A systematic review of injury/illness prevention and loss control ...

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prevention programs, which was observed in another recent systematicreview (13).In order to advance the field and shift the level of evidence from moderate tostrong, further research of these interventions should be of highmethodological quality (see Table 2 for quality criteria).There was a mixed level of evidence for the following interventions and theireffect on injury/illness and workers’ compensation outcomes:• policy (employer-level)• data entry devices• arm supports, training (manual lifting)• programs (regulatory)The studies on regulatory programs were not examining the effectiveness ofregulations. These studies concentrated on determining how certainregulatory programs related to a reduction in injuries/illnesses and workers’compensation claims within specified workplaces. This created uniquechallenges and opportunities. The regulatory studies typically had theopportunity to build large sample sizes. However, they had a challenge inreporting loss to follow-up information, which was typically not availablefrom the data sources used to build the large samples (e.g. state OHSA data).Interventions with a mixed or moderate level of evidence should be ofparticular importance to researchers, funders, labour (unions) and employersparticipating in research. For the these categories, the addition of one or twohigh quality studies could have shifted the level of evidence from mixed tomoderate, or moderate to strong.Overall, the interventions that had a mixed level of evidence typically focusedon practices or policies and not on programs. The interventions withmoderate and strong levels of evidence that had positive outcomes typicallyfocused on multi-component programs rather than on a specific employeepractice.The Hager (1982) study is notable as it is the only study with a reportednegative effect. However, the negative effect represents a comparisonbetween workers in a voluntary hearing protection program and a controlgroup of workers. The same study showed that a mandatory hearingprotection program had a positive effect on hearing loss. This study alsodemonstrates the value of using a long time-series to study the effectivenessof IPCs.Finally, due to the breadth of the subject being evaluated, we found severalunique interventions that were done in only one study. Single study34 Institute for Work & Health
interventions provide an insufficient level of evidence to enable us to drawconclusions or make recommendations.There was insufficient evidence for the following interventions:• bricklaying method• new chair• loss control as a service• new office• participatory ergonomics• hearing protectors• safety training• skin care training• training and equipment forklifts.Some types of interventions were not included in the evidence synthesisdespite the impact they have on employees, because they did not make it tothe data extraction phase. These studies were on: evaluating confined spaces,fall protection, driver injuries not as a result of driving, hazardcommunication, respiratory protection or power presses. These areas arefrequently associated with many injuries/illnesses (including deaths), citedviolations by OSHA and workers’ compensation claims. None of thepublications from the grey literature, identified by content experts, made it tothe data extraction phase either.Also worthy of noting is that, of the 72 studies identified as evaluating safetyclimate/culture, only one that met the criteria of being an IPC and having arelevant outcome made it to the evidence synthesis stage (Zohar 2002). Theoutcomes in the majority of the safety climate/culture articles were change inbehaviour or per cent safe behaviours, and these outcomes were not includedin this review. Several of the safety climate/culture articles were classified asa measurement tool or measurement model, but did not meet the IPCrelevancy criteria.The majority of high quality studies were completed in office environmentsand focused on reports of pain and discomfort. Each high quality study wasdesigned to limit threats to internal and external validity. However, fewmeasured similar outcomes, making it a challenge to integrate findings orgeneralize the findings to other business sectors.One potential action for stakeholders would be to discuss how to completehigh quality research in the sectors that were under-represented in the review.These sectors include construction and manufacturing, which generally havea greater number of hazards than those presented by office environments.Due to the use of technology, construction and manufacturing environmentshave similar ergonomic risks as office environments plus additional hazardssuch as confined spaces, working at heights, chemical exposures, etc. TheA systematic review of injury/illness prevention and loss controlprograms (IPCs)35
Page 1 and 2: A systematic review of injury/illne
Page 3 and 4: Table of ContentsForeword ………
Page 5 and 6: ForewordIn recent years, the Instit
Page 7 and 8: employers with valuable information
Page 9 and 10: forward. In 1970, the Occupational
Page 11 and 12: Figure 1: IPC frameworkInput(to wor
Page 13 and 14: publish the results of the review i
Page 15 and 16: A key part of the literature would
Page 17 and 18: 2.4 Level 2 - Quality AssessmentIn
Page 19 and 20: allowed us to insure the answers pr
Page 21 and 22: Table 4: Best evidence synthesis gu
Page 23 and 24: Figure 3: Flowchart of systematic r
Page 25 and 26: • Return-to-work/disability manag
Page 27 and 28: etween groups, but only 32% adjuste
Page 29 and 30: Workstationadjustment andtrainingRo
Page 31 and 32: focused on just RTW (Durand et al.
Page 33 and 34: ExerciseThree medium quality studie
Page 35: compensation and medical bills is m
Page 39 and 40: Researchers and practitioners also
Page 41 and 42: 5.0 MessagesBefore making recommend
Page 43 and 44: 1) Of the articles that remained af
Page 45 and 46: 11) Agency for Healthcare Research
Page 47 and 48: Carayon P, Haims MC, Hoonakker PLT,
Page 49 and 50: workers: Randomized controlled work
Page 51 and 52: Nelson NA, Silverstein BA. Workplac
Page 53 and 54: pain in sedentary office workers -
Page 55 and 56: Appendix A: Content expertsNameBarb
Page 57 and 58: Appendix C: Stakeholder search term
Page 59 and 60: Appendix D - Literature search term
Page 61 and 62: A systematic review of injury and i
Page 63 and 64: Zohar DZohar D,Modifying Supervisor
Page 65 and 66: Level 1 Guide for ReviewersThe guid
Page 67 and 68: Appendix G: Quality Appraisal Revie
Page 69 and 70: Q4. Were time-based comparisons use
Page 71 and 72: If there are no major significant d
Page 73 and 74: Q17. Was the calendar duration of t
Page 75 and 76: a) YesBaseline differences were obs
Page 77 and 78: 5. List the jurisdiction where the
Page 79 and 80: have intended to prevent both “as
Page 81 and 82: Sample SizeEg: C 1 , C 2 , …(or I
Page 83 and 84: 29. If injury rates were calculated
Page 85 and 86: 38. Describe for each injury/illnes
Page 87 and 88:
Appendix J: Quality assessment tabl
Page 89 and 90:
StudyTime-Based ComparisonsRandom A
Page 91 and 92:
Appendix K: Intervention descriptio
Page 93 and 94:
InterventionCategoryErgonomictraini
Page 95 and 96:
InterventionCategoryBricklayingmeth
Page 97 and 98:
InterventionCategoryTraining &equip
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Appendix L: Study description*key t
Page 101 and 102:
InterventioncategoryPrograms(regula
Page 103 and 104:
InterventioncategoryWorkstationadju
Page 105 and 106:
InterventioncategoryErgonomictraini
Page 107 and 108:
InterventioncategoryAuthor, Year QA
Page 109:
InterventioncategoryWorkstationadju
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