More Research Needed To Help Workers With Upper Limb Disorders

Main Category: Rehabilitation / Physical Therapy
Article Date: 23 Jun 2009 - 3:00 PDT

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A severe lack of evidence is holding doctors back from providing the right treatment for workers suffering from Upper Limb Disorders, according to new research by the NHS Plus funded Occupational Health Clinical Effectiveness Unit (OHCEU) at the Royal College of Physicians. Upper Limb Disorders is an umbrella term for a number of common conditions of the shoulder, arm, wrist and hand, including carpal tunnel syndrome which is estimated to affect around 5% of UK adults

The review by the OHCEU's Guideline Development Group (GDG) looked for evidence on the best way to manage four specific conditions; carpal tunnel syndrome, non-specific arm pain, tenosynovitis and lateral epicondylitis. The GDG found only four papers of acceptable quality looking at how people with these conditions could be helped in their workplace. The group is now calling for researchers to build an evidence base to inform future management

The group believe research is needed in the following areas:

- Establishing clear and consistent definitions for the various disorders studied
- Assessing outcomes such as job retention and sickness absence in relation to multi-disciplinary rehabilitation.
- The effect of modern keyboard design on occupational outcomes in comparison with current standard workstation equipment.

Despite the scarcity of evidence, the GDG was able to make a number of recommendations for occupational health practitioners and employers with employees suffering from these conditions. These include:

- Allowing people with carpal tunnel syndrome to try out alternative computer keyboards

- Offering or facilitating a multi-discipline rehabilitation to workers with non-specific arm pain who have been absent from work for more than four weeks.

Commenting on the new guideline, Dr Sian Williams, Clinical Director of the OHCEU, said:

"The major benefit of this review is that it has revealed the lack of high quality research on workplace management of Upper Limb Disorders. Our recommendations provide a starting point for clinicians and employers managing workers with Upper Limb Disorders and for researchers planning studies in this area."

Dr Ira Madan, Director of Clinical Standards at NHS Plus, said:

"For the first time all the evidence on the effectiveness of occupational health interventions in the management of upper limb pain in the workplace has been collated into one document. NHS Plus is concerned by the lack of research in this important area and we would encourage academic departments to fill the gaps in the evidence base. NHS Plus recognises that there is a need to identify and prioritise gaps in occupational health clinical effectiveness research and will be incorporating this aim into its future project plan."

Professor David Coggon, President of the Faculty of Occupational Medicine, commented:

"Upper Limb Disorders are a major cause of incapacity for work in the UK. The OHCEU Review is helpful in prioritising questions for research so that these conditions can be managed more effectively in the workplace."

Notes

1. OHCEU is funded by NHS Plus, and operated in partnership by the Royal College of Physicians and the Faculty of Occupational Medicine.

2. The primary purpose of the OHCEU is to improve the quality of occupational health in the NHS. It will also make evidence-based guidelines and associated implementation strategies available for the wider delivery of occupational health care in the UK. The NHS Plus Project aims to improve the quality and delivery of occupational health services to NHS staff and in turn increase the availability of NHS Plus services to small and medium employers.

3. Clinical audit is about improving the quality of care. It is conventionally considered as a cycle with a number of key elements including: Determining what the standard is for practice; Measuring practice; Improving practice to approximate to the accepted standard; Re-measuring practice.

Source
Royal College of Physicians

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