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

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evidence with a positive effect were exercise, supervisor practices, andworkstation adjustment and training.However in two intervention categories where the results showed moderatelevels of evidence, the interventions evaluated were very different betweenstudies and “practices to consider” were not clear-cut. The exerciseinterventions included a workplace-based program and a home-basedprogram, so either intervention does not seem to be a practice to consider.The supervisor practices interventions were also varied, as each study used adifferent intervention to try to change behaviour to reduce injuries.The third category with a moderate level of evidence was workstationadjustment and training. This is significant because, when initiated asseparate interventions, ergonomic training and workstation adjustment eachshowed a moderate level of evidence for NO effect. Even though theworkstation adjustments varied across all the studies, a practice to consideris that workstation adjustment and training appear to be more effective whenused together compared to using either intervention independently.An important message is that the current state of the peer-reviewed literatureprovides limited high quality studies and the majority of the better qualitystudies examining IPCs are completed in office environments.As more research is conducted and supported by employers, labour andgovernment, here are some issues to consider:• Researchers should use concurrent worksite control groups as opposedto study designs with simulated controls, statistical controls or crossoverdesigns. True concurrent controls contribute results that are moregeneralizable across industrial sectors.• Field studies should have adequate sample sizes to reduce the risk ofmistakenly concluding an intervention has no effect, simply becausethe sample is too small.• Researchers should present outcomes using standard approaches thatare common to the reporting requirements demanded of stakeholderswhen using workers’ compensation, injury records or other regulatedinjury reporting systems.• Covariates and confounders should be measured and adjusted forusing multivariate statistical models. This is especially true when theresearchers are unable to randomize workers into either interventionor control groups.The review resulted in many lessons learned about search strategies, thevaried use of terms across disciplines and which interventions were beingstudied. However, two major points emerged from trying to consider the IPCliterature as a whole rather than studying only one part.40 Institute for Work & Health
1) Of the articles that remained after the Level 1 review, studies in theoffice sector and health-care accounted for 44% of the literature.Again, this is important because two business sectors are dominatingthe field. The office sector specifically is known for frequency ofinjuries but not necessarily severity (e.g. fatalities). One also has toconsider how generalizable a back school completed in a health-careor office environment is to the transportation, construction ormanufacturing sectors.2) The interventions used to control injuries are the only area where astrong level evidence of positive effects exists. This finding isimportant because it emerged while trying to characterize the broadfield of IPCs. We found no prevention programs that had a strongeffect. This does not mean prevention does not work. What itdemonstrates is that studies of prevention programs are not completedoften enough to find a strong level of evidence. Researchers andstakeholders should consider this an important finding and worktogether to develop high quality studies that are generalizable acrossbusiness sectors.The amount of literature reviewed in this study was enormous. The team wasamazed and somewhat frustrated by the levels of evidence that emerged fromthe literature. The review proved fertile ground for discovering gaps in theIPC literature. Because researchers and stakeholders use terms differently,this a key factor when trying to create actionable messages from research.The small lessons learned, major points to consider and level of evidencefindings combine to create a not-so-surprising message. Researcherscompleting workplace research can design and conduct a high quality study ifthey approach the study with the realization that involving the people in theworkplace prior to designing the study is integral to their scientific success.A systematic review of injury/illness prevention and loss controlprograms (IPCs)41
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 and 36: compensation and medical bills is m
Page 37 and 38: interventions provide an insufficie
Page 39 and 40: Researchers and practitioners also
Page 41: 5.0 MessagesBefore making recommend
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
Page 99 and 100:
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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