance (strength) training has strong evidence to help prevent and manage upper extremity musculoskeletal disorders and symptoms; stretching, forearm supports and mouse-use feedback have moderate supporting evidence, while workstation adjustment alone, EMG biofeedback and stress management training showed no clear benefit.
Moderate evidencePublished
Evidence hierarchy
Study participants
Workers in real workplace settings across multiple sectors and 11 countries in the update; roughly 60% of update studies were office-based
Study Summary
This systematic review updated an earlier review of workplace-based interventions to prevent and manage upper extremity musculoskeletal disorders (UEMSD) and symptoms. Searching six databases (2008-April 2013) yielded 9909 references; 26 high- and medium-quality studies from the update were combined with 35 from the original review (61 studies total) across 30 intervention categories. The authors found strong evidence that workplace-based resistance training exercise programmes can help prevent and manage UEMSD and symptoms, plus moderate evidence of benefit for stretching programmes, mouse-use vibration feedback, and forearm supports. They also found moderate evidence of no effect for EMG biofeedback, job stress management training, and office workstation adjustment alone.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Strong evidence for workplace resistance training | Seven studies (four high-quality, three medium-quality) reported a positive effect of resistance exercise (such as dumbbell or kettlebell exercises) on UEMSD outcomes, reaching a strong level of evidence and the recommendation to implement workplace-based resistance training to help prevent and manage UEMSD and symptoms. | High |
| Moderate evidence of benefit for three other interventions | Forearm supports (two high-quality, one medium-quality study), vibration feedback about static mouse use (two high-quality, one medium-quality study), and stretching exercise programmes (one high-quality, five medium-quality studies) each showed a moderate level of evidence for a positive effect, leading to the message to consider implementing them if applicable to the work context. | Medium |
| Moderate evidence of no effect for three interventions | EMG biofeedback (two high-quality, three medium-quality studies), job stress management training (two high-quality studies), and office workstation adjustment alone (one high-quality, three medium-quality studies) had a moderate level of evidence of no effect on UEMSD outcomes, leading to the message to seek alternatives based on OHS experience/knowledge. | Medium |
| No interventions caused harm | Across all 61 studies there were no negative effects reported (no intervention increased symptoms or lost-time claims). The most common UEMSD outcome reported was symptoms. | Medium |
| Most intervention categories had insufficient evidence | The remaining 23 of the 30 intervention categories had too few high-quality studies or conflicting evidence, resulting in the message that there is not enough scientific evidence to guide current policies or practices; the authors note this does not mean those interventions are ineffective. | Medium |
Seven studies (four high-quality, three medium-quality) reported a positive effect of resistance exercise (such as dumbbell or kettlebell exercises) on UEMSD outcomes, reaching a strong level of evidence and the recommendation to implement workplace-based resistance training to help prevent and manage UEMSD and symptoms.
Forearm supports (two high-quality, one medium-quality study), vibration feedback about static mouse use (two high-quality, one medium-quality study), and stretching exercise programmes (one high-quality, five medium-quality studies) each showed a moderate level of evidence for a positive effect, leading to the message to consider implementing them if applicable to the work context.
EMG biofeedback (two high-quality, three medium-quality studies), job stress management training (two high-quality studies), and office workstation adjustment alone (one high-quality, three medium-quality studies) had a moderate level of evidence of no effect on UEMSD outcomes, leading to the message to seek alternatives based on OHS experience/knowledge.
Across all 61 studies there were no negative effects reported (no intervention increased symptoms or lost-time claims). The most common UEMSD outcome reported was symptoms.
The remaining 23 of the 30 intervention categories had too few high-quality studies or conflicting evidence, resulting in the message that there is not enough scientific evidence to guide current policies or practices; the authors note this does not mean those interventions are ineffective.
Strengths
- Combined newer evidence with the original review for a larger evidence base of 61 studies across 30 intervention categories
- Transparent best evidence synthesis with clearly defined, pre-specified criteria for grading the level of evidence
- Iterative OHS stakeholder engagement throughout the review to ensure a relevant question, comprehensive search terms and practical, usable messages
- Data extraction and synthesis restricted to high- and medium-quality studies, with paired independent reviewers and consensus processes to reduce bias
- Included many studies reporting no effect, suggesting publication bias was not a major problem in the synthesis
Limitations
- No meta-analysis or pooled effect estimate due to substantial heterogeneity in interventions, contexts and study designs
- Best evidence synthesis approach has been criticised in the literature
- An intervention was classified as having a positive effect if any single outcome was positive (a non-conservative rule that could overstate benefit)
- Non-English references were excluded from screening
- Publication bias could not be formally ruled out
- Most evidence comes from office-based settings, limiting generalisability to other work environments
Key Takeaways for Patients
What This Means for You
- 01If your job involves upper-limb strain, a structured strength-training (resistance) exercise programme done at work has the strongest evidence to help prevent and ease arm, neck and hand symptoms.
- 02Stretching programmes, forearm supports at the workstation, and feedback that reminds you not to grip the mouse statically may help, though the evidence is more moderate.
- 03Adjusting an office workstation on its own, EMG biofeedback, and job stress management training showed no clear benefit for upper extremity symptoms in this review.
- 04No intervention studied made symptoms worse, but for most approaches there is simply not enough high-quality evidence yet to say whether they work.
Read the Full Paper
Access the complete peer-reviewed study from Occupational and Environmental Medicine
View Full Study