BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review onlyEffectiveness of interventions to prevent workplace injuries
and occupational diseases: an overview of reviews
Journal: BMJ Open
Manuscript ID bmjopen-2019-032528
Article Type: Original research
Date Submitted by the Author: 22-Jun-2019
Complete List of Authors: Teufer, Birgit; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologyEbenberger, Agnes; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologyAffengruber, Lisa; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologyKien, Christina; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologyKlerings, Irma; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologySzelag, Monika; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologyGrillich, Ludwig; Danube University Krems, Department for Evidence-based Medicine and Clinical EpidemiologyGriebler, Ursula; Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology
Keywords: overview of reviews, occupational injuries, occupational diseases, occupational health and safety, OHS
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open on A
ugust 10, 2021 by guest. Protected by copyright.
http://bmjopen.bm
j.com/
BM
J Open: first published as 10.1136/bm
jopen-2019-032528 on 11 Decem
ber 2019. Dow
nloaded from
For peer review only
1 Effectiveness of interventions to prevent 2 workplace injuries and occupational 3 diseases: an overview of reviews4 Authors:
5 Birgit Teufer (corresponding author),
6 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
7 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
9 phone: 0043 2732 893 2918
10 ORCID-ID: https://orcid.org/0000-0002-3324-0639
11
12 Agnes Ebenberger,
13 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
14 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
16
17 Lisa Affengruber,
18 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
19 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
21
22 Christina Kien
23 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
24 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
Page 1 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
26
27 Irma Klerings,
28 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
29 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
31
32 Monika Szelag,
33 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
34 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
36
37 Ludwig Grillich,
38 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
39 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
41
42 Ursula Griebler,
43 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
44 based Medicine and Clinical Epidemiology, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
46
47
48 Word count: 5002 (including Competing interests and Funding statements)
49
Page 2 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
50 Abstract
51 Objectives: Occupational injuries and diseases are a huge public health problem and cause extensive
52 suffering and productivity losses. Nevertheless, many occupational health and safety (OHS)
53 guidelines are still not based on the best available evidence. In the last decade, numerous systematic
54 reviews on behavioural, relational and mixed interventions to reduce occupational injuries and
55 diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this
56 overview of reviews is to provide a comprehensive basis for making evidence-based decisions about
57 interventions in the field of OHS.
58 Methods: We conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library
59 (Wiley), Epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between
60 January 2008 and June 2018. Two authors independently screened abstracts and full-text
61 publications and determined the risk of bias of the included systematic reviews with the ROBIS tool.
62 Results: We screened 2287 abstracts and 200 full texts for eligibility. Finally, we included 35
63 systematic reviews with a low or unclear risk of bias for data synthesis and analysis. We identified
64 systematic reviews on the prevention of occupational injuries, musculoskeletal, skin and lung
65 diseases, occupational hearing impairment and interventions without specific target diseases. Several
66 interventions led to consistently positive results on individual diseases; other interventions did not
67 show any effects, or the studies are contradictory. We provide detailed results on all included
68 interventions.
69 Discussion: To our knowledge, this is the first comprehensive overview of behavioural, relational and
70 mixed interventions and their effectiveness in preventing occupational injuries and diseases. It
71 provides policy makers with an important basis for making evidence-based decisions on interventions
72 in this field.
73 Systematic review registration: PROSPERO CRD42018100341
74 Keywords: overview of reviews, occupational injuries, occupational diseases, occupational health 75 and safety, OHS
Page 3 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
76 ARTICLE SUMMARY
77 Strengths and limitations of this study
78 To our knowledge, this is the first comprehensive overview of reviews on behavioural,
79 relational and mixed interventions to prevent injuries at work and occupational diseases.
80 We based our overview of reviews on an extensive, comprehensive and systematic literature
81 search.
82 Two scientists independently carried out all the essential steps in the preparation of this
83 review.
84 A secondary literature analysis may result in evidence base gaps, either due to periods not
85 covered by the included SRs or to further limitations in the SRs.
86 We considered only SRs with a low or at least unclear risk of bias for the data extraction
87 analysis to ensure validity but on the contrary, this approach may have led to a loss of
88 information in topics where only SRs with a high risk of bias were available.
89
90
91
Page 4 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
92 BACKGROUND
93 Occupational injuries and diseases cause extensive suffering and productivity losses. The
94 World Health Organization (WHO) estimates that, globally, there are 1.2 million deaths per year
95 attributable to occupational risks, which relates to 2.1% of all deaths in the general population[1, 2].
96 Estimates from the Workplace Safety and Health Institute, Singapore, in cooperation with the
97 International Labour Organization (ILO) are even higher, with nearly 2.8 million deaths annually being
98 attributed to work, and another 374 million to non-fatal occupational accidents[3]. Although the
99 estimation of occupationally related mortality and morbidity worldwide varies widely due to
100 methodological problems, the general conclusion is that occupational diseases and injuries are a
101 huge public health problem[4]. Not only do social and ethical arguments support preventive
102 occupational health and safety (OHS) services[5] but so do the monetary consequences of ill health
103 at work[6].
104 Decisions on which interventions to implement are usually dominated by negotiations
105 between unions, employers and government representatives[7]. However, expert advice can be
106 seriously biased[8], leading to wide variations in expert judgments[9].
107 The WHO states that the principle that all their guidelines must be based on systematic and
108 comprehensive assessment of potential benefits and harms[10]. Nevertheless, many OHS guidelines
109 are still not based on the best available evidence[11]. Healthcare providers and policy makers are
110 confronted with an unmanageable amount of information[12], and there is a large amount of
111 systematic reviews on interventions to prevent single occupational diseases or injuries according to
112 very specific risks available (e.g. on work.cochrane.org). Systematic reviews are regarded as the most
113 appropriate method to avoid bias in synthesising the best available evidence. Because so many
114 systematic reviews are already available, we conducted an overview of reviews. That means we
115 compiled the results from multiple systematic reviews (SRs), addressing the effects of interventions
116 for a health problem or condition according to a predefined procedure. We appraised their quality
117 and summarized their evidence for important outcomes[13]. The aim of this overview of reviews is to
Page 5 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
118 provide a comprehensive basis for making evidence-based decisions on interventions in the OHS field
119 by answering the following research question:
120 ‘What effects do interventions in the workplace setting have on working conditions,
121 exposure to disease-causing factors and the behaviour of employees as well as on accidents at work
122 and the development of occupational diseases?’
123 To our knowledge, this is the first comprehensive overview of reviews on behavioural,
124 relational and mixed interventions to prevent injuries at work and occupational diseases, based on a
125 comprehensive and systematic search, critical appraisal and the synthesis of SRs. It enables
126 prioritisation between different interventions based on the quality of evidence (QoE).
127 METHODS
128 We have registered the protocol of the overview of reviews at the International Prospective
129 Register of Systematic Reviews (PROSPERO), registration number CRD42018100341. We adhered to
130 the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement[14]
131 throughout this manuscript (PRISMA checklist see Appendix 6).
132 Study design
133 We conducted an overview of reviews following the guidance provided in the Cochrane
134 Handbook[12].
135 Information sources and literature search
136 An information specialist conducted the database search in MEDLINE (Ovid), the Cochrane Library
137 (Wiley), Epistemonikos.org and Scopus (Elsevier) in June 2018. The usefulness of SRs also depends on
138 their actuality, but there is no consensus on when SRs are obsolete and when an update is
139 necessary[15]. To prevent us from relying on outdated evidence, we limited the search to SRs
140 published since 2008. The full search strategies are reported in Appendix 1.
141 Additionally, we checked the bibliographies of the included SRs and relevant articles for further
142 references to eligible reviews. To ensure that the evidence is up to date, we conducted forward
Page 6 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
143 citation tracking of selected SRs using Scopus (Elsevier). We also checked the websites of the
144 Cochrane Work Group1, the ILO2, the Occupational Safety and Health Administration (OSHA)3, the
145 WHO4 and the European Agency for Safety and Health at Work (EU-OSHA)5.
146 Eligibility criteria
147 You can find a detailed description of the inclusion and exclusion criteria in Table 1. We provide
148 additional information and definitions thereafter.
149 Table 1: Eligibility criteria for the overview of reviews on OHS interventions
Inclusion criteria Exclusion criteria
Study design Systematic reviews (with or without meta-analysis) of randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBA studies) and/or interrupted time series (ITS)
Systematic reviews of other study designs only if they reported a subgroup analysis on the study designs listed above, or at least 50% of included studies corresponded to those study designs
Primary studies, narrative reviews, editorials, opinion papers
Population Any kind of employees aged 15 or over, who were not self-employed
Mixed population of employed and self-employed employees only if at least 50% employed
Exclusively self-employed persons
Specific occupations (i.e. teachers or sex workers)
Intervention All types of workplace-related interventions designed to protect against occupational injuries and for the primary prevention of occupational diseases:
Organisational-level workplace interventions according to Montano et al. [16]: 1) material conditions, 2) work time-related conditions, 3) work organisation conditions
Provision of educational materials (e.g. brochures, films)
Training, counselling or workshops aimed at multipliers or directly at employees and workers
Legislation Audits by the health and safety executive
Vaccinations at the workplace
Comparison Another intervention (active control) or no
1 https://work.cochrane.org/cochrane-reviews-about-occupational-safety-and-health2 https://www.ilo.org/global/lang--en/index.htm3 https://www.osha.gov/pls/publications/publication.AthruZ?pType=Types4 http://www.who.int/occupational_health/publications/en/5 https://osha.europa.eu/en/tools-and-publications
Page 7 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
intervention
Outcomes Prevalence, incidence and severity of occupational diseases, occupational injuries, physical disability, physical symptoms (e.g. pain experience)
Sickness absence rates
Risk factors that can lead to occupational injuries or diseases
Surrogate parameters (e.g. high blood pressure)
Quality changes at organisational level (e.g. in production)
Cost efficiency Job satisfaction or work
motivation
Setting Interventions at the workplace Studies conducted in OECD (Organisation for
Economic Cooperation and Development) countries (at least 50% of included studies in SR)
Leisure time School Non-OECD countries
150
151 We defined systematic review according to the Cochrane Handbook as ‘a literature review that
152 attempts to collate all empirical evidence using a) clearly stated objectives and pre-defined eligibility
153 criteria, b) an explicit reproducible methodology, c) a systematic search, d) an assessment of the
154 validity of the findings of the included studies, and e) a systematic presentation, and synthesis, of the
155 characteristics and findings of the included studies’.[12] In addition, to be included in this overview of
156 reviews, SRs had to conduct the search in at least two scientific databases and perform abstract and
157 full-text screening by two independent reviewers.
158 We included SRs of all types of workplace-related interventions designed to protect against
159 occupational injuries and for the primary prevention of occupational diseases, including legislation
160 and audits by the health and safety executive as well as organisational-level workplace interventions.
161 According to Montano et al.[16], interventions that modify working conditions can be described in
162 three broad categories: material condition (physical and chemical agents needed during work), work
163 time-related condition (amount of working time and intensity of work) and work organisation
164 conditions (psychological factors and processes and procedures necessary for the completion of work
165 tasks).
166 We defined occupational diseases in accordance with the definition of the ILO[17] that groups
167 occupational diseases caused by exposure to agents arising from work activities (caused by chemical
168 agents, physical agents, biological agents or infectious or parasitic diseases), by target organ systems
Page 8 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
169 (respiratory diseases, skin diseases, musculoskeletal disorders and mental and behavioural disorders)
170 and occupational cancer.
171 Work-related injuries are injuries which are causally, locally and temporally related to the insured
172 occupation and which lead to physical injury[18]. Risk factors that can lead to occupational injuries or
173 diseases were defined as changes in environmental conditions, changes in exposure to disease-
174 causing factors (e.g. noise, extreme temperatures) and changes at the employees’ or workers’
175 behavioural level (e.g. wearing protective equipment).
176 Study selection
177 The study selection was dually conducted by two independent reviewers (BT, AE, LA, UG, MS) in two
178 consecutive steps (abstract and full-text selection) based on the previously defined inclusion criteria.
179 Conflicts between reviewers were resolved through discussion and consensus or by involving a third
180 person. We used the software Covidence (https://www.covidence.org/) for the study selection
181 process.
182 Risk of bias assessment and certainty of evidence
183 Two independent reviewers appraised the quality of the SRs with the ROBIS (Risk of Bias in
184 Systematic Reviews) tool[19]. This assesses four dimensions of SRs: ‘study eligibility criteria’,
185 ‘identification and selection of studies’, ‘data collection and study appraisal’ and ‘synthesis and
186 findings’. The result is an assessment of the risk of bias of each SR using the categories low, unclear
187 and high (see Table 2). Disagreements in appraisal between reviewers were resolved through
188 discussion and consensus or by involving a third person.
189 Table 2: Definition and interpretation of risk of bias[19]
Risk of bias InterpretationLow risk of bias The findings of the review are likely to be reliable. No concerns with the review
process, or concerns were appropriately considered in the review conclusions. The conclusions were supported by the evidence and included consideration of the relevance of included studies.
High risk of bias One or more of the concerns raised during the assessment was not addressed in the review conclusions, the review conclusions were not supported by the evidence or the conclusions did not consider the relevance of the included studies to the review question.
Page 9 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Unclear risk of bias There is insufficient information reported to make a judgment on risk of bias.190
191 Data synthesis and analysis
192 We synthesised data narratively and in forms of evidence tables. Due to the large number of SRs
193 available and to ensure validity, we extracted only those SRs with a low or unclear risk of bias. We
194 excluded SRs with a high risk of bias for our data synthesis and analysis.
195 We extracted the following data:
196 - Details of the SR (author, title, year of publication, aim of the SR)
197 - Details of the included studies (number of studies and persons included, risk of bias of
198 studies)
199 - Details of the population (age, gender, type of occupation)
200 - Details of the intervention (duration, type of measures)
201 - Details of the results (time of outcome measurement, results for each endpoint)
202 - Quality of evidence (if reported in the included SR)
203 Several institutions (e.g. Cochrane, WHO, BMJ Clinical Evidence and many more[20]) and the
204 researchers of several included SRs use the GRADE approach (Grading of Recommendations,
205 Assessments, Developments and Evaluations) or modifications thereof to assess the QoE. Table 3
206 presents the significance of the four levels of evidence.
207 Table 3: Significance of the four levels of evidence[21]
Quality level Definition
highWe are very confident that the true effect lies close to that of the estimate of the effect
moderateWe are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
low
Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
very lowWe have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
Page 10 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
208 If the researchers of the included SRs used evidence assessment tools other than the GRADE
209 approach, we provide the definition of the used levels of evidence in a footnote.
210 We did not extract data from primary studies. If information was not apparent from the included
211 review, it was presented as ‘not available’ (n.a.). If the SR was an update of an older version, we only
212 extracted data of the most recent version. We did not find SRs that answered the exact same
213 research question; therefore, we did not check for overlap in the included primary studies.
214 Patient and Public Involvement
215 It was not appropriate or possible to involve patients or the public in this work.
216 RESULTS
217 We identified 2215 citations from electronic database searches after the removal of duplicates, and
218 we found another 72 citations from additional searches. Overall, 2287 citations were screened by
219 title and abstract and, subsequently, we assessed 200 full texts for eligibility. From the 71 SRs (74
220 records) that met our eligibility criteria, we appraised 32 with a high risk of bias. Four of the included
221 SRs were updates from previous versions. Finally, we included 35 SRs reported in 38 publications for
222 data synthesis and analysis. Figure 1 shows the details of the study selection process. We provide a
223 list of excluded full-text articles with reasons for exclusion as well as a detailed risk of bias
224 assessment (including SRs with a high risk of bias) in online appendices 3 and 4.
225 Please insert Figure 1 here
226 Figure 1: PRISMA Flowchart of the study selection process
227
228 Description of included studies
229 Table 4 (Appendix 2) provides an overview of the included SRs, summarising the interventions,
230 description of measured outcomes and risk of bias rating.
Page 11 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
231 Among the 35 included SRs , we rated 25 as having a low risk of bias[22-46] and 10 as having an
232 unclear risk of bias[16, 28, 47-54] (see Table 1). A considerable number of studies (15 SRs) dealt with
233 research questions on the topic of the prevention of musculoskeletal disorders, nine investigated the
234 efficacy of interventions for the prevention of occupational injuries, and six reviews studied
235 interventions for the prevention of occupational skin and lung diseases. One review examined the
236 efficacy of interventions for the prevention of occupational hearing loss, and another four SRs dealt
237 with diverse interventions about occupational health and safety (OHS) without limiting to a specific
238 target disease. Detailed information about all abovementioned SRs including the interventions,
239 control interventions, included studies, setting, method of data synthesis and a graphical
240 presentation of the results can be found in the online-only supplementary material (Appendix 5).
241 Prevention of musculoskeletal disorders
242 Overall, 15 SRs reported on different interventions for the prevention of musculoskeletal disorders.
243 They included mixed interventions with several different components[22-26]: physical exercises at
244 the workplace[27, 28], work organisation and psychosocial working environment[55], job rotation
245 [47], educational interventions for the prevention of musculoskeletal disorders[29], ergonomic
246 interventions[30, 48] and interventions in the area of manual handling of loads[31-33].
247 Strengthening exercises or fitness training had a positive effect on musculoskeletal disorders in
248 general as well as in the shoulder and neck area and on back pain in various occupational groups[23,
249 25, 27, 28]. The QoE varied widely between outcomes. See Table 6 in the online appendix 5 for
250 further details.
251 Lowry et al.[25] found a significant reduction in the prevalence of shoulder pain with workplace
252 adjustments (QoE: low). Additional breaks compared to conventional break schedules seem to
253 reduce symptom intensity in different body regions (QoE: moderate)[55]. Both SRs included a wide
254 range of occupational groups. Contradictory results regarding the effects of workplace rotation in
255 manufacturing industries on musculoskeletal disorders (QoE: n.a.) were shown by Padula et al.[47].
Page 12 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
256 Educational interventions alone (e.g. training) showed no effect on the reduction of musculoskeletal
257 disorders (QoE: very low to moderate)([26, 29, 55],[33] only on training for manual material
258 transfer).
259 The results of ergonomic interventions on musculoskeletal disorders are mixed and varied but, in
260 general, tend to result in some form of pain reduction. Driessen et al.[48] found no statistically
261 significant effect of ergonomic interventions on lower back pain and no reduction in the incidence
262 and prevalence of neck pain (QoE: low to moderate), but they did find a reduction in the intensity of
263 neck pain (QoE: low). Chen et al.[23] found evidence of low quality for the efficacy of ergonomic
264 interventions on neck pain. The use of an arm support with alternative computer mice reduces the
265 incidence of musculoskeletal disorders in the neck/shoulder but not in the right upper extremity
266 (QoE: moderate)[30]. There is no difference for musculoskeletal disorders in the neck/shoulder and
267 right upper extremity between alternative and conventional computer mice with and without arm
268 support (QoE: moderate)[30]. Richardson et al.[26] found a positive effect of unstable shoes on pain
269 in nurses (QoE: n.a.). No effect of physiotherapist or ergonomist feedback sessions on the optimal
270 design of computer workstations, work techniques and the psychosocial aspects of work could be
271 observed (QoE: low)[55]. Goodman et al.[24] concluded that not a single measure but a combination
272 of measures (included interventions, e.g. education, work station adjustments, exercise, rest breaks,
273 specific ergonomic equipment) is most effective in addressing cumulative trauma disorder (CTD)
274 symptoms.
275 Aids for patient transfer (both small aids such as bed steps, anti-slip mats, etc., and mechanical aids
276 such as mechanical transport devices for patients) led to positive effects on pain and/or injuries of
277 the musculoskeletal system in two SRs (QoE: very low to low)[31, 32]. Stock et al.[55] showed that
278 ‘lifting programmes’ as well as multi-component interventions on safe patient handling in hospitals
279 had no effect on several outcomes measured (e.g. the prevalence of neck/shoulder pain,
280 forearm/wrist pain, lower back pain and musculoskeletal pain in any body region; upper extremity or
281 back-related functional status; musculoskeletal work injury rates and time loss injury rates; QoE: very
Page 13 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
282 low to low) except for two outcomes: they found low-quality evidence that a safe lifting program is
283 more effective than usual practice in reducing the frequency of work-related shoulder pain and work-
284 related low back pain (QoE: low)[55].
285 Prevention of occupational injuries
286 Overall, nine SRs investigated interventions for the prevention of occupational injuries. One review
287 dealt with different interventions for the prevention of occupational injuries in the agricultural
288 sector[34], one SR examined the effects of interventions for the prevention of occupational injuries
289 in the construction industry[35], and another review examined the effects of alcohol and drug
290 screening of professional drivers on accidents[36]. Five SRs searched for safety products and
291 practices in the health sector to prevent occupational injuries[37-40, 50], and one additional review
292 examined the effect of training measures for the prevention of eye injuries[49].
293 Rautiainen et al.[34] found no effect of education on the prevention of injuries in the agricultural
294 sector. Financial incentives (insurance premium discounts) showed a short-term positive effect but
295 no long-term progressive improvement. Legislation banning Endosulfan pesticides showed a
296 progressive reduction in deaths by poisoning. Regulations for the use of rollover protection
297 structures showed contradictory results. For all outcomes, no QoE was stated.
298 Van der Molen et al.[35] found contradictory evidence on the impact of regulations and inspections
299 to prevent injuries in construction workers. Regional safety campaigns, training, inspections or the
300 introduction of occupational health services are unlikely to reduce the number of non-fatal injuries in
301 construction companies, while company-oriented measures, such as safety campaigns, a drug
302 workplace programme or subsidies for safe scaffolding, can have a positive effect (QoE: very low for
303 all outcomes).
304 Cashman et al.[36] investigated the effects of alcohol and drug screening of occupational drivers on
305 accidents and injuries. This review included two ITS studies which analysed data over a period of 13
306 and 14 years, respectively. Binding alcohol tests brought with them fewer accidents in the short term
Page 14 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
307 but had no effect on the long-term trend. With regard to mandatory drug tests, the studies did not
308 show a uniform picture of the short-term effects but a uniform strengthening of the long-term trend
309 towards declining accident rates. The authors of the study judged the QoE as limited, which was
310 defined as ‘one low quality RCT or one CBA study or one ITS’[36].
311 Five SRs investigated for safety products and practices in the health sector to prevent occupational
312 injuries. Parantainen et al.[38] showed that the use of blunt surgical suture needles reduced the risk
313 of glove perforation (QoE: high) and the number of self-reported needle stick injuries (QoE:
314 moderate) compared to sharp suture needles. Reddy et al.[39] found that the use of safe blood
315 collection systems showed inconsistent effects on the number of needle stick injuries (QoE: very
316 low). The use of safe passive intravenous systems showed a decrease in needle stick injuries and a
317 reduction in the incidence of blood splashes (QoE: very low). However, evidence of moderate quality
318 was found that active systems might increase exposure to blood. For safe injection devices (QoE:
319 very low to low), the introduction of several safety products (QoE: very low) or safety containers
320 (QoE: very low) showed inconsistent results, or there was no clear evidence of benefit. Two ITS
321 studies showed that interrupted introduction of legislation on the use of safety-engineered devices
322 reduced the rate of needle stick injuries among healthcare workers (QoE: moderate), whereas one
323 ITS with low-quality evidence showed an increase in the level of needle stick injuries with gradual
324 introduction. Evidence showed varying results in the trend over time for needle stick injury rates
325 (QoE: very low to low)[39].
326 Mischke et al.[37] reported that there is moderate-quality evidence that double gloves reduce
327 perforations and bloodstains on the skin compared to single gloves during surgery, which may mean
328 a decrease in percutaneous exposure events. Triple gloves and the use of special gloves can further
329 reduce the risk of glove perforations compared to double gloves made of normal material (QoE: low).
330 Verbeek et al.[40] found very low-quality evidence that more breathable types of PPE would not lead
331 to more contamination with body fluids. Double gloves and the Center for Disease Control and
332 Prevention (CDC) doffing guidelines reduced the risk of contamination with body fluids, and more
Page 15 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
333 active training in PPE use could reduce PPE errors and PPE doffing errors more than passive training
334 (QoE: very low). However, the data all come from individual studies with a high risk of bias, so there
335 is uncertainty about the estimates of the effects. Ballout et al.[50] found a moderate QoE that the
336 use of safety products for intravenous injections and infusions reduces needle stick injuries.
337 We further included an SR[49] from 2009 that examined the effect of educational interventions for
338 the prevention of eye injuries. Two of the included studies dealt with interventions at the workplace,
339 specifically the wearing of protective glasses by agricultural workers and ship fitters. According to
340 observations, training by community health workers led to the wearing of distributed protective
341 glasses by agricultural workers twice as often as the sole distribution or mere provision of glasses
342 (QoE: very low). Training supervisors in the fundamentals of behaviour modification related to
343 wearing protective eyewear resulted in a not statistically significant reduction in eye injuries than in
344 the control group without training (QoE: very low).
345 Prevention of occupational skin and lung diseases
346 Six SRs included studies about the efficacy of interventions to prevent occupational skin and lung
347 diseases[41-43, 51-53].
348 Lunt et al. [41] found low positive effects of behavioural interventions at the workplace (training for
349 behavioural changes or for influencing knowledge and attitudes about health and safety precautions)
350 on exposure to occupational health hazards for workers exposed to dermal and respiratory hazards
351 (QoE: n.a.). Luong Than et al.[42] found evidence of low to very low quality that behavioural
352 interventions (education and training to improve the use of respiratory protective equipment) did
353 not largely contribute to workers using protective equipment correctly or more frequently. Bauer et
354 al.[43] found that moisturisers used alone or in combination with barrier creams can provide
355 clinically relevant protection against irritant hand dermatitis (QoE: low). For advanced training
356 interventions for skin protection, the results of the individual studies varied considerably. Altogether,
357 they showed no clinically relevant effect (QoE: very low)[43].
Page 16 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
358 Offeddu et al.[51] conducted an SR and meta-analysis and showed low-quality evidence to support
359 the use of respiratory protection to prevent clinical respiratory diseases, flu-like diseases and acute
360 respiratory syndrome. De Groene et al.[52] found low-quality evidence that eliminating exposures
361 improves asthma symptoms and lung function compared to prolonged exposure. Reducing exposure
362 also improved symptoms but did not appear to be as effective as eliminating them. Van Holland et
363 al.[53] found moderate evidence of the positive effects of multi-component programmes
364 (educational activities and skin protection measures such as protective gloves and skin care) on the
365 prevalence of eczema. These programmes had positive effects on the use of gloves and the inclusion
366 of information on prevention, but no significant effect was found on the use of skin care products
367 (QoE: n.a.).
368 Prevention of occupational hearing loss
369 We identified one SR which examined the effect of interventions for the prevention of occupational
370 hearing loss[44]. On average, wearing hearing protection reduced noise exposure by about 20 dB(A)
371 (QoE: low), and more noise was attenuated with instruction on how to use hearing protection than
372 without instruction (QoE: moderate). With regard to hearing impairment, there was no difference
373 between ear protectors and earplugs at noise levels above 89 dB(A) (QoE: very low). Implementing
374 stricter legislation to protect against occupational hearing loss (multiple components, e.g. prioritising
375 technical and administrative controls, setting a threshold) led to an immediate reduction in the mean
376 personal noise exposure in coal construction and a further positive, but statistically not significant,
377 trend in the reduction of the noise dose (QoE: very low). Furthermore, the authors found no
378 statistically significant differences between on-site training and information online (QoE: low),
379 information about personal noise exposure and no information about it (QoE: low), intensive hearing
380 loss prevention programmes (HLPP) compared to pure audiometry (QoE: moderate) and HLPP with
381 personal noise exposure information compared to HLPP without this information (QoE: very low).
382 General occupational health and safety interventions
Page 17 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
383 We included two SRs that examined the effects of laws and regulations on occupational safety and
384 health[45, 54]. One SR each dealt with interventions for the prevention of the inability to work after
385 sick leave[46, 56] and the effects of interventions at the organisational level on employee health[16].
386 Mischke et al.[48] found positive effects of compliance inspections on injuries at work (QoE: low).
387 However, the effects only became apparent in the long term (mean 36 and 48 months follow-up),
388 and no statistically significant risk reductions could be observed in the short term (mean 21–24
389 months). Inspections also had no statistically significant effect on employees’ physical workload
390 (QoE: low).
391 Tompa et al.[51] showed an unclear risk of bias and did not provide any information on the
392 methodology of the individual studies included. Hence, the results should be interpreted with
393 caution. This review identified positive effects of OHS legislation on injuries and fatality (QoE:
394 moderate6) and on exposure and compliance (QoE: limited1). Moderate1 evidence has been found
395 that legislation on smoke-free workplaces has positive effects on respiratory and sensory symptoms,
396 and strong1 evidence was found for a positive effect on exposure and cigarette consumption. The
397 first inspection had a greater impact on improvements than following inspections (QoE: moderate1),
398 and specific deterrents with sanctions were more effective than general deterrent interventions or
399 specific deterrents without sanctions (QoE: moderate to strong1). In relation to awareness-raising
400 campaigns, the authors found limited1 evidence for their positive effect on injuries and moderate1
401 evidence for their effect on awareness and compliance. Van Vilsteren et al.[46] showed that
402 interventions to prevent work disability in workers on sick leave shortened the time to first return-to-
403 work of workers with musculoskeletal disorders (QoE: moderate) and the time to lasting return-to-
404 work (Qoe: very low) for this group of workers but not for people with mental illness or cancer (QoE:
405 very low). Workplace interventions reduced the cumulative sickness duration by an average of 33
406 days (QoE: high). Significant results were only shown for persons with musculoskeletal disorders but
6 The authors assessed the strength of the evidence on the basis of minimum study quality, minimum number of studies and a consistency criteria. Detailed assessment criteria can be found in the original publication.
Page 18 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
407 not for persons with mental illnesses. However, the risk of sick leave recurrences for persons with
408 musculoskeletal disease was higher for workplace interventions (QoE: moderate). In addition, the
409 authors found positive effects on the functional status of employees with musculoskeletal disorders
410 (QoE: moderate) and pain (QoE: high) but no significant effect on depression (QoE: very low). Overall,
411 the SR found evidence for the positive effects of workplace interventions to prevent work disability in
412 workers on sick leave with musculoskeletal disorders (QoE: moderate) but no effects on persons with
413 mental illnesses or cancer (QoE: low)[46].
414 Montano et al.[16] summarised interventions at the organisational level to change working
415 conditions: changes in materials, changes in work time, changes in work organisation or changes in
416 several working conditions jointly. A regression analysis showed that interventions to simultaneously
417 change several types of working conditions (material, time, organisation) tended to lead to more
418 significant results in the intended outcomes (not significant; QoE: n.a.).
419 DISCUSSION
420 This overview of reviews provides a comprehensive overview of behavioural, relational and mixed
421 interventions and their effectiveness in preventing occupational injuries and diseases. We identified
422 SRs on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational
423 hearing impairment and interventions without specific target diseases.
424 Almost half of all the included reviews refer to work-related illnesses of the musculoskeletal system,
425 which demonstrates the importance of this topic and is in accordance with the fact that
426 musculoskeletal disorders are one of the main causes for work-related mortality and morbidity [57].
427 Several interventions (e.g. strengthening exercises, individual ergonomic interventions and patient
428 transfer aids) led to consistently positive results on individual musculoskeletal system diseases. Other
429 interventions (e.g. workplace rotation, educational and cognitive behavioural interventions) targeting
430 illnesses of the musculoskeletal system did not show any effects, or the studies are contradictory.
Page 19 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
431 With regard to the prevention of occupational accidents and the reduction of exposure to risk
432 factors, legislation and regulations as well as inspections can be effective (e.g. ban on Endosulfan
433 pesticides, general workplace inspections, etc.). In some cases, however, contradictory results (e.g.
434 regulations on the use of rollover protection structures) or no effects (e.g. inspections in the
435 construction sector) were found. Financial incentives such as insurance premium discounts and
436 subsidies for safe scaffolding showed positive effects. Company-oriented interventions such as safety
437 campaigns, awareness-raising campaigns or drug workplace programmes appear to have positive
438 effects on injuries at work and compliance with rules. The evidence for the effectiveness of training
439 and education interventions, in general, is mixed and must be considered specifically by target
440 disease or intervention.
441 In the medical field, there is partly good evidence for the use of safety products (e.g. blunt needles,
442 double gloves, etc.), but inconsistent effects have been observed for other safety products and
443 practices (e.g. use of safe blood collection systems, safe injection needles, etc.). With regard to skin
444 and lung diseases, there is some good evidence of the efficacy of various interventions (e.g.
445 moisturisers, barrier creams, protective gloves, etc.). There are also effective interventions to
446 prevent work-related hearing loss (e.g. wearing hearing protection, well-implemented HLPP).
447 Changes in working conditions are more effective the more conditions they affect (material, working
448 time, work organisation).
449 While many relevant endpoints were covered in the included reviews, cancer and circulatory
450 diseases were not mentioned in any of them. On one hand, this may result from the limitation of
451 certain primary study designs—such as RCTs or CBA studies—which are considered robust but may
452 not be suitable to assess effects on diseases that are relatively rare and develop in the long term,
453 such as cancer. On the other hand, this may be interpreted as a demonstration of an important gap
454 in the research literature, especially as cancer and circulatory diseases are two of the main causes for
455 work-related mortality and morbidity[57]. A strength of this overview of reviews is the extensive
456 literature search. The search strategy was not restricted to specific target diseases or interventions to
Page 20 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
457 obtain the most comprehensive results possible. Through the use of several additional search
458 strategies, such as reviewing multiple organisational websites and backward and forward citation
459 tracking, further SRs could be identified. Nonetheless, there remains a residual risk of not having
460 found all relevant reviews. As a methodological limitation, it can be stated that a secondary literature
461 analysis may result in evidence base gaps, either due to periods not covered by the included SRs or to
462 further limitations in the SRs, such as limitations on study design or included interventions[58].
463 Our approach of considering only SRs with a low or at least unclear risk of bias for the data extraction
464 analysis may be seen as ensuring validity in topics where good systematic reviews were available. On
465 the contrary, this approach may have led to a loss of information in topics where only SRs with a high
466 risk of bias were available, such as mental diseases. However, the large number of identified SRs with
467 a high risk of bias highlights the need for more reviews in the field of OHS that apply rigorous
468 methods. A further strength of this overview of reviews is that two scientists independently carried
469 out all the essential steps in the preparation of this review. This ensures that both the screening of
470 the references and the assessment of the risk of bias of the included reviews minimized subjective
471 influences. To our knowledge, this is the first comprehensive overview of reviews on interventions to
472 prevent injuries at work and occupational diseases. It provides policy makers with an important basis
473 for making evidence-based decisions on interventions in this field.
474 COMPETING INTERESTS
475 All authors declare that they have no competing interests.
476 FUNDING
477 This overview of reviews was funded by the Austrian General Accident Insurance Institution
478 (Allgemeine Unfallversicherung, AUVA). The funding source had no role in the collection, analysis or
479 interpretation of data.
480 DIFFERENCES BETWEEN PROTOCOL AND REVIEW
Page 21 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
481 The protocol allowed for the inclusion of all systematic reviews that fulfilled our eligibility criteria
482 regardless of their quality (risk of bias). Due to the large number of available reviews, we decided to
483 include for data extraction only systematic reviews with a low or at least unclear risk of bias.
484 ACKNOWLEDGMENTS
485 We wish to thank Danielle Eder-Linder from the University of Continuing Education (Danube
486 University Krems) for administrative support.
487 AUTHOR CONTRIBUTIONS
488 CK drafted the research protocol, and BT, UG and LG provided substantial contributions to the
489 protocol. BT coordinated the reviewing process. BT, AE, LA, UG and MS contributed to the abstract
490 and full-text screening, data extraction and risk of bias assessment of the reviews. IK developed the
491 search strategy, performed the search and contributed to the data extraction. All authors wrote
492 substantial parts of the first draft of the manuscript and revised it critically for important intellectual
493 content, and all approved the final manuscript.
494 REFERENCES
495 1. Stanaway JD, Afshin A, Gakidou E, et al. Global, regional, and national comparative risk 496 assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of 497 risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of 498 Disease Study 2017. The Lancet. 2018;392(10159):1923-94.499 2. Wolf J, Prüss-Ustün A, Ivanov I, et al. Preventing disease through a healthier and safer 500 workplace. Geneva: World Health Organization; 2018.501 3. Hämäläinen P, Takala J, Kiat TB. Global estimates of occupational accidents and work-related 502 illnesses 2017. World. 2017;2017:3-4.503 4. Rushton L. The global burden of occupational disease. Current environmental health reports. 504 2017;4(3):340-8.505 5. World Health Organization. Declaration on Occupational Health for All: approved at the 506 Second Meeting of the WHO Collaborating Centres in Occupational Health, Beijing, China, 11-14 507 October 1994. Geneva: World Health Organization; 1994.508 6. Stewart WF, Ricci JA, Chee E, et al. Lost productive work time costs from health conditions in 509 the United States: results from the American Productivity Audit. Journal of occupational and 510 environmental medicine. 2003;45(12):1234-46.511 7. Verbeek J, Morata T, Ruotsalainen J, et al. Prevention of occupational diseases: implementing 512 the evidence. Cochrane Database Syst Rev [Internet]. 2013 [cited E; (4). Available from: 513 http://cochranelibrary-wiley.com/doi/10.1002/14651858.ED000056/abstract.514 8. Michaels D. Doubt is their product, how industry’s assault on science threatens your health. 515 New York: Oxford University Press; 2008.
Page 22 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
516 9. Sutherland WJ, Burgman M. Policy advice: Use experts wisely. Nature. 2015;526(7573):317-8.517 10. World Health Organization. WHO Handbook for Guideline Development. 2nd edition. 518 Geneva: World Health Organization; 2014.519 11. Verbeek J. Could we have better occupational health guidelines, please? Scand J Work 520 Environ Health. 2018;44(5):441-2.521 12. Green S, Higgins JP, Alderson P, et al. Cochrane Handbook for Systematic Reviews of 522 Interventions; CHAPTER 1: INTRODUCTION training.cochrane.org/handbook: The Cochrane 523 Collaboration; 2011 [5.1:[524 13. Higgins J, S G. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 525 [updated March 2011] Chapter 22: Overviews of reviews: The Cochrane Collaboration; 2011 526 [Available from: www.handbook.cochrane.org.527 14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 528 meta-analyses: the PRISMA statement. International journal of surgery (London, England). 529 2010;8(5):336-41.530 15. Moher D, Tsertsvadze A, Tricco A, et al. When and how to update systematic reviews. 531 Cochrane Database Syst Rev. 2008(1).532 16. Montano D, Hoven H, Siegrist J. Effects of organisational-level interventions at work on 533 employees' health: a systematic review. BMC Public Health. 2014;14:135.534 17. International Labour Organization (ILO). ILO List of Occupational Diseases (revised 2010) 2010 535 [10. August 2017]. Available from: http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---536 protrav/---safework/documents/publication/wcms_125137.pdf.537 18. Allgemeine Unvfallversicherungsanstalt (AUVA). Liste der Berufskrankheiten, Inkrafttreten: 538 01.01.2014 2014 [Available from: https://www.auva.at/cdscontent/load?contentid=10008.541831.539 19. Whiting P, Savovic J, Higgins JP, et al. ROBIS: A new tool to assess risk of bias in systematic 540 reviews was developed. J Clin Epidemiol. 2016;69:225-34.541 20. Green S, Higgins JP, Alderson P, et al. Cochrane Handbook for Systematic Reviews of 542 Interventions; PART 2; 12.2.1 The GRADE approach training.cochrane.org/handbook: The Cochrane 543 Collaboration; 2011 [5.1:[544 21. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of 545 evidence. J Clin Epidemiol. 2011;64(4):401-6.546 22. Aas RW, Tuntland H, Holte KA, et al. Workplace interventions for neck pain in workers. 547 Cochrane Database Syst Rev. 2011(4):CD008160.548 23. Chen X, Coombes BK, Sjogaard G, et al. Workplace-Based Interventions for Neck Pain in 549 Office Workers: Systematic Review and Meta-Analysis. Phys Ther. 2018;98(1):40-62.550 24. Goodman G, Kovach L, Fisher A, et al. Effective interventions for cumulative trauma disorders 551 of the upper extremity in computer users: practice models based on systematic review. Work. 552 2012;42(1):153-72.553 25. Lowry V, Desjardins-Charbonneau A, Roy JS, et al. Efficacy of workplace interventions for 554 shoulder pain: A systematic review and meta-analysis. J Rehabil Med. 2017;49(7):529-42.555 26. Richardson A, McNoe B, Derrett S, et al. Interventions to prevent and reduce the impact of 556 musculoskeletal injuries among nurses: A systematic review. Int J Nurs Stud. 2018;82:58-67.557 27. Kelly D, Shorthouse F, Roffi V, et al. Exercise therapy and work-related musculoskeletal 558 disorders in sedentary workers. Occupational Medicine. 2018;68(4):262-72.559 28. Moreira-Silva I, Teixeira PM, Santos R, et al. The Effects of Workplace Physical Activity 560 Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Workplace Health Saf. 561 2016;64(5):210-22.562 29. Crawford JO, Laiou E, Spurgeon A, et al. Musculoskeletal disorders within the 563 telecommunications sector-A systematic review. Int J Ind Ergon. 2008;38(1):56-72.564 30. Hoe VC, Urquhart DM, Kelsall HL, et al. Ergonomic design and training for preventing work-565 related musculoskeletal disorders of the upper limb and neck in adults. Cochrane Database Syst Rev. 566 2012(8):CD008570.
Page 23 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
567 31. Freiberg A, Euler U, Girbig M, et al. Does the use of small aids during patient handling 568 activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic 569 review. Int Arch Occup Environ Health. 2016;89(4):547-59.570 32. Hegewald J, Berge W, Heinrich P, et al. Do Technical Aids for Patient Handling Prevent 571 Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies. 572 Int J Environ Res Public Health. 2018;15(3):09.573 33. Verbeek JH, Martimo KP, Karppinen J, et al. Manual material handling advice and assistive 574 devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 575 2011(6):CD005958.576 34. Rautiainen RH, Lehtola MM, Day LM, et al. Interventions for preventing injuries in the 577 agricultural industry. Cochrane Database Syst Rev. 2008(1):CD006398.578 35. van der Molen HF, Basnet P, Hoonakker PL, et al. Interventions to prevent injuries in 579 construction workers. Cochrane Database Syst Rev. 2018;2:CD006251.580 36. Cashman CM, Ruotsalainen JH, Greiner BA, et al. Alcohol and drug screening of occupational 581 drivers for preventing injury. Cochrane Database Syst Rev. 2009(2):CD006566.582 37. Mischke C, Verbeek JH, Saarto A, et al. Gloves, extra gloves or special types of gloves for 583 preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev. 584 2014(3):CD009573.585 38. Parantainen A, Verbeek JH, Lavoie MC, et al. Blunt versus sharp suture needles for preventing 586 percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev. 2011(11):CD009170.587 39. Reddy VK, Lavoie MC, Verbeek JH, et al. Devices for preventing percutaneous exposure 588 injuries caused by needles in healthcare personnel. Cochrane Database Syst Rev. 2017;11:CD009740.589 40. Verbeek JH, Ijaz S, Mischke C, et al. Personal protective equipment for preventing highly 590 infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane 591 Database Syst Rev [Internet]. 2016 [cited I; (4). Available from: http://cochranelibrary-592 wiley.com/doi/10.1002/14651858.CD011621.pub2/abstract.593 41. Lunt JA, Sheffield D, Bell N, et al. Review of preventative behavioural interventions for dermal 594 and respiratory hazards. Occup Med (Oxf). 2011;61(5):311-20.595 42. Luong Thanh BY, Laopaiboon M, Koh D, et al. Behavioural interventions to promote workers' 596 use of respiratory protective equipment. Cochrane Database Syst Rev. 2016;12:CD010157.597 43. Bauer A, Ronsch H, Elsner P, et al. Interventions for preventing occupational irritant hand 598 dermatitis. Cochrane Database Syst Rev. 2018;4:CD004414.599 44. Tikka C, Verbeek JH, Kateman E, et al. Interventions to prevent occupational noise-induced 600 hearing loss. Cochrane Database Syst Rev. 2017;7:CD006396.601 45. Mischke C, Verbeek JH, Job J, et al. Occupational safety and health enforcement tools for 602 preventing occupational diseases and injuries. Cochrane Database Syst Rev. 2013(8):CD010183.603 46. van Vilsteren M, van Oostrom SH, de Vet HC, et al. Workplace interventions to prevent work 604 disability in workers on sick leave. Cochrane Database Syst Rev. 2015(10):CD006955.605 47. Padula RS, Comper MLC, Sparer EH, et al. Job rotation designed to prevent musculoskeletal 606 disorders and control risk in manufacturing industries: A systematic review. Appl Ergon. 2017;58:386-607 97.608 48. Driessen MT, Proper KI, van Tulder MW, et al. The effectiveness of physical and 609 organisational ergonomic interventions on low back pain and neck pain: a systematic review. 610 Occupational and Environmental Medicine. 2010;67(4):277.611 49. Shah A, Blackhall K, Ker K, et al. Educational interventions for the prevention of eye injuries. 612 Cochrane Database Syst Rev. 2009(4):CD006527.613 50. Ballout RA, Diab B, Harb AC, et al. Use of safety-engineered devices by healthcare workers for 614 intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-615 analysis. BMC Health Serv Res. 2016;16:458.616 51. Offeddu V, Yung CF, Low MSF, et al. Effectiveness of Masks and Respirators Against 617 Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clinical 618 infectious diseases : an official publication of the Infectious Diseases Society of America. 619 2017;65(11):1934-42.
Page 24 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
620 52. de Groene GJ, Pal TM, Beach J, et al. Workplace interventions for treatment of occupational 621 asthma. Cochrane Database Syst Rev. 2011(5):CD006308.622 53. van Holland BJ, Soer R, de Boer MR, et al. Preventive occupational health interventions in the 623 meat processing industry in upper-middle and high-income countries: a systematic review on their 624 effectiveness. Int Arch Occup Environ Health. 2015;88(4):389-402.625 54. Tompa E, Kalcevich C, Foley M, et al. A systematic literature review of the effectiveness of 626 occupational health and safety regulatory enforcement. Am J Ind Med. 2016;59(11):919-33.627 55. Stock SR, Nicolakakis N, Vezina N, et al. Are work organization interventions effective in 628 preventing or reducing work-related musculoskeletal disorders? A systematic review of the 629 literature. Scand J Work Environ Health. 2018;44(2):113-33.630 56. van Oostrom SH, Driessen MT, de Vet HC, et al. Workplace interventions for preventing work 631 disability. Cochrane Database Syst Rev. 2009(2):CD006955.632 57. Elsler D, Takala J, Remes J. An International Comparison of the Cost or Work-Related 633 Accidents and Illnesses. European Agency for Safety and Health at Work: Bilbao, Spain. 2017.634 58. Piso B, Semlitsch T, Reinsperger I, et al. Practical experience with overviews of reviews–635 valuable decision aid or academic exercise? Zeitschrift für Evidenz, Fortbildung und Qualität im 636 Gesundheitswesen. 2015;109(4):300-8.
637
638
Page 25 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Figure 1: PRISMA Flowchart of the study selection process
271x255mm (96 x 96 DPI)
Page 26 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 1 – Search strategies
Search strategy MEDLINE (Ovid)
Ovid MEDLINE(R) 1946 to May Week 5 2018, Ovid MEDLINE(R) Epub Ahead of Print June 11, 2018, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations June 11, 2018, Ovid MEDLINE(R) Daily Update June 11, 2018
# Searches Results
1 Occupational Diseases/pc [Prevention & Control] 16456
2 Occupational Exposure/pc [Prevention & Control] 6085
3 Accidents, Occupational/pc [Prevention & Control] 5270
4 Occupational Injuries/pc [Prevention & Control] 686
5 Occupational Health/ed, lj, st [Education, Legislation & Jurisprudence, Standards] 3238
6 ((worker* or workplace or work related or occupation*) and intervention*).ti. 2050
7 or/1-6 30483
8
Occupational Exposure/ or Air Pollutants, Occupational/ or Accidents, Occupational/ or Dermatitis, Occupational/ or Occupational Diseases/ or Occupational Injuries/ or Asthma, Occupational/ or Noise, Occupational/ 149967
9 Occupational Health/ 30516
10 (worker* or workplace or work related or occupation*).ti. 116658
11 ((work* or occupation*) adj3 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)).ti,ab. 87656
12 *Work/ 15722
13 *Workplace/ 9376
14 *Occupations/ 9517
15 or/8-14 279210
16 Primary Prevention/ 16807
17 Health Education/ 57758
18 Health Promotion/ 66696
19 Risk Reduction Behavior/ 10752
20 Safety Management/ 18827
21 "Facility Design and Construction"/ 8866
22 Personal Protective Equipment/ 240
23 Occupational Health Services/ 10302
24 (health adj2 (safety or outcome? or benefit? or harm? or effect?)).ti,ab. 109219
25 (prevent* or promot* or reduc* or protect*).ti. 843783
26 ((prevent* or promot* or reduc* or protect*) adj4 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)).ab. 364870
27 or/16-26 1360949
28 15 and 27 47978
29 7 or 28 64546
30 exp age groups/ not (adolescent/ or exp adult/) 1190456
31 29 not 30 63888
32 review.pt. 2393987
Page 27 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only33
(medline or medlars or embase or pubmed or cochrane or (scisearch or psychinfo or psycinfo) or (psychlit or psyclit) or cinahl or ((hand adj2 search$) or (manual$ adj2 search$)) or (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$) or (pooling or pooled or mantel haenszel) or (peto or dersimonian or der simonian or fixed effect)).tw,sh. or (retraction of publication or retracted publication).pt. 270445
34 32 and 33 135062
35
meta-analysis.pt. or meta-analysis.sh. or (meta-analys$ or meta analys$ or metaanalys$).tw,sh. or (systematic$ adj5 review$).tw,sh. or (systematic$ adj5 overview$).tw,sh. or (quantitativ$ adj5 review$).tw,sh. or (quantitativ$ adj5 overview$).tw,sh. or (quantitativ$ adj5 synthesis$).tw,sh. or (methodologic$ adj5 review$).tw,sh. or (methodologic$ adj5 overview$).tw,sh. or (integrative research review$ or research integration).tw. 244993
36 34 or 35 296663
37 31 and 36 1349
38 limit 37 to yr="2008 -Current" 1071
Search strategy the Cochrane Library (Wiley)
Cochrane Library 12 June 2018 ID Search Hits
#1 [mh ^"Occupational Diseases"/pc] 448
#2 [mh ^"Occupational Exposure"/pc] 106
#3 [mh ^"Accidents, Occupational"/pc] 81
#4 [mh ^"Occupational Injuries"/pc] 29
#5 [mh ^"Occupational Health"/ed,lj,st] 32
#6 ((worker* or workplace or work related or occupation*) and intervention*):ti 936
#7 {or #1-#6} 1501
#8
[mh ^"Occupational Exposure"] or [mh ^"Air Pollutants, Occupational"] or [mh ^"Accidents, Occupational"] or [mh "Dermatitis, Occupational"] or [mh ^"Occupational Diseases"] or [mh ^"Occupational Injuries"] or [mh ^"Asthma, Occupational"] or [mh ^"Noise, Occupational"] 1611
#9 [mh ^"Occupational Health"] 666
#10 (worker* or workplace or "work related" or occupation*):ti,kw 9385
#11 ((work* or occupation*) near/3 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)):ti,ab,kw 4919
#12 [mh ^work] 225
#13 [mh ^workplace] 829
#14 [mh ^occupations] 165
#15 {or #8-#14} 11318
#16 [mh ^"Primary Prevention"] 1070
#17 [mh ^"Health Education"] 3823
Page 28 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
#18 [mh ^"Health Promotion"] 5699
#19 [mh ^"Risk Reduction Behavior"] 1708
#20 [mh ^"Safety Management"] 239
#21 [mh ^"Facility Design and Construction"] 30
#22 [mh ^"Personal Protective Equipment"] 14
#23 [mh ^"Occupational Health Services"] 423
#24 (health near/2 (safety or outcome* or benefit* or harm* or effect*)):ti,ab,kw 21303
#25 (prevent* or promot* or reduc* or protect*):ti,kw 148148
#26 ((prevent* or promot* or reduc* or protect*) near/4 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)):ab 45883
#27 {or #16-#26} 191090
#28 #15 and #27 4272
#29 #7 or #28 4857
#30 [mh "age groups"] not ([mh adolescent] or [mh adult]) 14410
#31 #29 not #30 4832
#32 #31 Publication Year from 2008 to 2018, in Cochrane Reviews (Reviews and Protocols), Other Reviews, Technology Assessments and Economic Evaluations 520
Search strategy Epistemonikos.org
Epistemonikos 12 June 2018 Query Results
(advanced_title_en:((worker* OR workplace OR "work related" OR occupation*) AND (disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance) AND (prevent* OR promot* OR reduc* OR protect*)) OR advanced_abstract_en:((worker* OR workplace OR "work related" OR occupation*) AND (disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance) AND (prevent* OR promot* OR reduc* OR protect*))) NOT advanced_title_en:(child* OR infant* OR newborn* OR neonat*) [Filters: protocol=no, classification=systematic-review, min_year=2008, max_year=2018] 926
Search strategy Scopus (Elsevier)
Scopus
12 June 2018
# Search Terms Results Comment
3 TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* )
3,066 document results
Page 29 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
4 TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) )
78,866 document results
5 ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) )
81,302 document results
3 OR 4
6 TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) )
355,097 document results
7 ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) )
1,440 document results
5 AND 6
8 INDEX ( medline ) 23,755,237 document results
9 ( ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) ) ) AND NOT ( INDEX ( medline ) )
396 document results
7 NOT 8
Page 30 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
10
( ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) ) ) AND NOT ( INDEX ( medline ) ) AND ( LIMIT-TO ( PUBYEAR , 2018 ) OR LIMIT-TO ( PUBYEAR , 2017 ) OR LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) OR LIMIT-TO ( PUBYEAR , 2011 ) OR LIMIT-TO ( PUBYEAR , 2010 ) OR LIMIT-TO ( PUBYEAR , 2009 ) OR LIMIT-TO ( PUBYEAR , 2008 ) )
324 document results
2008-2018
Page 31 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 2 – Characteristics of included studies
Table4: Characteristics of included studies
Author, year Risk of bias
Interventions Outcomes
Prevention of musculoskeletal disorders
Multi-component interventions for musculoskeletal disorders
Aas et al. 2011 [21]
Low Single-component and multi-component workplace interventions (includes, e.g. mental health education, physical education, workplace adjustments, relaxation breaks)
Pain severity, pain prevalence, sickness absence
Chen et al. 2017 [22]
Low Exercise interventions, ergonomic interventions, breaks, cognitive behaviour therapy, education, myofeedback
Neck pain intensity
Goodman et al. 2012 [23]
Low Forearm supports, ergonomic keyboards, ergonomic mice, ergonomic training, workout or rest breaks
Symptoms of cumulative trauma disorders of the upper extremity
Lowry et al. 2017 [24]
Low Workplace exercise programmes, ergonomic interventions
Intensity of shoulder pain
Richardson et al. 2018 [25]
Low Patient lift systems, patient handling training, cognitive behavioural interventions, unstable shoes
Musculoskeletal pain, injuries, sickness absence
Exercises at the workplace
Kelly et al. 2018 [26]
Low Exercise therapy Pain and functionality in work-related diseases of the upper extremities
Moreira-Silva et al. 2016 [27]
Unclear Exercise interventions at the workplace (strength, endurance, coordination, etc.)
Pain
Work organisational interventions (work organisation, work environment, job rotation) for musculoskeletal disorders
Stock et al. 2018 [28]
Low Supplementary pauses, participatory ergonomic interventions, participatory organisational intervention, interventions to reduce patient lifting (safe lifting programmes and equipment), feedback about computer workstation setup and psychosocial aspects of work
Musculoskeletal symptom intensity, prevalence of various musculoskeletal pains
Padula et al. 2017 [29]
Unclear Job rotation schedules Musculoskeletal symptoms
Educational interventions for musculoskeletal disorders
Crawford et al. 2008 [30]
Low Training in workstation adjustment and posture, Muscle Learning Therapy
Musculoskeletal symptoms
Ergonomic interventions
Hoe et al. 2012 [31]
Low Ergonomically designed equipment, such as a specially designed computer mouse or arm support; ergonomically designed work environment (including workplace and work design); ergonomic training; ergonomic training combined with ergonomic equipment
Frequency of neck/shoulder diseases or complaints, musculoskeletal disorders, diseases or complaints of the right upper extremity, wrist complaints
Driessen et al. 2010 [32]
Unclear Physical ergonomic interventions, organisational ergonomic interventions
Incidence and prevalence of lower back pain and neck pain
Manual handling of loads
Freiberg et al. 2016 [33]
Low Provision of small aids and intensive education on how to handle patients
Prevalence of low back pain, upper arm pain, shoulder pain
Hegewald et al. 2018 [34]
Low Technical patient handling equipment, also in combination with education/training
Musculoskeletal injuries, back pain, repeated musculoskeletal injuries, cervical spine injuries, shoulder pain
Verbeek et al. Low Training, professional education, video, use of a back Incidence, intensity of back pain
Page 32 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Author, year Risk of bias
Interventions Outcomes
2011 [35] Update from [36]
belt, exercise, training plus lifting aids
Prevention of occupational injuries
Prevention of eye injuries
Shah et al. 2009 [37]
Unclear Distribution of protective eyewear with or without training; training for superiors in the fundamentals of behaviour modification
Eye injuries, frequency of wearing protective glasses
Prevention of occupational injuries in the agricultural sector and the construction industry
Rautiainen et al. 2008 [38]
Low Educational interventions, insurance premium discount programme, legislation banning Endosulfan pesticides, legislation on rollover protection structures or safety cabs for tractors
Injuries, poisoning
Van der Molen 2018 [39] Update from [40]
Low Training programmes, health and safety laws (e.g. vertical fall arrest standard, trench and excavation standard) and inspections, subsidy for scaffolds, safety campaign, drug-free workplace programme
Fatal and non-fatal injuries
Alcohol and drug screening of professional drivers
Cashman et al. 2009 [41]
Low Mandatory random and for-cause alcohol tests, mandatory random drug tests
Injuries levels (immediate and long-term)
Safety products and practices in the health sector
Mischke et al. 2014 [42]
Low Increase in the number of glove layers, use of thick gloves or gloves manufactured with special protective materials, use of glove puncture indication systems to warn staff about glove perforations
Glove perforations, frequency of blood contamination
Parantainen et al. 2011 [43]
Low Use of blunt suture needles compared to sharp needles
Glove perforations, number of self-reported needle stick injuries
Reddy et al. 2017 [44]
Low Safety-engineered devices for blood collection, safe intravenous systems, safety-engineered devices for injection fluids, use of multiple safety devices, containers for collecting sharps, introduction of legislation
Needle stick injuries, blood splashes
Verbeek et al. 2016 [45]
Low Comparison of types of personal protective equipment (PPE); procedures for the donning and doffing of PPE; training to improve PPE compliance
Contamination of skin or clothing, compliance
Ballout et al. 2016 [46]
Unclear Intravenous safety devices, phlebotomy safety devices Needle stick injuries
Prevention of skin and lung diseases
Lunt et al. 2011 [47]
Low Training for behavioural change Exposure to occupational health hazards
Luong Thanh et al. 2016 [48]
Low Behavioural interventions (education and training to improve the use of respiratory protective equipment)
Frequency and correctness of respiratory protective equipment use
Bauer et al. 2018 [49]
Low Barrier creams, moisturisers, barrier creams plus moisturisers, skin protection education
Signs of occupational irritant hand dermatitis
Offeddu et al. 2017 [50]
Unclear Use of personal respiratory equipment: medical masks, N95 respirators (specially designed to protect users from small particles in the air, including aerosols)
Clinical respiratory illness, influenza-like illness, laboratory-confirmed viral infections, bacterial respiratory infections
de Groene et al. 2011 [51]
Unclear Elimination of exposures that increase the symptoms or severity of occupational asthma; reduction of exposure (use of personal respiratory protective equipment or more effective respiratory protective equipment, educational programmes, relocation to another work area with lower exposure)
Asthma symptoms, unspecific bronchial hyperreactivity, number of people without asthma symptoms
Page 33 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Author, year Risk of bias
Interventions Outcomes
van Holland et al. 2015 [52]
Unclear Intervention programme consisting of educational activities and evidence-based recommendations (e.g. protective gloves, skin care)
Eczema prevalence, use of gloves, use of skin care, reception of information on prevention
Prevention of occupational hearing loss
Tikka et al. 2017 [53] Update from [54]
Low Hearing loss prevention programmes, exposure information, earmuff, earplugs, instructions for wearing hearing protection, legislation on hearing protection, combinations of the abovementioned interventions
Hearing loss, noise exposure/noise level reduction, noise attenuation
General occupational health and safety interventions
Mischke et al. 2013 [55]
Low Inspections of health and safety regulations with or without penalty
Fatal and non-fatal injuries, physical workload
van Vilsteren et al. 2015 [56] Update from [57]
Low Workplace interventions to prevent work disability in workers on sick leave: changes to the workplace and equipment, changes of work design and organisations, changes to working conditions, changes to work environment, case management with the worker and employer (supervisor)
Time until first return-to-work, time until lasting return-to-work, cumulative duration of sickness absence, risk of recurrences of sick leave, functional status (Roland disability questionnaire), depression, pain
Montano et al. 2014 [15]
Unclear Interventions at the organisational level, e.g. material conditions, work time-related conditions, work organisation conditions and combinations of these
Significant results yes vs. no (independent of concrete endpoints)
Tompa et al. 2016 [58]
Unclear Legislation on occupational safety and health; introduction of law on smoke-free workplaces; inspections with/without sanctions, different procedures, different ways of enforcement; awareness-raising campaigns
Injuries and deaths, truck crashes, exposure, regulatory compliance, respiratory and sensory symptoms, lost workdays, awareness
Page 34 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 3 – List of excluded full texts
Ineligible study design
Addo MA, Stephen AI, Kirkpatrick P. Acute mental health/psychiatric nurses' experiences of clinical supervision in promoting their wellbeing in their workplace: a systematic review. JBI Libr Syst Rev. 2012;10(56 Suppl):1-16.
Apisarnthanarak A, Uyeki T, Puthavathana P, Kitphati R, Mundy L. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand (Provisional abstract). Infection Control and Hospital Epidemiology [Internet]. 2010 [cited E; 31(10):[996-1003 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22010001963/frame.html.
Baldasseroni A, Olimpi N, Bonaccorsi G. [A systematic review of the effectiveness of workplace safety interventions]. Med Lav. 2009;100(4):268-71.
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med. 2009;48(5):454-61.
Birdi K, Beach J. Management of sensitizer-induced occupational asthma: avoidance or reduction of exposure? Curr Opin Allergy Clin Immunol. 2013;13(2):132-7.
Bruno Garza JL, Young JG. A literature review of the effects of computer input device design on biomechanical loading and musculoskeletal outcomes during computer work. Work. 2015;52(2):217-30.
Bullock SH, Jones BH, Gilchrist J, Marshall SW. Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med. 2010;38(1 Suppl):S156-81.
Burdorf A, Koppelaar E, Evanoff B. Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Occup Environ Med. 2013;70(7):491-7.
Cadth. Respiratory precautions for protection from bioaerosols or infectious agents: a review of the clinical effectiveness and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000193/frame.html.
Cadth. Wear compliance and donning/doffing of respiratory protection for bioaerosols or infectious agents: a review of the effectiveness, safety, and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000192/frame.html.
de Matteis S, Heederik D, Burdorf A, Colosio C, Cullinan P, Henneberger PK, et al. Current and new challenges in occupational lung diseases. Eur. 2017;26(146).
De Sio S, Traversini V, Rinaldo F, Colasanti V, Buomprisco G, Perri R, et al. Ergonomic risk and preventive measures of musculoskeletal disorders in the dentistry environment: an umbrella review. Peerj. 2018;6:e4154.
Flynn JP, Gascon G, Doyle S, Matson Koffman DM, Saringer C, Grossmeier J, et al. Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements. Am J Health Promot. 2018:890117118761887.
Frutiger M, Tuchin PJ. Chiropractic curriculum mapping and congruence of the evidence for workplace interventions in work-related neck pain. J Chiropractic Educ. 2017;31(2):115-24.
Page 35 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Goldgruber J, Ahrens D. Effectiveness of workplace health promotion and primary prevention interventions: A review. J Public Health (Oxf). 2010;18(1):75-88.
Goldgruber J, Ahrens D. Health-related interventions in the workplace : Review of the effectiveness of workplace health promotion and primary prevention. Pravent Gesundheitsforderung. 2009;4(1):83-95.
Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, et al. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46(4):683-97.
Maguire E, Spurr A. Implementation of ultraviolet radiation safety measures for outdoor workers: A Canadian perspective. J Cutaneous Med Surg. 2017;21(2):117-24.
Miguelino ES. A meta-analytic review of the effectiveness of single-layer clothing in preventing exposure from pesticide handling. J. 2014;19(4):373-83.
Mohammadi M, Danaee L, Alizadeh E. Reduction of Radiation Risk to Interventional Cardiologists and Patients during Angiography and Coronary Angioplasty. The Journal of Tehran Heart Center. 2017;12(3):101-6.
Nafees AA, Fatmi Z. Available Interventions for Prevention of Cotton Dust-Associated Lung Diseases Among Textile Workers. J Coll Physicians Surg Pak. 2016;26(8):685-91.
Nicholson PJ, Llewellyn D, English JS, Guidelines Development G. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis. 2010;63(4):177-86.
Parikh JR, Geise RA, Bluth EI, Bender CE, Sze G, Jones AK, et al. Potential Radiation-Related Effects on Radiologists. AJR Am J Roentgenol. 2017;208(3):595-602.
Shiftwork and health risks: possibilities for prevention (Structured abstract). Health Technology Assessment Database [Internet]. 2015 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32016000066/frame.html.
Snodgrass J. Special issue on work-related injuries and illnesses and the role of occupational therapy: implications of a systematic literature review for practice, research, education, and policy. Am J Occup Ther. 2011;65(1):7-9.
Tarlo SM, Lemiere C. Occupational asthma. New Engl J Med. 2014;370(7):640-9.
Theis J, Finkelstein M. Long-term effects of safe patient handling program on staff injuries (Provisional abstract). Rehabilitation Nursing Journal [Internet]. 2014 [cited E; 39(1):[26-35 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22014013150/frame.html.
Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P, et al. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J. 2011;38(4):804-11.
Verbeek J, Ivanov I. Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence. Saf Health Work. 2013;4(2):77-83.
Walden C, Bankard S, Cayer B, Floyd W, Garrison H, Hickey T, et al. Mobilization of the obese patient and prevention of injury (Provisional abstract). Annals of Surgery [Internet]. 2013 [cited E; 258(4):[646-50 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22013045482/frame.html.
Wassell JT. Workplace violence intervention effectiveness: A systematic literature review. Safety Science. 2009;47(8):1049-55.
Page 36 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Westgaard RH, Winkel J. Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review. Appl Ergon. 2011;42(2):261-96.
Westgaard RH. RCTs of ergonomic interventions. Occup Environ Med. 2010;67(4):217-8.
Yassi A, Lockhart K, Sykes M, Buck B, Stime B, Spiegel JM. Effectiveness of joint health and safety committees: a realist review. Am J Ind Med. 2013;56(4):424-38.
Zhou Z, Goh YM, Li Q. Overview and analysis of safety management studies in the construction industry. Safety Science. 2015;72:337-50.
Ineligible document type
Alahmari MAS, Sun Z. A systematic review of the efficiency of radiation protection training in raising awareness of medical staff working in catheterisation laboratory. Curr Med Imaging Rev. 2015;11(3):200-6.
Buchberger B, Heymann R, Huppertz H, Frieportner K, Pomorin N, Wasem J. The effectiveness of interventions in workplace health promotion as to maintain the working capacity of health care personal. GMS Health Technol Assess. 2011;7:Doc06.
de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma: a Cochrane systematic review. Occup Environ Med. 2012;69(5):373-4.
El Dib RP, Mathew JL. Interventions to promote the wearing of hearing protection. Cochrane Database Syst Rev. 2009(4):Cd005234.
Lipscomb HJ, Dement JM. A counterview on data quality and the systematic review process for occupational injury interventions: are we missing the forest for the trees? Am J Prev Med. 2009;36(4):377-8; author reply 8.
Picheansathian W, Chotibang J. Glove utilization in the prevention of cross transmission: a systematic review. JBI Database System Rev Implement Rep. 2015;13(4):188-230.
Verbeek J, Morata T, Ruotsalainen J, Vainio H. Prevention of occupational diseases: implementing the evidence. Cochrane Database Syst Rev [Internet]. 2013 [cited E; (4). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.ED000056/abstract.
Ineligible study population
Nieuwenhuijsen K, Bultmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, van der Feltz-Cornelis CM. Interventions to improve occupational health in depressed people. Cochrane Database Syst Rev. 2008(2):CD006237.
Schaafsma FG, Mahmud N, Reneman MF, Fassier JB, Jungbauer FH. Pre-employment examinations for preventing injury, disease and sick leave in workers. Cochrane Database Syst Rev. 2016(1):CD008881.
Stojanovic MD, Ostojic SM. Preventing ACL Injuries in Team-Sport Athletes: A Systematic Review of Training Interventions. Research in sports medicine (Print). 2012;20(3-4):223-38.
Ineligible intervention
Page 37 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Bercier ML, Maynard BR. Interventions for Secondary Traumatic Stress With Mental Health Workers: A Systematic Review. Res Soc Work Pract. 2015;25(1):81-9.
Bernaldo-De-Quirós M, Labrador FJ, Piccini AT, Mar Gómez M, Cerdeira JC. Workplace violence in prehospital emergency care: A systematic review and outlines of psychological intervention Second prize of the 20th "rafael Burgaleta" Applied Psychology Awards 2013. Clin Salud. 2014;25(1):11-8.
Breeze J, Baxter D, Carr D, Midwinter MJ. Defining combat helmet coverage for protection against explosively propelled fragments. J R Army Med Corps. 2015;161(1):9-13.
Christian MS, Bradley JC, Wallace JC, Burke MJ. Workplace safety: a meta-analysis of the roles of person and situation factors. J Appl Psychol. 2009;94(5):1103-27.
Furlan AD, Gnam WH, Carnide N, Irvin E, Amick BC, 3rd, DeRango K, et al. Systematic review of intervention practices for depression in the workplace. J Occup Rehabil. 2012;22(3):312-21.
Pereira-de-Paiva MH, Calassa-Albuquerque MdC, Latham EE, Furtado-Bezerra C, da-Silva-Sousa A, Cunha-e-Silva-de-Araújo L, et al. Occupational hazards of Brazilian solid waste workers: a systematic literature review. Rev bras med trab. 2017;15(4):364-71.
van Wyk BE, Pillay-Van Wyk V. Preventive staff-support interventions for health workers. Cochrane Database Syst Rev. 2010(3):CD003541.
Ineligible comparison
Moreira RF, Foltran FA, Albuquerque-Sendin F, Mancini MC, Coury HJ. Comparison of randomized and non-randomized controlled trials evidence regarding the effectiveness of workplace exercise on musculoskeletal pain control. Work. 2012;41 Suppl 1:4782-9.
Ineligible outcome
Basu S, Qayyum H, Mason S. Occupational stress in the ED: a systematic literature review. Emerg Med J. 2017;34(7):441-7.
Brand SL, Thompson Coon J, Fleming LE, Carroll L, Bethel A, Wyatt K. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLoS ONE. 2017;12(12):e0188418.
Butler M, Collins R, Drennan J, Halligan P, O'Mathúna DP, Schultz TJ, et al. Hospital nurse staffing models and patient and staff-related outcomes. Cochrane Database Syst Rev [Internet]. 2011 [cited E; (7). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD007019.pub2/abstract.
Cassidy JD, Cote P. Is it time for a population health approach to neck pain? J Manipulative Physiol Ther. 2008;31(6):442-6.
Cooklin A, Joss N, Husser E, Oldenburg B. Integrated Approaches to Occupational Health and Safety: A Systematic Review. Am J Health Promot. 2017;31(5):401-12.
Feltner C, Peterson K, Palmieri Weber R, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. The Effectiveness of Total Worker Health Interventions: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2016;165(4):262-9.
Page 38 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Feltner C, Peterson K, Weber RP, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. Total Worker Health(®)2016 2016/05/None.
Kahn-Marshall J, Gallant M. Making healthy behaviors the easy choice for employees: a review of the literature on environmental and policy changes in worksite health promotion (Structured abstract). Health Education and Behavior [Internet]. 2012 [cited E; 39(6):[752-76 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12013005967/frame.html.
Ker K, Edwards PJ, Felix LM, Blackhall K, Roberts I. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev. 2010(5):CD008508.
Lachance CC, Jurkowski MP, Dymarz AC, Robinovitch SN, Feldman F, Laing AC, et al. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety. PLoS ONE. 2017;12(2):e0171652.
LaMontagne, A. D., Keegel, T., Louie, A. M., Ostry, A., & Landsbergis, P. A. A systematic review of the job-stress intervention evaluation literature, 1990-2005 (International Journal of Occupational and Environmental Health (2007) 13, (268-80)). International Journal of Occupational and Environmental Health. 2008;14(1):24.
Lu ML, Putz-Anderson V, Garg A, Davis KG. Evaluation of the Impact of the Revised National Institute for Occupational Safety and Health Lifting Equation. Hum Factors. 2016;58(5):667-82.
Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. Bmj. 2015;351:h3728.
MacEwen BT, MacDonald DJ, Burr JF. A systematic review of standing and treadmill desks in the workplace. Prev Med. 2015;70:50-8.
Martin A, Sanderson K, Cocker F. Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms. Scand J Work Environ Health. 2009;35(1):7-18.
Neil-Sztramko SE, Pahwa M, Demers PA, Gotay CC. Health-related interventions among night shift workers: a critical review of the literature. Scand J Work Environ Health. 2014;40(6):543-56.
Pachito DV, Eckeli AL, Desouky AS, Corbett MA, Partonen T, Rajaratnam SM, et al. Workplace lighting for improving alertness and mood in daytime workers. The Cochrane database of systematic reviews. 2018;3:CD012243.
Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008. J Occup Environ Med. 2009;51(7):822-37.
Plat MJ, Frings-Dresen MH, Sluiter JK. A systematic review of job-specific workers' health surveillance activities for fire-fighting, ambulance, police and military personnel. Int Arch Occup Environ Health. 2011;84(8):839-57.
Price L, Melone L, McLarnon N, Bunyan D, Kilpatrick C, Flowers P, et al. A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers. Am J Infect Control. 2018;27:27.
Page 39 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Sayapathi BS, Su AT, Koh D. The effectiveness of applying different permissible exposure limits in preserving the hearing threshold level: a systematic review. J Occup Health. 2014;56(1):1-11.
Silva J, Santos Baptista J, Rodrigues C, editors. Use of effectiveness and efficiency concepts in occupational safety management on motorways: A systematic review2016. E: CRC Press/Balkema.
Slanger TE, Gross JV, Pinger A, Morfeld P, Bellinger M, Duhme A-L, et al. Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work. Cochrane Database Syst Rev [Internet]. 2016 [cited E; (8). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD010641.pub2/abstract.
Srigley JA, Corace K, Hargadon DP, Yu D, MacDonald T, Fabrigar L, et al. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. The Journal of hospital infection. 2015;91(3):202-10.
Studnek JR, Infinger AE, Renn ML, Weiss PM, Condle JP, Flickinger KL, et al. Effect of Task Load Interventions on Fatigue in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review. Prehosp Emerg Care. 2018;22(sup1):81-8.
Varatharajan S, Cote P, Shearer HM, Loisel P, Wong JJ, Southerst D, et al. Are work disability prevention interventions effective for the management of neck pain or upper extremity disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. J Occup Rehabil. 2014;24(4):692-708.
Yazdani A, Wells R. Prevention of MSD within OHSMS/IMS: a systematic review of risk assessment strategies. Work. 2012;41 Suppl 1:2765-7.
Full text not retrievable
Bonfiglioli R, Farioli A, Mattioli S, Violante FS. [Evidence based prevention and upper limb work-related musculoskeletal disorders]. G Ital Med Lav Ergon. 2008;30(3 Suppl):26-31.
Buil Cosiales P. Educative techniques and training in weight lifting does not prevent back pain in workers. FMC Formacion Med Continuada Aten Prim. 2008;15(9):626.
Cadth. Hearing protection fit testing systems: clinical and cost-effectiveness and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000305/frame.html.
dos Santos NC, Santos LS, Camelier FWR, Maciel RRBT, Portella DDA. Technologies applied to occupational health promotion: a systematic review. Rev bras med trab. 2017;15(1):113-22.
El Dib RP. A systematic review of hearing protective devises: Types, uses and safety. Deafness, Hearing Loss and the Auditory System: Nova Science Publishers, Inc.; 2011. p. 227-48.
Leas B, Umscheid C. Healthcare worker clothing and infection control (Structured abstract). Health Technology Assessment Database [Internet]. 2011 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32011001593/frame.html.
Parantainen A, Anthoni M, Hellgren UM, Lavoie MC, Valdes A, Verbeek JH. Prevention of percutaneous injuries with risk of hepatitis B, hepatitis C, or other viral infections for health-care workers. Cochrane Database Syst Rev. 2008(2).
Page 40 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Sancini A, Caciari T, Fioravanti M, Tria M, Scimitto L, Fiaschetti M, et al. [Meta-analysis: effectiveness of the preventive interventions in agriculture accidents]. G Ital Med Lav Ergon. 2010;32(4 Suppl):25-30.
Ineligible setting
Awa WL, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010;78(2):184-90.
Gross A, Forget M, St GK, Fraser MM, Graham N, Perry L, et al. Patient education for neck pain. Cochrane Database Syst Rev [Internet]. 2012 [cited E; (3). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005106.pub4/abstract.
Simonelli AP, Almeida IMd, Vilela RAG, Jackson Filho JM. Influence of behavioral safety practices and models of prevention of occupational accidents: a systematic review of the literature. Saúde Soc. 2016;25(2):463-78.
Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. Cmaj. 2016;188(8):567-74.
Zhang YT, Wang LS. Protection education towards needle stick injuries among nursing students in China: A meta-analysis. Chin J Evid-Based Med. 2013;13(6):754-9.
Ineligible study design primary studies
Anger WK, Elliot DL, Bodner T, Olson R, Rohlman DS, Truxillo DM, et al. Effectiveness of Total Worker Health interventions. J Occup Health Psychol. 2015;20(2).
Bambra C, Whitehead M, Sowden A, Akers J, Petticrew M. "A hard day's night?" The effects of Compressed Working Week interventions on the health and work-life balance of shift workers: a systematic review. J Epidemiol Community Health. 2008;62(9):764-77.
Barger LK, Runyon MS, Renn ML, Moore CG, Weiss PM, Condle JP, et al. Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis. Prehosp Emerg Care. 2018;22(sup1):58-68.
Bercier ML. Interventions that help the helpers: A systematic review and meta-analysis of interventions targeting compassion fatigue, secondary traumatic stress and vicarious traumatization in mental health workers. Dissertation Abstracts International Section A: Humanities and Social Sciences. 2014;74(10-A(E)).
Caffaro F, Micheletti Cremasco M, Bagagiolo G, Vigoroso L, Cavallo E. Effectiveness of occupational safety and health training for migrant farmworkers: a scoping review. Public Health. 2018;160:10-7.
Clemes SA, Haslam CO, Haslam RA. What constitutes effective manual handling training? A systematic review. Occup Med (Oxf). 2010;60(2):101-7.
Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016;13(6):22.
Cooke CE, Stephens JM. Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Med Devices (Auckl). 2017;10:225-35.
Crickman R, Finnell D. Systematic Review of Control Measures to Reduce Hazardous Drug Exposure for Health Care Workers. J Nurs Care Qual. 2016;31(2):183-90.
Page 41 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
d'Ettorre G, Criscuolo M, Mazzotta M. Managing Formaldehyde indoor pollution in anatomy pathology departments. Work. 2017;56(3):397-402.
Eastlake A, Zumwalde R, Geraci C. Can Control Banding be Useful for the Safe Handling of Nanomaterials? A Systematic Review. J Nanopart Res. 2016;18.
Edwards R, Charani E, Sevdalis N, Alexandrou B, Sibley E, Mullett D, et al. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. The Lancet infectious diseases. 2012;12(4):318-29.
Gulumian M, Verbeek J, Andraos C, Sanabria N, de Jager P. Systematic Review of Screening and Surveillance Programs to Protect Workers from Nanomaterials. PLoS ONE. 2016;11(11):e0166071.
Gurusamy KS, Best LM, Tanguay C, Lennan E, Korva M, Bussieres JF. Closed-system drug-transfer devices plus safe handling of hazardous drugs versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff. Cochrane Database Syst Rev. 2018;3:CD012860.
Jaworska-Burzyńska L, Kanaffa-Kilijańska U, Przysiȩzna E, Szczepańska-Gieracha J. The role of therapy in reducing the risk of job burnout - A systematic review of literature. Arch Psychiatry Psychother. 2016;18(4):43-52.
Kolar C, von Treuer K. Alcohol Misuse Interventions in the Workplace: A Systematic Review of Workplace and Sports Management Alcohol Interventions. Int J Ment Health Addict. 2015;13(5):563-83.
Leider PC, Boschman JS, Frings-Dresen MH, van der Molen HF. Effects of job rotation on musculoskeletal complaints and related work exposures: a systematic literature review. Ergonomics. 2015;58(1):18-32.
Lindsay R, Su Ern Y, Dinanda NK. Non‐pharmacological interventions for preventing venous insufficiency in a standing worker population. Cochrane Database Syst Rev. 2013;10(10):CD006345.
Morphet J, Griffiths D, Beattie J, Velasquez Reyes D, Innes K. Prevention and management of occupational violence and aggression in healthcare: A scoping review. Collegian. 2018.
Myojo T, Nagata T, Verbeek J. The Effectiveness of Specific Risk Mitigation Techniques Used in the Production and Handling of Manufactured Nanomaterials: A Systematic Review. J Uoeh. 2017;39(3):187-99.
Nilsson K. Interventions to reduce injuries among older workers in agriculture: A review of evaluated intervention projects. Work. 2016;55(2):471-80.
Pidd K, Roche AM. How effective is drug testing as a workplace safety strategy? A systematic review of the evidence. Accid Anal Prev. 2014;71:154-65.
Richter K, Acker J, Adam S, Niklewski G. Prevention of fatigue and insomnia in shift workers-a review of non-pharmacological measures. Epma J. 2016;7:16.
Rinder MM, Genaidy A, Salem S, Shell R, Karwowski W. Interventions in the construction industry: A systematic review and critical appraisal. Human Factors and Ergonomics in Manufacturing. 2008;18(2).
Schmidt BM, Engel ME, Abdullahi L, Ehrlich R. Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review. BMC Public Health. 2018;18(1):661.
Sena JS, Girao RJ, Carvalho SM, Tavares RM, Fonseca FL, Silva PB, et al. Occupational skin cancer: Systematic review. Rev Assoc Med Bras. 2016;62(3):280-6.
Page 42 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Smedley J, Williams S, Peel P, Pedersen K, Dermatitis Guideline Development G. Management of occupational dermatitis in healthcare workers: a systematic review. Occupational and environmental medicine. 2012;69(4):276-9.
Surber C, Diepgen TL. Outdoor workers sun-related knowledge, attitudes and protective behaviors: A systemic review of cross-sectional and interventional studies. Dermatol Beruf Umwelt. 2013;61(2):79-86.
Tarigan LH, Cifuentes M, Quinn M, Kriebel D. Prevention of needle-stick injuries in healthcare facilities: a meta-analysis. Infect Control Hosp Epidemiol. 2015;36(7):823-9.
Teeple E, Collins JE, Shrestha S, Dennerlein JT, Losina E, Katz JN. Outcomes of safe patient handling and mobilization programs: A meta-analysis. Work. 2017;58(2):173-84.
Vandenplas O, Dressel H, Nowak D, Jamart J, Asthma ERSTFotMoW-r. What is the optimal management option for occupational asthma? Eur. 2012;21(124):97-104.
Superseded by more comprehensive review
de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ. Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. J Physiother. 2018;64(3):159-65.
Mahmud N, Schonstein E, Lehtola MM, Verbeek JH, Fassier JB, Reneman MF, et al. Health examination for preventing occupational injuries and disease in workers. Cochrane Database Syst Rev. 2008(3
Page 43 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 4 – Risk of bias assessment
Table 5 is primarily sorted by overall risk of bias (last column, from low to high) and within the categories alphabetically by first author.
Table5: Risk of bias assessment
Authors, year Title CONCERNS regarding
specification of study eligibility
criteria?
CONCERNS regarding
methods used to identify and/or select studies?
CONCERNS regarding
methods used to collect data and appraise studies
CONCERNS regarding
methods used to synthesize
results
RISK OF BIAS introduced by
methods used to identify and/or select studies?
Aas, R. W.; Tuntland, H.; Holte, K. A.; Roe, C.; Lund, T.; Marklund, S.; Moller, A., 2011
Workplace interventions for neck pain in workers low low low low low
Bauer, A.; Ronsch, H.; Elsner, P.; Dittmar, D.; Bennett, C.; Schuttelaar, M. L. A.; Lukacs, J.; John, S. M.; Williams, H. C., 2018
Interventions for preventing occupational irritant hand dermatitis
low low low low low
Cashman, C. M.; Ruotsalainen, J. H.; Greiner, B. A.; Beirne, P. V.; Verbeek, J. H., 2009
Alcohol and drug screening of occupational drivers for preventing injury
low low low low low
Chen, X.; Coombes, B. K.; Sjogaard, G.; Jun, D.; O'Leary, S.; Johnston, V., 2018
Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis
low low low low low
Crawford, J. O.; Laiou, E.; Spurgeon, A.; McMillan, G., 2008
Musculoskeletal disorders within the telecommunications sector-A systematic review
low low low low low
Freiberg, A.; Euler, U.; Girbig, M.; Nienhaus, A.; Freitag, S.; Seidler, A., 2016
Does the use of small aids during patient handling activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic review
low low low low low
Page 44 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Goodman, G.; Kovach, L.; Fisher, A.; Elsesser, E.; Bobinski, D.; Hansen, J., 2012
Effective interventions for cumulative trauma disorders of the upper extremity in computer users: practice models based on systematic review
low low low low low
Hegewald, J.; Berge, W.; Heinrich, P.; Staudte, R.; Freiberg, A.; Scharfe, J.; Girbig, M.; Nienhaus, A.; Seidler, A., 2018
Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies
low low low low low
Hoe, V. C.; Urquhart, D. M.; Kelsall, H. L.; Sim, M. R., 2012
Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults
low low low low low
Kelly, D.; Shorthouse, F.; Roffi, V.; Tack, C., 2018
Exercise therapy and work-related musculoskeletal disorders in sedentary workers
low high low low low
Lowry, V.; Desjardins-Charbonneau, A.; Roy, J. S.; Dionne, C. E.; Fremont, P.; MacDermid, J. C.; Desmeules, F., 2017
Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis
low low low low low
Lunt, J. A.; Sheffield, D.; Bell, N.; Bennett, V.; Morris, L. A., 2011
Review of preventative behavioural interventions for dermal and respiratory hazards
low low low low low
Luong Thanh, B. Y.; Laopaiboon, M.; Koh, D.; Sakunkoo, P.; Moe, H., 2016
Behavioural interventions to promote workers' use of respiratory protective equipment
low low low low low
Mischke, C.; Verbeek, J. H.; Job, J.; Morata, T. C.; Alvesalo-Kuusi, A.; Neuvonen, K.; Clarke, S.; Pedlow, R. I., 2013
Occupational safety and health enforcement tools for preventing occupational diseases and injuries
low low low low low
Page 45 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Mischke, C.; Verbeek, J. H.; Saarto, A.; Lavoie, M. C.; Pahwa, M.; Ijaz, S., 2014
Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel
low low low low low
Parantainen, A.; Verbeek, J. H.; Lavoie, M. C.; Pahwa, M., 2011
Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff
low low low low low
Rautiainen, R. H.; Lehtola, M. M.; Day, L. M.; Schonstein, E.; Suutarinen, J.; Salminen, S.; Verbeek, J., 2008 Lehtola, M. M.; Rautiainen, R. H.; Day, L. M.; Schonstein, E.; Suutarinen, J.; Salminen, S.; Verbeek, J. H., 2008
Interventions for preventing injuries in the agricultural industry Effectiveness of interventions in preventing injuries in agriculture – a systematic review and meta-analysis
low low low low low
Reddy, V. K.; Lavoie, M. C.; Verbeek, J. H.; Pahwa, M., 2017
Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel
low low low low low
Richardson, A.; McNoe, B.; Derrett, S.; Harcombe, H., 2018
Interventions to prevent and reduce the impact of musculoskeletal injuries among nurses: A systematic review
low low low low low
Stock, S. R.; Nicolakakis, N.; Vezina, N.; Vezina, M.; Gilbert, L.; Turcot, A.; Sultan-Taieb, H.; Sinden, K.; Denis, M. A.; Delga, C.; Beaucage, C., 2018
Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature
low low low low low
Tikka, C.; Verbeek, J. H.; Kateman, E.; Morata, T. C.; Dreschler, W. A.; Ferrite, S., 2017
Interventions to prevent occupational noise-induced hearing loss
low low low low low
Page 46 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
van der Molen, H. F.; Basnet, P.; Hoonakker, P. L.; Lehtola, M. M.; Lappalainen, J.; Frings-Dresen, M. H.; Haslam, R.; Verbeek, J. H., 2018
Interventions to prevent injuries in construction workers
low low low low low
van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR, 2015
Workplace interventions to prevent work disability in workers on sick leave
low low low low low
Verbeek, J. H.; Martimo, K. P.; Karppinen, J.; Kuijer, P. P.; Viikari-Juntura, E.; Takala, E. P., 2011 Verbeek, J. H.; Martimo, K. P.; Kuijer, P. P.; Karppinen, J.; Viikari-Juntura, E.; Takala, E. P., 2012 Verbeek, J.; Martimo, K. P.; Karppinen, J.; Kuijer, P. P.; Takala, E. P.; Viikari-Juntura, E., 2012
Manual material handling advice and assistive devices for preventing and treating back pain in workers Proper manual handling techniques to prevent low back pain, a Cochrane systematic review Manual material handling advice and assistive devices for preventing and treating back pain in workers: a Cochrane Systematic Review
low low low low low
Verbeek, Jos H; Ijaz, Sharea; Mischke, Christina; Ruotsalainen, Jani H; Mäkelä, Erja; Neuvonen, Kaisa; Edmond, Michael B; Sauni, Riitta; Kilinc, Balci F Selcen; Mihalache, Raluca C, 2016
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff
low low low low low
Page 47 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Ballout, R. A.; Diab, B.; Harb, A. C.; Tarabay, R.; Khamassi, S.; Akl, E. A., 2016
Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis
low low low unclear unclear
de Groene, G. J.; Pal, T. M.; Beach, J.; Tarlo, S. M.; Spreeuwers, D.; Frings-Dresen, M. H.; Mattioli, S.; Verbeek, J. H., 2011
Workplace interventions for treatment of occupational asthma
low low unclear low unclear
Driessen, Maurice T.; Proper, Karin I.; van Tulder, Maurits W.; Anema, Johannes R.; Bongers, Paulien M.; van der Beek, Allard J., 2010
The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review
unclear unclear low unclear unclear
Montano, D.; Hoven, H.; Siegrist, J., 2014
Effects of organisational-level interventions at work on employees' health: a systematic review
unclear unclear unclear unclear unclear
Moreira-Silva, I.; Teixeira, P. M.; Santos, R.; Abreu, S.; Moreira, C.; Mota, J., 2016
The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis
low low unclear low unclear
Offeddu, V.; Yung, C. F.; Low, M. S. F.; Tam, C. C., 2017
Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis
low unclear unclear low unclear
Padula, R. S.; Comper, M. L. C.; Sparer, E. H.; Dennerlein, J. T., 2017
Job rotation designed to prevent musculoskeletal disorders and control risk in manufacturing industries: A systematic review
low unclear unclear low unclear
Shah, A.; Blackhall, K.; Ker, K.; Patel, D., 2009
Educational interventions for the prevention of eye injuries
low unclear low low unclear
Page 48 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Tompa, E.; Kalcevich, C.; Foley, M.; McLeod, C.; Hogg-Johnson, S.; Cullen, K.; MacEachen, E.; Mahood, Q.; Irvin, E., 2016
A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement
low unclear low low unclear
van Holland, B. J.; Soer, R.; de Boer, M. R.; Reneman, M. F.; Brouwer, S., 2015
Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness
low unclear low low unclear
Ahola, K.; Toppinen-Tanner, S.; Seppänen J., 2017
Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis
low high high high high
Alias, A. N.; Karuppiah, K.; Tamrin, S. B. M.; Abidin, E. Z.; Shafiei, U. K. M., 2015
A systematic review of intervention to reduce musculoskeletal disorders: Hand and arm disorders
unclear high high high high
Bell, J. A.; Burnett, A., 2009 Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review
low high unclear low high
Breslin, F. C.; Kyle, N.; Bigelow, P.; Irvin, E.; Morassaei, S.; MacEachen, E.; Mahood, Q.; Couban, R.; Shannon, H.; Amick, B. C., 3rd; Small Business Systematic Review, Team, 2010
Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions
low high low high high
Bui, D. P.; Balland, S.; Giblin, C.; Jung, A.; Kramer, S.; Peng, A.; Aquino, M. C. P.; Griffin, S.; French, D. D.; Pollack Porter, K.; Crothers, S.; Burgess, J. L., 2018
Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review
high high high high high
Page 49 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Clough, B. A.; March, S.; Chan, R. J.; Casey, L. M.; Phillips, R.; Ireland, M. J., 2017
Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review
low high unclear low high
Coury, H. J. C. G.; Moreira, R. F. C.; Dias, N. B., 2009
Evaluation of the effectiveness of workplace exercise in controlling neck, shoulder and low back pain: A systematic review
low low high low high
DeGirolamo, K. M.; Courtemanche, D. J.; Hill, W. D.; Kennedy, A.; Skarsgard, E. D., 2013
Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence?
unclear high high high high
Demoulin, C.; Marty, M.; Genevay, S.; Vanderthommen, M.; Mahieu, G.; Henrotin, Y., 2012
Effectiveness of preventive back educational interventions for low back pain: A critical review of randomized controlled clinical trials
low high high low high
Dick, F. D.; Graveling, R. A.; Munro, W.; Walker-Bone, K.; Guideline Development, Group, 2011
Workplace management of upper limb disorders: a systematic review
low high low low high
Graveling, Ra; Crawford, Jo; Cowie, H; Amati, C; Vohra, S, 2008
A review of workplace interventions that promote mental wellbeing in the workplace (Provisional abstract)
low high high low high
Hogan, D. A.; Greiner, B. A.; O'Sullivan, L., 2014
The effect of manual handling training on achieving training transfer, employee's behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review
high high high unclear high
Horsham, C.; Auster, J.; Sendall, M. C.; Stoneham, M.; Youl, P.; Crane, P.; Tenkate, T.; Janda, M.; Kimlin, M., 2014
Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review
low low high high high
Page 50 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Kennedy, C. A.; Amick, B. C., 3rd; Dennerlein, J. T.; Brewer, S.; Catli, S.; Williams, R.; Serra, C.; Gerr, F.; Irvin, E.; Mahood, Q.; Franzblau, A.; Van Eerd, D.; Evanoff, B.; Rempel, D., 2010
Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time
low high low unclear high
Krungkraipetch, N.; Krungkraipetch, K.; Kaewboonchoo, O.; Arphorn, S.; Sim, M., 2012
Interventions to prevent musculoskeletal disorders among informal sector workers: a literature review
low unclear low high high
Leyshon, R.; Chalova, K.; Gerson, L.; Savtchenko, A.; Zakrzewski, R.; Howie, A.; Shaw, L., 2010
Ergonomic interventions for office workers with musculoskeletal disorders: a systematic review
unclear high high high high
Maricuţoiu, L. P.; Sava, F. A.; Butta, O., 2016
The effectiveness of controlled interventions on employees' burnout: A meta-analysis
low high high low high
Mullan, B.; Smith, L.; Sainsbury, K.; Allom, V.; Paterson, H.; Lopez, AL, 2015
Active behaviour change safety interventions in the construction industry: A systematic review
unclear high high unclear high
Pelletier, K. R., 2011 A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010
high high high high high
Ricci, F.; Chiesi, A.; Bisio, C.; Panari, C.; Pelosi, A., 2016
Effectiveness of occupational health and safety training: A systematic review with meta-analysis
unclear high unclear unclear high
Shorthouse, F. M.; Roffi, V.; Tack, C., 2016
Effectiveness of educational materials to prevent occupational low back pain
low high low low high
Page 51 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Skamagki, G.; King, A.; Duncan, M.; Wåhlin, C., 2018
A systematic review on workplace interventions to manage chronic musculoskeletal conditions
low low high low high
Stewart, W.; Terry, L., 2014 Reducing burnout in nurses and care workers in secure settings
low high high low high
Tullar, J. M.; Brewer, S.; Amick, B. C., 3rd; Irvin, E.; Mahood, Q.; Pompeii, L. A.; Wang, A.; Van Eerd, D.; Gimeno, D.; Evanoff, B., 2010
Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector
low high low low high
Tuncel, S; Genaidy, A; Shell, R; Salem, S; Karwowski, W; Darwish, M; Noe, F; Singh, D, 2008
Research to practice: effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment - critical appraisal and meta-analysis (Provisional abstract)
low unclear unclear unclear high
Van Eerd, D.; Munhall, C.; Irvin, E.; Rempel, D.; Brewer, S.; van der Beek, A. J.; Dennerlein, J. T.; Tullar, J.; Skivington, K.; Pinion, C.; Amick, B., 2016
Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence
low high low unclear high
van Gils, R. F.; Boot, C. R.; van Gils, P. F.; Bruynzeel, D.; Coenraads, P. J.; van Mechelen, W.; Riphagen, II; Anema, J. R., 2011
Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature
low high low low high
van Niekerk, S. M.; Louw, Q. A.; Hillier, S., 2012
The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review
low high unclear low high
Wardle, S. L.; Greeves, J. P., 2017
Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel
high high high high high
Page 52 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Watt, A. M.; Patkin, M.; Sinnott, M. J.; Black, R. J.; Maddern, G. J., 2010
Scalpel safety in the operative setting: a systematic review
high unclear high high high
Yang, L.; Mullan, B., 2011 Reducing needle stick injuries in healthcare occupations: an integrative review of the literature
unclear high high high high
Page 53 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 5 – Overview of results
Table 6: Overview of behavioural interventions to prevent diseases of the musculoskeletal system
Intervention Comparison Number of studies; study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Combined stretching and endurance training for the neck
No intervention 1 RCT Office workers Individual study
Neck pain High Chen et al. 2017 (60)
Manual material handling advice
No intervention 7 RCTs Varying professions MA Back pain Moderate Verbeek et al. 2011 (44)
Different physical exercise sessions (strength, endurance, co-ordination and others)
No intervention 12 RCTs
Industrial workers, office workers, hospital employees, nursing aides
MA
A: General Pain B: Neck and shoulder pain C: Low back pain and arm, elbow, wrist, hand, or finger pain
A: B: C:
A: Moderate B: Moderate C: Low
Moreira-Silva et al. 2016 (24)
Exercise therapy No intervention 9 RCTs, 2 SR
Computer users, office workers, computer screen workers
Narrative
A: Pain in work-related upper limb disorders B: Functional outcomes in work-related upper limb disorders
A: B:
Moderate Kelly et al. 2018 (74)
Group education No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2017 (60)
Whole-body light resistance exercise
No intervention 1 RCT Office workers Individual study
Neck pain Moderate Chen et al. 2017 (60)
Myofeedback No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2017 (60)
Neck/shoulder strengthening exercise
1: No intervention 2: Physiotherapy
10 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain 1A: 1B: 2B:
Moderate Chen et al. 2017 (60)
Qi Gong No intervention 1 RCT Office workers Individual study
Neck pain Moderate Chen et al. 2017 (60)
Page 54 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number of studies; study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Extensive manual material handling training
One-time video training
3 cohort studies
Varying professions MA Back pain Moderate Verbeek et al. 2011 (44)
General fitness exercise No intervention 4 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain A: B:
Low to Moderate
Chen et al. 2017 (60)
Muscle Learning Therapy
n. a. 1 RCT
Call center workers, telemarketers, engineers, assembly workers
Narrative Muskel-Skelett-Symptome
Limited1 to Moderate
Crawford et al. 2008 (79)
Training in workstation adjustment and posture
n. a. 2 RCTs
Call center workers, telemarketers, engineers, assembly workers
Individual studies
Musculoskeletal disorders
Limited1 to Moderate
Crawford et al. 2008 (79)
Physical education No intervention 2 RCTs Office workers Individual study
Pain severity Low Aas et al. 2011 (46)
Manual material handling advice and devices
Advice only or no intervention
1 RCT Varying professions Individual study
Back pain Low Verbeek et al. 2011 (44)
Manual material handling advice
Back belt use 2 cohort studies
Varying professions MA Back pain Low Verbeek et al. 2011 (44)
Education for mental health
No intervention 1 RCT Office workers MA Pain prevalence Low Aas et al. 2011 (46)
Cognitive behavioural therapy
No intervention 1 RCT Office workers Individual study
Neck pain Low Chen et al. 2017 (60)
Workplace exercise programmes
Counselling or no intervention
5 RCTs Varying professions (symptomatic and asymptomatic)
MA Shoulder pain intensity Low Lowry et al. 2017 (17)
Workplace exercise programmes
Workplace modifications
1 RCT Varying professions Individual study
Shoulder pain intensity Low Lowry et al. 2017 (17)
Page 55 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number of studies; study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Safe and no strenuous lifting
Usual practice 1 RCT Office workers Individual study
Shoulder symptoms Low Hoe et al. 2012 (37)
Manual material handling advice
Professional education
1 cohort study
Varying professions MA Back pain Very low Verbeek et al. 2011 (44)
Ergonomic training No intervention 2 RCTs Office workers MA
Neck/shoulder and wrist/hand symptoms, upper extremity symptoms
Very low Hoe et al. 2012 (37)
Neck/shoulder stretching exercise
No intervention 1 RCT Office workers Individual study
Neck pain Very low Chen et al. 2017 (60)
Cognitive behavioural interventions
n. a. 1 RCT Nurses Individual study
Pain n. a. Richardson et al. 2018 (69)
Patient handling training
n. a.
2 cohort studies with control group
Nurses Individual studies
A: Back pain B: Physical discomfort
A: B:
n. a. Richardson et al. 2018 (69)
Abbreviations: MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials; SR = systematic review
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Defined as: limited or contradictory evidence, produced by one scientific study or inconsistent findings in multiple scientific studies.
Page 56 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 7: Overview of relational interventions to prevent diseases of the musculoskeletal system
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Ergonomic mouse Conventional mouse
2 RCTs, 1 prospective parallel group design
Office workers Individual studies
Upper extremity discomfort
High Goodman et al. 2012 (39)
Ergonomic keyboards n. a. 1 quasi-expe-rimental design, 1 RCT
Office workers Individual studies
A: Phalen-test results B: Decrease of symptoms C: Endonitis and carpal tunnel syndrome D: Pain intensity
A: B: C: D:
High Goodman et al. 2012 (39)
Forearm supports n. a.
1 RCT, 1 prospective parallel group design
Office workers Individual studies
A: Neck/shoulder pain B: Short term hand/arm pain C: Long term hand/arm pain D: Risk rates for disorders in the left upper extremities
A: B: C: D:
High Goodman et al. 2012 (39)
Alternative mouse Conventional mouse
2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders
Moderate Hoe et al. 2012 (37)
Alternative mouse Conventional mouse
2 RCTs Office workers MA Neck pain Moderate Chen et al. 2017 (60)
Alternative mouse with arm support
Conventional mouse with arm support
2 RCTs Office workers MA
A: Incidence of neck/shoulder and right upper limb disorders B: Neck/shoulder discomfort C: Right upper limb discomfort
A: B: C:
A: Moderate B: Low C: Low
Hoe et al. 2012 (37)
Page 57 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Conventional mouse with arm support
Conventional mouse without arm support
2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders
Moderate Hoe et al. 2012 (37)
Alternative mouse with arm support
Conventional mouse without arm support
2 RCTs Office workers MA
A: Neck/shoulder disorders B: Incidence of right upper limb disorders C: Upper body disorders (neck, shoulder, and upper extremity) D: Incidence of neck/shoulder and right upper limb disorders
A: B: C:
A: Moderate B: Moderate C: Moderate
Hoe et al. 2012 (37)
Interventions targeting the work-rest cycle through supplementary pauses
Conventional pause schedule
4 RCTs Varying professions
Narrativee
A: Intensity of musculoskeletal symptoms in general B: Musculoskeletal symptom intensity separately for the neck, back, shoulder/upper arm and forearm/wrist/hand
A: B:
Moderate Stock et al. 2018 (61)
A: Technical aids to prevent strenuous lifting B: Small aids
No intervention 1 RCT Healthcare personnel
Individual study
1-week shoulder pain ratings
Low Hegewald et a. 2018 (59)
Workplace modifications
Advice, brochure or no intervention
5 RCTs
Varying professions (symptomatic and asymptomatic)
MA Shoulder pain intensity Low Lowry et al. 2017 (17)
Arm support Conventional mouse
3 RCTs Office workers Narrativee Neck pain Low Chen et al. 2017 (60)
Page 58 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Alternative mouse with arm support
Conventional mouse without arm support
2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders
Low Hoe et al. 2012 (37)
Feedback about computer workstation set-up & psychosocial aspects of work
Work as usual 1 RCT Computer workers
Narrativee one-month prevalence of any musculoskeletal pain
Low Stock et al. 2018 (61)
Lower monitor angle High monitor angle 1 RCT Office workers Individual study
Neck pain Low Chen et al. 2017 (60)
Interventions to reduce patient lifting in a hospital setting through safe lifting programs and equipment
Usual practice 1 RCT Healthcare workers
Narrativee
A: Frequency of work-related shoulder pain and of work-related low back pain B: Compensated musculoskeletal work injury rates and time loss injury rates
A: B:
Low Stock et al. 2018 (61)
Supplementary breaks or reduced work hours
Conventional breaks and normal work hours
2 RCTs Office workers MA Upper-extremity symptoms or pain, discomfort, work ability
Low Hoe et al. 2012 (37)
Ergonomic adjustments (eg, keyboard, monitor, mouse)
No intervention 4 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain A: B:
Low to very low
Chen et al. 2017 (60)
Job-rotation schedules n. a. 2 RCTs, 1 Case-control
Industrial workers, mainly assembly-line area in the automotive/automobile industry
Narrativee Musculoskeletal disorders
Weak1 Padula et al. 2017 (22)
Technical patient handling equipment
No intervention 2 CBAs Healthcare personnel
MA Back pain at 1-year follow-up
Very low Hegewald et al. 2018 (59)
Page 59 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Supplementary work breaks
Conventional work breaks
3 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain A: B:
Very low Chen et al. 2017 (60)
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Explanation according to the review: contradictory results in several studies.
Table 8: Overview of mixed interventions/programmes to prevent diseases of the musculoskeletal system
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Education/ergonomics training, workplace modification
No intervention 1 quasi-experimental design
Office workers Individual study
Work-related musculoskeletal disorders
High Goodman et al. 2012 (39)
Physical and organisational ergonomic interventions (training, modifications)
No intervention A: 4 RCTs B. 3 RCTs
Office workers, kitchen workers
A: MA B: Individual studies
A: Short term incidence and prevalence of neck pain B: Long term incidence and prevalence of neck pain
A: B:
A: Moderate B: Low
Driessen et al. 2010 (81)
Workplace interventions with several components (including exercise, workplace modifications, breaks)
No intervention 5 RCTs Computer users Individual studies1
Pain prevalence or pain severity, sick leave
Low to Moderate
Aas et al. 2011 (46)
Page 60 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Physical and organisational ergonomic interventions (training, modifications)
No intervention A: 2 RCTs B: 1 RCT
Office workers, kitchen workers
Individual studies
A: Short term intensity of neck pain B: Long term intensity of neck pain
A, B: A, B: Low Driessen et al. 2010 (81)
Physical and organisational ergonomic interventions (training, modifications)
No intervention A: 3 RCTs B: 1 RCT
Office workers, kitchen workers
A: MA B: Individual study
A: Short term incidence and prevalence of lower back pain B: Long term incidence and prevalence of lower back pain
A: B:
A:, B: Low Driessen et al. 2010 (81)
Physical and organisational ergonomic interventions (training, modifications)
No intervention 1 RCT Office workers, kitchen workers
Individual study
Intensity of lower back pain Low Driessen et al. 2010 (81)
Participatory ergonomic interventions based on training groups of workers to analyze work, identify problems and propose solutions
Work as usual 4 RCTs, 1 non-RCT
Varying professions
Narrative
A: Three-month prevalence of neck pain and low-back pain B: Back pain intensity C: Number of days with any musculoskeletal pain D: Three-month prevalence of musculoskeletal sick leave
A: B: C: D:
A: Very low B: Low C: Low D: Low
Stock et al. 2018 (61)
Provision of and education in patient handling with small aids
No intervention or usual practice
1 non-RCT Nurses, nursing aids, teachers
Individual study
A: 1-month prevalence of low back pain B: 1-month prevalence of upper arm pain C: 1-year follow-up: 7-day prevalence of low back pain and shoulder pain
A: B: C:
Very low to low
Freiberg et al. 2016 (26)
Page 61 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Small aids Mechanical aids 1 RCT Nurses, nursing aids, teachers
Individual study
1-year follow-up: 7-day prevalence of low back pain and shoulder pain
Very low to low
Freiberg et al. 2016 (26)
Ergonomic training and equipment
No intervention 1 RCT Office workers Individual study
Frequency and intensity of neck, shoulder, or wrist/hand ache or pain
Very low Hoe et al. 2012 (37)
Provision of and education in patient handling with small aids
One‑time ergonomic education
1 non-RCT Nurses, nursing aids, teachers
Individual study
12-month prevalence of low back pain
Very low Freiberg et al. 2016 (26)
Technical patient handling equipment (i.e., nursing beds, low nursing home beds, bed movers, mobile lifts, wall lifts, overhead lifts, ceiling lifts, day care chairs, or mechanical position change aids); as a solitary measure or as part of a multimodal intervention
No intervention A) 4 CBAs B) 1 CBA C) 2 CBAs
Gesundheits-personal
A: MA B: Individual study C: Individual studies
A: Musculoskeletal injury claims B: Repeated musculoskeletal injuries (follow-up: 2 years) C: Cervical spine (neck) injuries
A: B: C:
Very low Hegewald et al. 2018 (59)
Multi-component interventions (e.g. training, guidelines for patient transfer, physical exercise, ergonomic interventions)
n. a.
2 cohort studies with control group, 1 RCT
Healthcare personnel
Individual study
A: Pain B: Sickness absence C: Accidents
A: B: C:
n. a. Richardson et al. 2018 (69)
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Results of all five RCTs were described separately; one RCT had positive effects, all others showed no significant effects. Pooled results of two studies also show no effect.
Page 62 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 9: Overview of behavioural interventions to prevent diseases of skin and lung diseases
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Continuous respiratory personal protective equipment use
No respiratory personal protective equipment
2 RCTs
Healthcare Workers (doctors, nurses, surgeons and other personnel)
MA
A: Clinical respiratory illness B: Influenza-like illness C: Laboratory-confirmed viral infections
A: B: C:
Low Offeddu et al. 2017 (71)
N95 Respirators Medical masks 4 RCTs
Healthcare Workers (doctors, nurses, surgeons and other personnel)
MA
A: Clinical respiratory illness B: Influenza-like illness C: Laboratory-confirmed viral infections D: Bacterial respiratory infection
A: B: C:
D:
Low Offeddu et al. 2017 (71)
Educational intervention No intervention 1 RCT, 4 CBA Farm and construction workers
Partially narrative, partially MA
Self-reported respiratory protective equipment use
Very low Luong Thanh et al. 2016 (23)
Skin protection education No intervention 3 Cluster-RCTs Varying professions MA Signs of occupational irritant hand dermatitis
Very low Bauer et al. 2018 (14)
Conventional training with additions (biosimulated vision training, program active or passive teaching, computer-simulated training)
Conventional training (lectures, books)
1 Cluster-RCT 2 RCTs
Health workers, adults (not specified)
Narrative Correct use of respiratory protective equipment
Very low Luong Thanh et al. 2016 (23)
Trainings based on motivating interviews
Conventional lectures
1 CBA Production line workers
Narrative Use of respiratory protective equipment
Very low Luong Thanh et al. 2016 (23)
Training for the correct use of respiratory masks or personal protective equipment
No training 1 CBA Hospital workers Narrative Proportion of correctly used respirators
Very low Luong Thanh et al. 2016 (23)
Training for behavioural change: interventions intended to affect
n. a. 5 RCTs, 3 CBA, 1 multiple baseline study
Varying professions Narrative Exposure to occupational health hazards
n. a. Lunt et al. 2011 (43)
Page 63 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
worker’s behavioural compliance (by affecting actions that workers take to comply with health and safety precautions)
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 10: Overview of relational interventions to prevent diseases of skin and lung diseases
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Barrier creams No intervention 4 RCTs, 1 Cluster-RCT
Varying professions
MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 (14)
Barrier cream plus moisturizers
No intervention 3 RCTs, 1 Cluster-RCT
Varying professions
MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 (14)
Moisturizers No intervention 3 RCTs, 1 Cluster-RCT
Varying professions
MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 (14)
Complete removal from exposure (occupational asthma)
Continued exposure 15 CBA Varying professions
MA
A: Absence of asthma symptoms B: Improvement of of asthma symptoms C: Lung function parameters D: Non-specific bronchial hyper-reactivity
A: B: C:
D:
Very low de Groene et al. 2011 (45)
Complete removal from exposure (occupational asthma)
Reduction of exposure
8 CBA Varying professions
MA A: Absence of asthma symptoms B: Improvement of of
A: B: C:
Very low de Groene et al. 2011 (45)
Page 64 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
asthma symptoms C: Lungenfunktions-parameter
Reduction of exposure (personal respiratory protective equipment, educational programmes, relocation to another work area with less exposure)
Continued exposure 6 CBA Varying professions
MA
A: absence of asthma symptoms B: number of persons without asthma symptoms C: Lung function parameters
A: B: C:
Very low de Groene et al. 2011 (45)
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 11: Overview of mixed interventions/programmes to prevent diseases of skin and lung diseases
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Multi-component programme: Educational activities and evidence-based recommendations (e.g., protective gloves, skin care)
No intervention 1 RCT Gut-cleaners in swine slaughterhouses
Individual study
A: 3-month prevalence of eczema B: Use of gloves C: Use of skin care products D: Retention of information on prevention
A: B: C: D:
A: Moderate B: n. a. C: n. a. D: n. a.
van Holland et al. 2015 (28)
Abbreviations: n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 65 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 12: Overview of behavioural interventions to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Earplugs with instruction
Earplugs without instruction
2 RCTs Varying professions MA Attenuation of noise
Moderate Tikka et al. 2017 (20)
Abbreviations: MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 13: Overview of relational interventions to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Exposure information Training as usual 1 RCT Construction workers
Individual study Mean noise level
Low Tikka et al. 2017 (20)
Use of hearing protection 1
n. a. 1 RCT, 3 CBA
n. a. n. a. Noise exposure Low Tikka et al. 2017 (20)
New stricter legislation Not applicable 1 ITS Coal mines Individual study
Median personal noise exposure A: Immediate effect B: Long-term trend
A: B:
Very low Tikka et al. 2017 (20)
Earmuffs Earplug 2 CBA Workers with noise exposition above 88–94 dB(A)
MA Hearing loss Very low Tikka et al. 2017 (20)
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1Total result on hearing protection devices only mentioned in Abstract, no further information given in review
Page 66 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 14: Overview of mixed interventions/programmes to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Hearing loss prevention programme
Audiometric testing 1 RCT Agricultural students involved in farm work
Individual study Hearing loss average
Moderate Tikka et al. 2017 (20)
Well-implemented hearing loss prevention programme
Less well-implemented HLPP for hearing loss
4 CBA Varying professions MA Hearing loss STS Very low Tikka et al. 2017 (20)
Hearing loss prevention programme
Non-exposed workers
3 CBA Varying professions MA Hearing loss average
Very low Tikka et al. 2017 (20)
Hearing loss prevention programme with exposure information
Hearing loss prevention programme without exposure information
1 CBA Various workers of an aluminium smelter
Individual study Hearing loss average
Very low Tikka et al. 2017 (20)
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials; STS: standard threshold shift,
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 15: Overview of general behavioural occupational health and safety interventions
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Specific deterrence from inspections with penalties
n. a. 9 Studies1 Varying professions Narrative Injuries and truck crashes
Strong4 Tompa et al. 2016 (19)
Introduction of smoke-free workplace legislation
No intervention 6 Studies1 Varying professions Narrative
A: Respiratory and sensory symptoms B: Smoke exposure, cigarette consumption
A: B:
A) Moderate B) Strong4
Tompa et al. 2016 (19)
Page 67 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Inspections with consultative activity
n. a. 3 Studies1 Varying professions Narrative Injuries
Strong4 or limited3 – depending on context
Tompa et al. 2016 (19)
First inspection for compliance with occupational health and safety regulations
Further inspections for compliance with occupational health and safety regulations
4 Studies1 Varying professions Narrative Compliance Moderate Tompa et al. 2016 (19)
Occupational health and safety legislation
No intervention 9 Studies1 Varying professions Narrative
A: Injuries and fatality B: Exposure and compliance
A: B:
A) Moderate B) Limited3
Tompa et al. 2016 (19)
Specific deterrence without sanctions
n. a. 9 Studies1 Varying professions Narrative Injuries and truck crashes
Moderate to limited3
Tompa et al. 2016 (19)
Occupational safety and health inspections
No inspections 1 RCT, 2 CBA, 1 ITS
Motor carrier drivers in ITS; various industries in other studies
Individual studies
Fatal and non-fatal injuries A: Short- and medium-term (Ø 21 and 24 months) B: Long-term (Ø 36 and 48 months)
A: B:
Low Mischke et al. 2013 (34)
Occupational safety and health inspections
No inspections 1 RCT Varying professions Individual study
Physical workload Low Mischke et al. 2013 (34)
Autonomy-supportive inspector style
n. a. 1 Study1 Varying professions Individual study
Visits to achieve compliance
Limited3 Tompa et al. 2016 (19)
Specific deterrence in a compliance review of motor safety performance
n. a. 1 Study1 Transport sector Individual study
Truck crashes Limited3 Tompa et al. 2016 (19)
State enforcement of inspections
Federal enforcement of inspections
2 Studies1 Varying professions Narrative A: Fatalities B: Injuries
A: B:
Limited3 Tompa et al. 2016 (19)
Modified working No intervention 39 Studies2 Varying professions Regression The more types of n. a. Montano et al.
Page 68 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
conditions: Material and/or organisation and/or time
analysis working conditions changed at the same time, the more likely it was that significant positive results were achieved in different outcomes
2014 (31)
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Type of included studies not mentioned in SR
2 Of these, 5 RCTs and 17 CBA studies met our inclusion criteria; other studies included in regression analysis.
3 Defined as 1-2 studies of at least medium quality, mostly consistent results
4 Defined as at least 3 studies of high quality, all three must show consistent results; for more studies: mostly consistent results, deviations explained by methods.
Table 16: Overview of general mixed occupational health and safety interventions/programmes
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Workplace interventions Usual care 8 RCTs Varying professions, after sickness absence
MA
Cumulative duration of sickness absence A: Total B: Persons with musculoskeletal disorders C: Persons with mental health problems
A: B: C:
High van Vilsteren et al. 2015 (27)
Workplace interventions Usual care 5 RCTs Varying professions, MA Pain High van Vilsteren et
Page 69 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
after sickness absence
al. 2015 (27)
Workplace interventions Usual care 5 RCTs Varying professions, after sickness absence
MA Time until first return-to-work
Moderate van Vilsteren et al. 2015 (27)
Workplace interventions Usual care 1 RCT Varying professions, after sickness absence
Individual study
Risk of recurrences of sick leave
Moderate van Vilsteren et al. 2015 (27)
Workplace interventions Usual care 6 RCTs Varying professions, after sickness absence
MA Functional status (Roland disability questionnaire)
Moderate van Vilsteren et al. 2015 (27)
Workplace interventions Usual care 6 RCTs Varying professions, after sickness absence
MA
Time until lasting return-to-work A: Total B: Persons with musculoskeletal disorders C: Persons with mental health problems D: Persons with cancer
A: B: C: D:
Very low van Vilsteren et al. 2015 (27)
Workplace interventions Usual care 4 RCTs Varying professions, after sickness absence
MA Depression Very low van Vilsteren et al. 2015 (27)
Abbreviations: MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 70 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Section/topic # Checklist item Reported on page #
TITLE
Title 1 Identify the report as a systematic review, meta-analysis, or both. 3
Identified as “Overview of reviews”
ABSTRACT
Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
51-74
INTRODUCTION
Rationale 3 Describe the rationale for the review in the context of what is already known. 92-126
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
120-122
METHODS
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
128-129
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered,
language, publication status) used as criteria for eligibility, giving rationale.
146-175
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
135-145
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
Appendix 1
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable,
included in the meta-analysis).
176-181
Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
191-213
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
195-202
Risk of bias in individual studies
12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
182-190
Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means). 192
Page 71 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
192-194; 210-213
Page 1 of 2
Section/topic # Checklist item Reported on page #
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
Not applicable for Overviews of reviews
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
Not applicable for Overviews of reviews
RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
216-225
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
Table 4 (Appendix 2)
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). Appendix 4
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Appendix 5 and line 239-416
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency. Not applicable for narrative synthesis
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15). Not applicable for Overviews of reviews
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]). Not applicable for
Page 72 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Overviews of reviews
DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
420-448
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
449-453; 459-462; 464-466
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research. 449-455
471-473
FUNDING
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
476-479
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097
For more information, visit: www.prisma-statement.org.
Page 2 of 2
Page 73 of 73
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review onlyEvidence-based occupational health and safety
interventions: a comprehensive overview of reviews
Journal: BMJ Open
Manuscript ID bmjopen-2019-032528.R1
Article Type: Original research
Date Submitted by the Author: 26-Sep-2019
Complete List of Authors: Teufer, Birgit; Danube University Krems, Department for Evidence-based Medicine and EvaluationEbenberger, Agnes; Danube University Krems, Department for Evidence-based Medicine and EvaluationAffengruber, Lisa; Danube University Krems, Department for Evidence-based Medicine and EvaluationKien, Christina; Danube University Krems, Department for Evidence-based Medicine and EvaluationKlerings, Irma; Danube University Krems, Department for Evidence-based Medicine and EvaluationSzelag, Monika; Danube University Krems, Department for Evidence-based Medicine and EvaluationGrillich, Ludwig; Danube University Krems, Department for Evidence-based Medicine and EvaluationGriebler, Ursula; Danube University Krems, Department for Evidence-based Medicine and Evaluation
<b>Primary Subject Heading</b>: Occupational and environmental medicine
Secondary Subject Heading: Evidence based practice, Health policy
Keywords: overview of reviews, occupational injuries, occupational diseases, occupational health and safety, OHS
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open on A
ugust 10, 2021 by guest. Protected by copyright.
http://bmjopen.bm
j.com/
BM
J Open: first published as 10.1136/bm
jopen-2019-032528 on 11 Decem
ber 2019. Dow
nloaded from
For peer review only
1 Evidence-based occupational health and 2 safety interventions: a comprehensive 3 overview of reviews4 Authors:
5 Birgit Teufer (corresponding author),
6 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
7 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
9 phone: 0043 2732 893 2918
10 ORCID-ID: https://orcid.org/0000-0002-3324-0639
11
12 Agnes Ebenberger,
13 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
14 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
16
17 Lisa Affengruber,
18 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
19 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
21
22 Christina Kien
23 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
24 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
Page 1 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
26
27 Irma Klerings,
28 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
29 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
31
32 Monika Szelag,
33 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
34 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
36
37 Ludwig Grillich,
38 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
39 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
41
42 Ursula Griebler,
43 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
44 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
46
47
48 Word count: 4661 (including Competing interests, Funding statements, Differences between protocol
49 and review, Data availability, Acknowledgments, and author contributions)
50
Page 2 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
51 Abstract
52 Objectives: Occupational injuries and diseases are a huge public health problem and cause extensive
53 suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS)
54 guidelines are still not based on the best available evidence. In the last decade, numerous systematic
55 reviews on behavioural, relational and mixed interventions to reduce occupational injuries and
56 diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this
57 overview of reviews is to provide a comprehensive basis to informevidence-based decision-making
58 about interventions in the field of OHS.
59 Methods: We conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library
60 (Wiley), Epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between
61 January 2008 and June 2018. Two authors independently screened abstracts and full-text
62 publications and determined the risk of bias of the included systematic reviews with the ROBIS tool.
63 Results: We screened 2287 abstracts and 200 full texts for eligibility. Finally, we included 25
64 systematic reviews with a low risk of bias for data synthesis and analysis. We identified systematic
65 reviews on the prevention of occupational injuries, musculoskeletal, skin and lung diseases,
66 occupational hearing impairment and interventions without specific target diseases. Several
67 interventions led to consistently positive results on individual diseases; other interventions did not
68 show any effects, or the studies are contradictory. We provide detailed results on all included
69 interventions.
70 Discussion: To our knowledge, this is the first comprehensive overview of behavioural, relational and
71 mixed interventions and their effectiveness in preventing occupational injuries and diseases. It
72 provides policy makers with an important basis for making evidence-based decisions on interventions
73 in this field.
74 Systematic review registration: PROSPERO CRD42018100341
75 Keywords: overview of reviews, occupational injuries, occupational diseases, occupational health 76 and safety, OHS
Page 3 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
77 ARTICLE SUMMARY
78 Strengths and limitations of this study
79 To our knowledge, this is the first comprehensive overview of reviews on behavioural,
80 relational and mixed interventions to prevent injuries at work and occupational diseases.
81 We based our overview of reviews on an extensive, comprehensive and systematic literature
82 search.
83 Two scientists independently carried out all the essential steps in the preparation of this
84 review.
85 A secondary literature analysis may result in evidence base gaps, either due to periods not
86 covered by the included SRs or to further limitations in the SRs.
87 We considered only SRs with a low risk of bias for the data extraction analysis to ensure
88 validity but on the contrary, this approach may have led to a loss of information in topics
89 where only SRs with a high or unclear risk of bias were available.
90
91
92
Page 4 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
93 BACKGROUND
94 Occupational injuries and diseases cause extensive suffering and loss of productivity. The
95 World Health Organization (WHO) estimates that, globally, there are 1.2 million deaths per year
96 attributable to occupational risks, which relates to 2.1% of all deaths in the general population[1, 2].
97 Estimates from the Workplace Safety and Health Institute, Singapore, in cooperation with the
98 International Labour Organization (ILO) are even higher, with nearly 2.8 million deaths annually being
99 attributed to work, and another 374 million to non-fatal occupational accidents[3]. Although the
100 estimation of occupationally related mortality and morbidity worldwide varies widely due to
101 methodological problems, the general conclusion is that occupational diseases and injuries are a
102 huge public health problem[4]. Not only do social and ethical arguments support preventive
103 occupational health and safety (OHS) services[5] but so do the monetary consequences of ill health
104 at work[6].
105 Decisions on which interventions to implement are usually dominated by negotiations
106 between unions, employers and government representatives[7]. However, expert advice can be
107 seriously biased[8], leading to wide variations in expert judgments[9].
108 The WHO states that the principle that all their guidelines must be based on systematic and
109 comprehensive assessment of potential benefits and harms[10]. Nevertheless, many OHS guidelines
110 are still not based on the best available evidence[11]. Healthcare providers and policy makers are
111 confronted with an unmanageable amount of information[12], and there is a large amount of
112 systematic reviews on interventions to prevent single occupational diseases or injuries according to
113 very specific risks available (e.g. on work.cochrane.org). Systematic reviews are regarded as the most
114 appropriate method to avoid bias in synthesising the best available evidence. Because so many
115 systematic reviews are already available, we conducted an overview of reviews. That means we
116 compiled the results from multiple systematic reviews (SRs), addressing the effects of interventions
117 for a health problem or condition according to a predefined procedure. We appraised their quality
118 and summarized their evidence for important outcomes[13]. The aim of this overview of reviews is to
Page 5 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
119 provide a comprehensive basis for making evidence-based decisions on interventions in the OHS field
120 by answering the following research question:
121 ‘What effects do interventions in the workplace setting have on working conditions,
122 exposure to disease-causing factors and the behaviour of employees as well as on accidents at work
123 and the development of occupational diseases?’
124 To our knowledge, this is the first comprehensive overview of reviews on behavioural,
125 relational and mixed interventions to prevent injuries at work and occupational diseases, based on a
126 comprehensive and systematic search, critical appraisal and the synthesis of SRs. It enables
127 prioritisation between different interventions based on the quality of evidence (QoE).
128 METHODS
129 We have registered the protocol of the overview of reviews at the International Prospective
130 Register of Systematic Reviews (PROSPERO), registration number CRD42018100341. We adhered to
131 the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement[14]
132 throughout this manuscript (PRISMA checklist see Appendix 1).
133 Study design
134 We conducted an overview of reviews following the guidance provided in the Cochrane
135 Handbook[12].
136 Information sources and literature search
137 An information specialist conducted the database search in MEDLINE (Ovid), the Cochrane Library
138 (Wiley), Epistemonikos.org and Scopus (Elsevier) in June 2018. The usefulness of SRs also depends on
139 their actuality, but there is no consensus on when SRs are obsolete and when an update is
140 necessary[15]. To prevent us from relying on outdated evidence, we limited the search to SRs
141 published since 2008. The full search strategies are reported in Appendix 2.
142 Additionally, we checked the bibliographies of the included SRs and relevant articles for further
143 references to eligible reviews. To ensure that the evidence is up to date, we conducted forward
Page 6 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
144 citation tracking of selected SRs using Scopus (Elsevier). We also checked the websites of the
145 Cochrane Work Group1, the ILO2, the Occupational Safety and Health Administration (OSHA)3, the
146 WHO4 and the European Agency for Safety and Health at Work (EU-OSHA)5.
147 Eligibility criteria
148 You can find a detailed description of the inclusion and exclusion criteria in Table 1. We provide
149 additional information and definitions thereafter.
150 Table 1: Eligibility criteria for the overview of reviews on OHS interventions
Inclusion criteria Exclusion criteria
Study design Systematic reviews (with or without meta-analysis) of randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBA studies) and/or interrupted time series (ITS)
Systematic reviews of other study designs only if they reported a subgroup analysis on the study designs listed above, or at least 50% of included studies corresponded to those study designs
Primary studies, narrative reviews, editorials, opinion papers
Population Any kind of employees aged 15 or over, who were not self-employed
Mixed population of employed and self-employed employees only if at least 50% employed
Exclusively self-employed persons
Specific occupations (i.e. teachers or sex workers)
Intervention All types of workplace-related interventions designed to protect against occupational injuries and for the primary prevention of occupational diseases:
Organisational-level workplace interventions according to Montano et al. [16]: 1) material conditions, 2) work time-related conditions, 3) work organisation conditions
Provision of educational materials (e.g. brochures, films)
Training, counselling or workshops aimed at multipliers or directly at employees and workers
Legislation
Vaccinations at the workplace
1 https://work.cochrane.org/cochrane-reviews-about-occupational-safety-and-health2 https://www.ilo.org/global/lang--en/index.htm3 https://www.osha.gov/pls/publications/publication.AthruZ?pType=Types4 http://www.who.int/occupational_health/publications/en/5 https://osha.europa.eu/en/tools-and-publications
Page 7 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Audits by the health and safety executive
Comparison Another intervention (active control) or no intervention
Outcomes Prevalence, incidence and severity of occupational diseases, occupational injuries, physical disability, physical symptoms (e.g. pain experience)
Sickness absence rates
Risk factors that can lead to occupational injuries or diseases
Surrogate parameters (e.g. high blood pressure)
Quality changes at organisational level (e.g. in production)
Cost efficiency Job satisfaction or work
motivation
Setting Interventions at the workplace Studies conducted in OECD (Organisation for
Economic Cooperation and Development) countries (at least 50% of included studies in SR)
Interventions in: leisure time School Non-OECD countries
151
152 We defined systematic review according to the Cochrane Handbook as ‘a literature review that
153 attempts to collate all empirical evidence using a) clearly stated objectives and pre-defined eligibility
154 criteria, b) an explicit reproducible methodology, c) a systematic search, d) an assessment of the
155 validity of the findings of the included studies, and e) a systematic presentation, and synthesis, of the
156 characteristics and findings of the included studies’[12]. In addition, to be included in this overview of
157 reviews, SRs had to conduct the search in at least two scientific databases and perform abstract and
158 full-text screening by two independent reviewers.
159 We included SRs of all types of workplace-related interventions designed to protect against
160 occupational injuries and for the primary prevention of occupational diseases, including legislation
161 and audits by the health and safety executive as well as organisational-level workplace interventions.
162 According to Montano et al.[16], interventions that modify working conditions can be described in
163 three broad categories: material condition (physical and chemical agents needed during work), work
164 time-related condition (amount of working time and intensity of work) and work organisation
165 conditions (psychological factors and processes and procedures necessary for the completion of work
166 tasks).
Page 8 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
167 We defined occupational diseases in accordance with the definition of the ILO[17] that groups
168 occupational diseases caused by exposure to agents arising from work activities (caused by chemical
169 agents, physical agents, biological agents or infectious or parasitic diseases), by target organ systems
170 (respiratory diseases, skin diseases, musculoskeletal disorders and mental and behavioural disorders)
171 and occupational cancer.
172 Work-related injuries are injuries which are causally, locally and temporally related to the insured
173 occupation and which lead to physical injury[18]. Risk factors that can lead to occupational injuries or
174 diseases were defined as changes in environmental conditions, changes in exposure to disease-
175 causing factors (e.g. noise, extreme temperatures) and changes at the employees’ or workers’
176 behavioural level (e.g. wearing protective equipment).
177 Study selection
178 The reviewer team consisted of five persons with experience in conducting systematic reviews (BT,
179 AE, LA, UG, MS). Each study was independently assessed by two reviewers from this team in two
180 consecutive steps (abstract and full-text selection) based on the previously defined inclusion criteria.
181 Conflicts between reviewers were resolved through discussion and consensus or by involving a third
182 person from the reviewer team. We used the software Covidence (https://www.covidence.org/) for
183 the study selection process.
184 Risk of bias assessment and certainty of evidence
185 Two independent reviewers appraised the quality of the SRs with the ROBIS (Risk of Bias in
186 Systematic Reviews) tool[19]. This assesses four dimensions of SRs: ‘study eligibility criteria’,
187 ‘identification and selection of studies’, ‘data collection and study appraisal’ and ‘synthesis and
188 findings’. The result is an assessment of the risk of bias of each SR using the categories low, unclear
189 and high (see Table 2). Disagreements in appraisal between reviewers were resolved through
190 discussion and consensus or by involving a third person.
Page 9 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
191 Table 2: Definition and interpretation of risk of bias[19]
Risk of bias InterpretationLow risk of bias The findings of the review are likely to be reliable. No concerns with the review
process, or concerns were appropriately considered in the review conclusions. The conclusions were supported by the evidence and included consideration of the relevance of included studies.
High risk of bias One or more of the concerns raised during the assessment was not addressed in the review conclusions, the review conclusions were not supported by the evidence or the conclusions did not consider the relevance of the included studies to the review question.
Unclear risk of bias There is insufficient information reported to make a judgment on risk of bias.192
193 Data synthesis and analysis
194 We synthesised data narratively and in forms of evidence tables. Due to the large number of SRs
195 available and to ensure validity, we excluded SRs with a high or unclear risk of bias for our data
196 synthesis and analysis.
197 For SRs with a low risk of bias we extracted the following data:
198 - Details of the SR (author, title, year of publication, aim of the SR)
199 - Details of the included studies (number of studies and persons included, risk of bias of
200 studies)
201 - Details of the population (age, gender, type of occupation)
202 - Details of the intervention (duration, type of measures)
203 - Details of the results (time of outcome measurement, results for each endpoint)
204 - Quality of evidence (if reported in the included SR)
205 Several institutions (e.g. Cochrane, WHO, BMJ Clinical Evidence and many more[20]) and the
206 researchers of several included SRs use the GRADE approach (Grading of Recommendations,
207 Assessments, Developments and Evaluations) or modifications thereof to assess the QoE. Table 3
208 presents the significance of the four levels of evidence.
209 Table 3: Significance of the four levels of evidence[21]
Quality level Definition
Page 10 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
high
We are very confident that the true effect lies close to that of the estimate of the effect
moderate
We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
low
Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
very low
We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
210 If the researchers of the included SRs used evidence assessment tools other than the GRADE
211 approach, we provide the definition of the used levels of evidence in a footnote.
212 We did not extract data from primary studies. If information was not apparent from the included
213 review, it was presented as ‘not available’ (n.a.). If the SR was an update of an older version, we only
214 extracted data of the most recent version. We did not find SRs that answered the exact same
215 research question; therefore, we did not check for overlap in the included primary studies.
216 Patient and Public Involvement
217 It was not appropriate or possible to involve patients or the public in this work.
218 RESULTS
219 We identified 2215 citations from electronic database searches after the removal of duplicates, and
220 we found another 72 citations from additional searches (reference list checking and forward citation
221 tracking). All potentially relevant systematic reviews (SRs) on the searched web pages (see
222 “Information sources and literature search”) were cross-checked with hits from the previous
223 database search. Because the database search had already covered all relevant SRs, we did not
224 identify any new references in this step. Overall, 2287 citations were screened by title and abstract
225 and, subsequently, we assessed 200 full texts for eligibility. From the 71 SRs (74 records) that met
226 our eligibility criteria, we appraised 32 with a high risk of bias and 10 with an unclear risk of bias.
227 Four of the included SRs were updates from previous versions. Finally, we included 25 SRs reported
Page 11 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
228 in 28 publications for data synthesis and analysis. Figure 1 shows the details of the study selection
229 process. We provide a list of excluded full-text articles with reasons for exclusion as well as a detailed
230 risk of bias assessment (including SRs with a high or unclear risk of bias) in online appendices 3 and 4.
231 Please insert Figure 1 here
232 Figure 1: PRISMA Flowchart of the study selection process
233
234 Description of included studies
235 Appendix 5 provides an overview of the included SRs, summarising the interventions, description of
236 measured outcomes and risk of bias rating.
237 From the 25 included SRs, a considerable number of studies (12 SRs) dealt with research questions
238 on the topic of the prevention of musculoskeletal disorders, seven investigated the efficacy of
239 interventions for the prevention of occupational injuries, and three reviews studied interventions for
240 the prevention of occupational skin and lung diseases. One review examined the efficacy of
241 interventions for the prevention of occupational hearing loss, and another two SRs dealt with diverse
242 interventions about occupational health and safety (OHS) without limiting to a specific target
243 disease. Detailed information about all above mentioned SRs including the interventions, control
244 interventions, included studies, setting, method of data synthesis and a graphical presentation of the
245 results can be found in the online-only supplementary material (Appendix 5).
246 Prevention of musculoskeletal disorders
247 Overall, 12 SRs reported on different interventions for the prevention of musculoskeletal disorders.
248 They included mixed interventions with several different components[22-26], physical exercises at
249 the workplace[27], work organisation and psychosocial working environment[28], educational
250 interventions for the prevention of musculoskeletal disorders[29], ergonomic interventions[30]] and
251 interventions in the area of manual handling of loads[31-33].
Page 12 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
252 Strengthening exercises or fitness training had a positive effect on musculoskeletal disorders in
253 general as well as in the shoulder and neck area and on back pain in various occupational groups[23,
254 25, 27]]. The QoE varied widely between outcomes. See online appendix 6 for further details.
255 Lowry et al.[25] found a significant reduction in the prevalence of shoulder pain with workplace
256 adjustments (QoE: low). Additional breaks compared to conventional break schedules seem to
257 reduce symptom intensity in different body regions (QoE: moderate)[28]. Both SRs included a wide
258 range of occupational groups.
259 Educational interventions alone (e.g. training) showed no effect on the reduction of musculoskeletal
260 disorders (QoE: very low to moderate)([26, 28, 29],[33] only on training for manual material
261 transfer).
262 The results of ergonomic interventions on musculoskeletal disorders are mixed and varied but, in
263 general, tend to result in some form of pain reduction. Chen et al.[23] found evidence of low quality
264 for the efficacy of ergonomic interventions on neck pain. The use of an arm support with alternative
265 computer mice reduces the incidence of musculoskeletal disorders in the neck/shoulder but not in
266 the right upper extremity (QoE: moderate)[30]. There is no difference for musculoskeletal disorders
267 in the neck/shoulder and right upper extremity between alternative and conventional computer mice
268 with and without arm support (QoE: moderate)[30]. Richardson et al.[26] found a positive effect of
269 unstable shoes on pain in nurses (QoE: n.a.). No effect of physiotherapist or ergonomist feedback
270 sessions on the optimal design of computer workstations, work techniques and the psychosocial
271 aspects of work could be observed (QoE: low)[28]. Goodman et al.[24] concluded that not a single
272 measure but a combination of measures (included interventions, e.g. education, work station
273 adjustments, exercise, rest breaks, specific ergonomic equipment) is most effective in addressing
274 cumulative trauma disorder (CTD) symptoms.
275 Aids for patient transfer (both small aids such as bed steps, anti-slip mats, etc., and mechanical aids
276 such as mechanical transport devices for patients) led to positive effects on pain and/or injuries of
Page 13 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
277 the musculoskeletal system in two SRs (QoE: very low to low)[31, 32]. Stock et al.[28] showed that
278 ‘lifting programmes’ as well as multi-component interventions on safe patient handling in hospitals
279 had no effect on several outcomes measured (e.g. the prevalence of neck/shoulder pain,
280 forearm/wrist pain, lower back pain and musculoskeletal pain in any body region; upper extremity or
281 back-related functional status; musculoskeletal work injury rates and time loss injury rates; QoE: very
282 low to low) except for two outcomes: they found low-quality evidence that a safe lifting programme
283 is more effective than usual practice in reducing the frequency of work-related shoulder pain and
284 work-related low back pain (QoE: low)[28].
285 Prevention of occupational injuries
286 Overall, seven SRs investigated interventions for the prevention of occupational injuries. One review
287 dealt with different interventions for the prevention of occupational injuries in the agricultural
288 sector[34], one SR examined the effects of interventions for the prevention of occupational injuries
289 in the construction industry[35], and another review examined the effects of alcohol and drug
290 screening of professional drivers on accidents[36]. Four SRs searched for safety products and
291 practices in the health sector to prevent occupational injuries[37-40].
292 Rautiainen et al.[34] found no effect of education on the prevention of injuries in the agricultural
293 sector. Financial incentives (insurance premium discounts) showed a short-term positive effect but
294 no long-term progressive improvement. Legislation banning Endosulfan pesticides showed a
295 progressive reduction in deaths by poisoning. Regulations for the use of rollover protection
296 structures showed contradictory results. For all outcomes, no QoE was stated.
297 Van der Molen et al.[35] found contradictory evidence on the impact of regulations and inspections
298 to prevent injuries in construction workers. Regional safety campaigns, training, inspections or the
299 introduction of occupational health services are unlikely to reduce the number of non-fatal injuries in
300 construction companies, while company-oriented measures, such as safety campaigns, a drug
Page 14 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
301 workplace programme or subsidies for safe scaffolding, can have a positive effect (QoE: very low for
302 all outcomes).
303 Cashman et al.[36] investigated the effects of alcohol and drug screening of occupational drivers on
304 accidents and injuries. This review included two ITS studies which analysed data over a period of 13
305 and 14 years, respectively. Binding alcohol tests brought with them fewer accidents in the short term
306 but had no effect on the long-term trend. With regard to mandatory drug tests, the studies did not
307 show a uniform picture of the short-term effects but a uniform strengthening of the long-term trend
308 towards declining accident rates. The authors of the study judged the QoE as limited, which was
309 defined as ‘one low quality RCT or one CBA study or one ITS’[36].
310 Four SRs investigated for safety products and practices in the health sector to prevent occupational
311 injuries. Parantainen et al.[38] showed that the use of blunt surgical suture needles reduced the risk
312 of glove perforation (QoE: high) and the number of self-reported needle stick injuries (QoE:
313 moderate) compared to sharp suture needles. Reddy et al.[39] found that the use of safe blood
314 collection systems showed inconsistent effects on the number of needle stick injuries (QoE: very
315 low). The use of safe passive intravenous systems showed a decrease in needle stick injuries and a
316 reduction in the incidence of blood splashes (QoE: very low). However, evidence of moderate quality
317 was found that active systems might increase exposure to blood. For safe injection devices (QoE:
318 very low to low), the introduction of several safety products (QoE: very low) or safety containers
319 (QoE: very low) showed inconsistent results, or there was no clear evidence of benefit. Two ITS
320 studies showed that interrupted introduction of legislation on the use of safety-engineered devices
321 reduced the rate of needle stick injuries among healthcare workers (QoE: moderate), whereas one
322 ITS with low-quality evidence showed an increase in the level of needle stick injuries with gradual
323 introduction. Evidence showed varying results in the trend over time for needle stick injury rates
324 (QoE: very low to low)[39].
Page 15 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
325 Mischke et al.[37] reported that there is moderate-quality evidence that double gloves reduce
326 perforations and bloodstains on the skin compared to single gloves during surgery, which may mean
327 a decrease in percutaneous exposure events. Triple gloves and the use of special gloves can further
328 reduce the risk of glove perforations compared to double gloves made of normal material (QoE: low).
329 Verbeek et al.[40] found very low-quality evidence that more breathable types of PPE would not lead
330 to more contamination with body fluids. Double gloves and the Center for Disease Control and
331 Prevention (CDC) doffing guidelines reduced the risk of contamination with body fluids, and more
332 active training in PPE use could reduce PPE errors and PPE doffing errors more than passive training
333 (QoE: very low). However, the data all come from individual studies with a high risk of bias, so there
334 is uncertainty about the estimates of the effects.
335 Prevention of occupational skin and lung diseases
336 Three SRs included studies about the efficacy of interventions to prevent occupational skin and lung
337 diseases[41-43]].
338 Lunt et al.[41] found low positive effects of behavioural interventions at the workplace (training for
339 behavioural changes or for influencing knowledge and attitudes about health and safety precautions)
340 on exposure to occupational health hazards for workers exposed to dermal and respiratory hazards
341 (QoE: n.a.). Luong Than et al.[42] found evidence of low to very low quality that behavioural
342 interventions (education and training to improve the use of respiratory protective equipment) did
343 not largely contribute to workers using protective equipment correctly or more frequently. Bauer et
344 al.[43] found that moisturisers used alone or in combination with barrier creams can provide
345 clinically relevant protection against irritant hand dermatitis (QoE: low). For advanced training
346 interventions for skin protection, the results of the individual studies varied considerably. Altogether,
347 they showed no clinically relevant effect (QoE: very low)[43].
348 Prevention of occupational hearing loss
Page 16 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
349 We identified one SR which examined the effect of interventions for the prevention of occupational
350 hearing loss[44]. On average, wearing hearing protection reduced noise exposure by about 20 dB(A)
351 (QoE: low), and more noise was attenuated with instruction on how to use hearing protection than
352 without instruction (QoE: moderate). With regard to hearing impairment, there was no difference
353 between ear protectors and earplugs at noise levels above 89 dB(A) (QoE: very low). Implementing
354 stricter legislation to protect against occupational hearing loss (multiple components, e.g. prioritising
355 technical and administrative controls, setting a threshold) led to an immediate reduction in the mean
356 personal noise exposure in coal construction and a further positive, but statistically not significant,
357 trend in the reduction of the noise dose (QoE: very low). Furthermore, the authors found no
358 statistically significant differences between on-site training and information online (QoE: low),
359 information about personal noise exposure and no information about it (QoE: low), intensive hearing
360 loss prevention programmes (HLPP) compared to pure audiometry (QoE: moderate) and HLPP with
361 personal noise exposure information compared to HLPP without this information (QoE: very low).
362 General occupational health and safety interventions
363 We included one SR that examined the effects of laws and regulations on occupational safety and
364 health[45] and one SR dealt with interventions for the prevention of the inability to work after sick
365 leave[46]
366 Mischke et al.[45] found positive effects of compliance inspections on injuries at work (QoE: low).
367 However, the effects only became apparent in the long term (mean 36 and 48 months follow-up),
368 and no statistically significant risk reductions could be observed in the short term (mean 21–24
369 months). Inspections also had no statistically significant effect on employees’ physical workload
370 (QoE: low).
371 Van Vilsteren et al.[46] showed that interventions to prevent work disability in workers on sick leave
372 shortened the time to first return-to-work of workers with musculoskeletal disorders (QoE:
373 moderate) and the time to lasting return-to-work (Qoe: very low) for this group of workers but not
Page 17 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
374 for people with mental illness or cancer (QoE: very low). Workplace interventions reduced the
375 cumulative sickness duration by an average of 33 days (QoE: high). Significant results were only
376 shown for persons with musculoskeletal disorders but not for persons with mental illnesses.
377 However, the risk of sick leave recurrences for persons with musculoskeletal disease was higher for
378 workplace interventions (QoE: moderate). In addition, the authors found positive effects on the
379 functional status of employees with musculoskeletal disorders (QoE: moderate) and pain (QoE: high)
380 but no significant effect on depression (QoE: very low). Overall, the SR found evidence for the
381 positive effects of workplace interventions to prevent work disability in workers on sick leave with
382 musculoskeletal disorders (QoE: moderate) but no effects on persons with mental illnesses or cancer
383 (QoE: low)[46].
384 DISCUSSION
385 This overview of reviews provides a comprehensive overview of behavioural, relational and mixed
386 interventions and their effectiveness in preventing occupational injuries and diseases. We identified
387 SRs on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational
388 hearing impairment and interventions without specific target diseases.
389 Almost half of all the included reviews refer to work-related illnesses of the musculoskeletal system,
390 which demonstrates the importance of this topic and is in accordance with the fact that
391 musculoskeletal disorders are one of the main causes for work-related mortality and morbidity[47].
392 Several interventions (e.g. strengthening exercises, individual ergonomic interventions and patient
393 transfer aids) led to consistently positive results on individual musculoskeletal system diseases. Other
394 interventions (e.g. educational and cognitive behavioural interventions) targeting illnesses of the
395 musculoskeletal system did not show any effects, or the studies are contradictory.
396 With regard to the prevention of occupational accidents and the reduction of exposure to risk
397 factors, legislation and regulations as well as inspections can be effective (e.g. ban on Endosulfan
398 pesticides, legislation on the use of safety-engineered devices in the healthcare sector etc.). In some
Page 18 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
399 cases, however, contradictory results (e.g. regulations on the use of rollover protection structures) or
400 no effects (e.g. inspections in the construction sector) were found. Financial incentives such as
401 insurance premium discounts and subsidies for safe scaffolding showed positive effects. Company-
402 oriented interventions such as safety campaigns, awareness-raising campaigns or drug workplace
403 programmes appear to have positive effects on injuries at work and compliance with rules. The
404 evidence for the effectiveness of training and education interventions, in general, is mixed and must
405 be considered specifically by target disease or intervention.
406 In the medical field, there is partly good evidence for the use of safety products (e.g. blunt needles,
407 double gloves, etc.), but inconsistent effects have been observed for other safety products and
408 practices (e.g. use of safe blood collection systems, safe injection needles, etc.). With regard to skin
409 and lung diseases, there is some good evidence of the efficacy of various interventions (e.g.
410 moisturisers, barrier creams, protective gloves, etc.). There are also effective interventions to
411 prevent work-related hearing loss (e.g. wearing hearing protection, well-implemented HLPP).
412 While the included reviews covered many relevant endpoints, cancer and circulatory diseases were
413 not mentioned in any of them. On one hand, this may result from the limitation of certain primary
414 study designs—such as RCTs or CBA studies—which are considered robust but may not be suitable to
415 assess effects on diseases that are relatively rare and develop in the long term, such as cancer. On
416 the other hand, this may be interpreted as a demonstration of an important gap in the research
417 literature, especially as cancer and circulatory diseases are two of the main causes for work-related
418 mortality and morbidity[47]. A strength of this overview of reviews is the extensive literature search.
419 The search strategy was not restricted to specific target diseases or interventions to obtain the most
420 comprehensive results possible. Through the use of several additional search strategies, such as
421 reviewing multiple organisational websites and backward and forward citation tracking, further SRs
422 could be identified. Nonetheless, there remains a residual risk of not having found all relevant
423 reviews. As a methodological limitation, it can be stated that a secondary literature analysis may
424 result in evidence base gaps, either due to periods not covered by the included SRs or to further
Page 19 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
425 limitations in the SRs, such as limitations on study design or included interventions[48]. Due to the
426 overview of reviews method, we did not extract data from the individual studies included in the
427 Systematic Reviews. Therefore, we have taken over the assessment of the Quality of Evidence (QoE)
428 from the authors of the reviews. Almost all included reviews used the GRADE system for the QoE
429 evaluation and assessed the QoE dually. Therefore, we are quite confident that we can rely on the
430 reviewers' assessment of Quality of Evidence, but we are aware that these assessments may be
431 subject to subjective influences of the respective systematic review authors.
432 Our approach of considering only SRs with a low risk of bias for the data extraction analysis may be
433 seen as ensuring validity in topics where good systematic reviews were available. On the contrary,
434 this approach may have led to a loss of information in topics where only SRs with a high or unclear
435 risk of bias were available, such as mental diseases. However, the large number of identified SRs with
436 a high or unclear risk of bias highlights the need for more reviews in the field of OHS that apply
437 rigorous methods. A further strength of this overview of reviews is that two scientists independently
438 carried out all the essential steps in the preparation of this review. This ensures that both the
439 screening of the references and the assessment of the risk of bias of the included reviews minimized
440 subjective influences. To our knowledge, this is the first comprehensive overview of reviews on
441 interventions to prevent injuries at work and occupational diseases. It provides policy makers with an
442 important basis for making evidence-based decisions on interventions in this field.
443 COMPETING INTERESTS
444 All authors declare that they have no competing interests.
445 FUNDING
446 This overview of reviews was funded by the Austrian General Accident Insurance Institution
447 (Allgemeine Unfallversicherung, AUVA). The funding source had no role in the collection, analysis or
448 interpretation of data.
Page 20 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
449 DIFFERENCES BETWEEN PROTOCOL AND REVIEW
450 The protocol allowed for the inclusion of all systematic reviews that fulfilled our eligibility criteria
451 regardless of their quality (risk of bias). Due to the large number of available reviews, we decided to
452 include for data extraction only systematic reviews with a low risk of bias.
453 DATA AVAILABILITY
454 Data are available upon reasonable request. No new data was collected in this overview of reviews.
455 Full data extraction from included systematic reviews is available upon request from the main
456 author.
457 ACKNOWLEDGMENTS
458 We wish to thank Danielle Eder-Linder from the University of Continuing Education (Danube
459 University Krems) for administrative support.
460 AUTHOR CONTRIBUTIONS
461 CK drafted the research protocol, and BT, UG and LG provided substantial contributions to the
462 protocol. BT coordinated the reviewing process. BT, AE, LA, UG and MS contributed to the abstract
463 and full-text screening, data extraction and risk of bias assessment of the reviews. IK developed the
464 search strategy, performed the search and contributed to the data extraction. All authors wrote
465 substantial parts of the first draft of the manuscript and revised it critically for important intellectual
466 content, and all approved the final manuscript.
467 REFERENCES
468 1. Stanaway JD, Afshin A, Gakidou E, et al. Global, regional, and national comparative risk 469 assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of 470 risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of 471 Disease Study 2017. The Lancet. 2018;392(10159):1923-94.472 2. Wolf J, Prüss-Ustün A, Ivanov I, et al. Preventing disease through a healthier and safer 473 workplace. Geneva: World Health Organization; 2018.474 3. Hämäläinen P, Takala J, Kiat TB. Global estimates of occupational accidents and work-related 475 illnesses 2017. World. 2017;2017:3-4.
Page 21 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
476 4. Rushton L. The global burden of occupational disease. Current environmental health reports. 477 2017;4(3):340-8.478 5. World Health Organization. Declaration on Occupational Health for All: approved at the 479 Second Meeting of the WHO Collaborating Centres in Occupational Health, Beijing, China, 11-14 480 October 1994. Geneva: World Health Organization; 1994.481 6. Stewart WF, Ricci JA, Chee E, et al. Lost productive work time costs from health conditions in 482 the United States: results from the American Productivity Audit. Journal of occupational and 483 environmental medicine. 2003;45(12):1234-46.484 7. Verbeek J, Morata T, Ruotsalainen J, et al. Prevention of occupational diseases: implementing 485 the evidence. Cochrane Database Syst Rev [Internet]. 2013 [cited E; (4). Available from: 486 http://cochranelibrary-wiley.com/doi/10.1002/14651858.ED000056/abstract.487 8. Michaels D. Doubt is their product, how industry’s assault on science threatens your health. 488 New York: Oxford University Press; 2008.489 9. Sutherland WJ, Burgman M. Policy advice: Use experts wisely. Nature. 2015;526(7573):317-8.490 10. World Health Organization. WHO Handbook for Guideline Development. 2nd edition. 491 Geneva: World Health Organization; 2014.492 11. Verbeek J. Could we have better occupational health guidelines, please? Scand J Work 493 Environ Health. 2018;44(5):441-2.494 12. Green S, Higgins JP, Alderson P, et al. Cochrane Handbook for Systematic Reviews of 495 Interventions; CHAPTER 1: INTRODUCTION training.cochrane.org/handbook: The Cochrane 496 Collaboration; 2011 [5.1:[497 13. Higgins J, S G. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 498 [updated March 2011] Chapter 22: Overviews of reviews: The Cochrane Collaboration; 2011 499 [Available from: www.handbook.cochrane.org.500 14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 501 meta-analyses: the PRISMA statement. International journal of surgery (London, England). 502 2010;8(5):336-41.503 15. Moher D, Tsertsvadze A, Tricco A, et al. When and how to update systematic reviews. 504 Cochrane Database Syst Rev. 2008(1).505 16. Montano D, Hoven H, Siegrist J. Effects of organisational-level interventions at work on 506 employees' health: a systematic review. BMC Public Health. 2014;14:135.507 17. International Labour Organization (ILO). ILO List of Occupational Diseases (revised 2010) 508 2010 [10. August 2017]. Available from: http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---509 protrav/---safework/documents/publication/wcms_125137.pdf.510 18. Allgemeine Unvfallversicherungsanstalt (AUVA). Liste der Berufskrankheiten, Inkrafttreten: 511 01.01.2014 2014 [Available from: https://www.auva.at/cdscontent/load?contentid=10008.541831.512 19. Whiting P, Savovic J, Higgins JP, et al. ROBIS: A new tool to assess risk of bias in systematic 513 reviews was developed. J Clin Epidemiol. 2016;69:225-34.514 20. Green S, Higgins JP, Alderson P, et al. Cochrane Handbook for Systematic Reviews of 515 Interventions; PART 2; 12.2.1 The GRADE approach training.cochrane.org/handbook: The Cochrane 516 Collaboration; 2011 [5.1:[517 21. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of 518 evidence. J Clin Epidemiol. 2011;64(4):401-6.519 22. Aas RW, Tuntland H, Holte KA, et al. Workplace interventions for neck pain in workers. 520 Cochrane Database Syst Rev. 2011(4):CD008160.521 23. Chen X, Coombes BK, Sjogaard G, et al. Workplace-Based Interventions for Neck Pain in 522 Office Workers: Systematic Review and Meta-Analysis. Phys Ther. 2018;98(1):40-62.523 24. Goodman G, Kovach L, Fisher A, et al. Effective interventions for cumulative trauma disorders 524 of the upper extremity in computer users: practice models based on systematic review. Work. 525 2012;42(1):153-72.526 25. Lowry V, Desjardins-Charbonneau A, Roy JS, et al. Efficacy of workplace interventions for 527 shoulder pain: A systematic review and meta-analysis. J Rehabil Med. 2017;49(7):529-42.
Page 22 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
528 26. Richardson A, McNoe B, Derrett S, et al. Interventions to prevent and reduce the impact of 529 musculoskeletal injuries among nurses: A systematic review. Int J Nurs Stud. 2018;82:58-67.530 27. Kelly D, Shorthouse F, Roffi V, et al. Exercise therapy and work-related musculoskeletal 531 disorders in sedentary workers. Occupational Medicine. 2018;68(4):262-72.532 28. Stock SR, Nicolakakis N, Vezina N, et al. Are work organization interventions effective in 533 preventing or reducing work-related musculoskeletal disorders? A systematic review of the 534 literature. Scand J Work Environ Health. 2018;44(2):113-33.535 29. Crawford JO, Laiou E, Spurgeon A, et al. Musculoskeletal disorders within the 536 telecommunications sector-A systematic review. Int J Ind Ergon. 2008;38(1):56-72.537 30. Hoe VC, Urquhart DM, Kelsall HL, et al. Ergonomic design and training for preventing work-538 related musculoskeletal disorders of the upper limb and neck in adults. Cochrane Database Syst Rev. 539 2012(8):CD008570.540 31. Freiberg A, Euler U, Girbig M, et al. Does the use of small aids during patient handling 541 activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic 542 review. Int Arch Occup Environ Health. 2016;89(4):547-59.543 32. Hegewald J, Berge W, Heinrich P, et al. Do Technical Aids for Patient Handling Prevent 544 Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies. 545 Int J Environ Res Public Health. 2018;15(3):09.546 33. Verbeek JH, Martimo KP, Karppinen J, et al. Manual material handling advice and assistive 547 devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 548 2011(6):CD005958.549 34. Rautiainen RH, Lehtola MM, Day LM, et al. Interventions for preventing injuries in the 550 agricultural industry. Cochrane Database Syst Rev. 2008(1):CD006398.551 35. van der Molen HF, Basnet P, Hoonakker PL, et al. Interventions to prevent injuries in 552 construction workers. Cochrane Database Syst Rev. 2018;2:CD006251.553 36. Cashman CM, Ruotsalainen JH, Greiner BA, et al. Alcohol and drug screening of occupational 554 drivers for preventing injury. Cochrane Database Syst Rev. 2009(2):CD006566.555 37. Mischke C, Verbeek JH, Saarto A, et al. Gloves, extra gloves or special types of gloves for 556 preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev. 557 2014(3):CD009573.558 38. Parantainen A, Verbeek JH, Lavoie MC, et al. Blunt versus sharp suture needles for preventing 559 percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev. 2011(11):CD009170.560 39. Reddy VK, Lavoie MC, Verbeek JH, et al. Devices for preventing percutaneous exposure 561 injuries caused by needles in healthcare personnel. Cochrane Database Syst Rev. 2017;11:CD009740.562 40. Verbeek JH, Ijaz S, Mischke C, et al. Personal protective equipment for preventing highly 563 infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane 564 Database Syst Rev [Internet]. 2016 [cited I; (4). Available from: http://cochranelibrary-565 wiley.com/doi/10.1002/14651858.CD011621.pub2/abstract.566 41. Lunt JA, Sheffield D, Bell N, et al. Review of preventative behavioural interventions for 567 dermal and respiratory hazards. Occup Med (Oxf). 2011;61(5):311-20.568 42. Luong Thanh BY, Laopaiboon M, Koh D, et al. Behavioural interventions to promote workers' 569 use of respiratory protective equipment. Cochrane Database Syst Rev. 2016;12:CD010157.570 43. Bauer A, Ronsch H, Elsner P, et al. Interventions for preventing occupational irritant hand 571 dermatitis. Cochrane Database Syst Rev. 2018;4:CD004414.572 44. Tikka C, Verbeek JH, Kateman E, et al. Interventions to prevent occupational noise-induced 573 hearing loss. Cochrane Database Syst Rev. 2017;7:CD006396.574 45. Mischke C, Verbeek JH, Job J, et al. Occupational safety and health enforcement tools for 575 preventing occupational diseases and injuries. Cochrane Database Syst Rev. 2013(8):CD010183.576 46. van Vilsteren M, van Oostrom SH, de Vet HC, et al. Workplace interventions to prevent work 577 disability in workers on sick leave. Cochrane Database Syst Rev. 2015(10):CD006955.578 47. Elsler D, Takala J, Remes J. An International Comparison of the Cost or Work-Related 579 Accidents and Illnesses. European Agency for Safety and Health at Work: Bilbao, Spain. 2017.
Page 23 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
580 48. Piso B, Semlitsch T, Reinsperger I, et al. Practical experience with overviews of reviews–581 valuable decision aid or academic exercise? Zeitschrift für Evidenz, Fortbildung und Qualität im 582 Gesundheitswesen. 2015;109(4):300-8.
Page 24 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
PRISMA Flowchart of the study selection process
Page 25 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Section/topic # Checklist item Reported on page #
TITLE
Title 1 Identify the report as a systematic review, meta-analysis, or both. 3
Identified as “Overview of reviews”
ABSTRACT
Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
50-73
INTRODUCTION
Rationale 3 Describe the rationale for the review in the context of what is already known. 92-126
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
120-122
METHODS
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
128-129
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered,
language, publication status) used as criteria for eligibility, giving rationale.
146-175
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
135-145
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
Appendix 1
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable,
included in the meta-analysis).
176-182
Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
192-214
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
196-203
Risk of bias in individual studies
12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
183-191
Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means). 193
Appendix 1 Page 26 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
192-195; 211-214
Page 1 of 2
Section/topic # Checklist item Reported on page #
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
Not applicable for Overviews of reviews
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
Not applicable for Overviews of reviews
RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
217-232
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
Table 4 (Appendix 2)
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). Appendix 4
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Appendix 5 and line 245-383
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency. Not applicable for narrative synthesis
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15). Not applicable for Overviews of reviews
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]). Not applicable for
Page 27 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Overviews of reviews
DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
385-411
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
412-415; 422-431; 432-435
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research. 412-418;
440-442
FUNDING
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
445-448
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097
For more information, visit: www.prisma-statement.org.
Page 2 of 2
Page 28 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 2 – Search strategies
Search strategy MEDLINE (Ovid)
Ovid MEDLINE(R) 1946 to May Week 5 2018, Ovid MEDLINE(R) Epub Ahead of Print June 11, 2018, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations June 11, 2018, Ovid MEDLINE(R) Daily Update June 11, 2018
# Searches Results
1 Occupational Diseases/pc [Prevention & Control] 16456
2 Occupational Exposure/pc [Prevention & Control] 6085
3 Accidents, Occupational/pc [Prevention & Control] 5270
4 Occupational Injuries/pc [Prevention & Control] 686
5 Occupational Health/ed, lj, st [Education, Legislation & Jurisprudence, Standards] 3238
6 ((worker* or workplace or work related or occupation*) and intervention*).ti. 2050
7 or/1-6 30483
8
Occupational Exposure/ or Air Pollutants, Occupational/ or Accidents, Occupational/ or Dermatitis, Occupational/ or Occupational Diseases/ or Occupational Injuries/ or Asthma, Occupational/ or Noise, Occupational/ 149967
9 Occupational Health/ 30516
10 (worker* or workplace or work related or occupation*).ti. 116658
11 ((work* or occupation*) adj3 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)).ti,ab. 87656
12 *Work/ 15722
13 *Workplace/ 9376
14 *Occupations/ 9517
15 or/8-14 279210
16 Primary Prevention/ 16807
17 Health Education/ 57758
18 Health Promotion/ 66696
19 Risk Reduction Behavior/ 10752
20 Safety Management/ 18827
21 "Facility Design and Construction"/ 8866
22 Personal Protective Equipment/ 240
23 Occupational Health Services/ 10302
24 (health adj2 (safety or outcome? or benefit? or harm? or effect?)).ti,ab. 109219
25 (prevent* or promot* or reduc* or protect*).ti. 843783
26 ((prevent* or promot* or reduc* or protect*) adj4 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)).ab. 364870
27 or/16-26 1360949
28 15 and 27 47978
29 7 or 28 64546
30 exp age groups/ not (adolescent/ or exp adult/) 1190456
31 29 not 30 63888
32 review.pt. 2393987
Page 29 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only33
(medline or medlars or embase or pubmed or cochrane or (scisearch or psychinfo or psycinfo) or (psychlit or psyclit) or cinahl or ((hand adj2 search$) or (manual$ adj2 search$)) or (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$) or (pooling or pooled or mantel haenszel) or (peto or dersimonian or der simonian or fixed effect)).tw,sh. or (retraction of publication or retracted publication).pt. 270445
34 32 and 33 135062
35
meta-analysis.pt. or meta-analysis.sh. or (meta-analys$ or meta analys$ or metaanalys$).tw,sh. or (systematic$ adj5 review$).tw,sh. or (systematic$ adj5 overview$).tw,sh. or (quantitativ$ adj5 review$).tw,sh. or (quantitativ$ adj5 overview$).tw,sh. or (quantitativ$ adj5 synthesis$).tw,sh. or (methodologic$ adj5 review$).tw,sh. or (methodologic$ adj5 overview$).tw,sh. or (integrative research review$ or research integration).tw. 244993
36 34 or 35 296663
37 31 and 36 1349
38 limit 37 to yr="2008 -Current" 1071
Search strategy the Cochrane Library (Wiley)
Cochrane Library 12 June 2018 ID Search Hits
#1 [mh ^"Occupational Diseases"/pc] 448
#2 [mh ^"Occupational Exposure"/pc] 106
#3 [mh ^"Accidents, Occupational"/pc] 81
#4 [mh ^"Occupational Injuries"/pc] 29
#5 [mh ^"Occupational Health"/ed,lj,st] 32
#6 ((worker* or workplace or work related or occupation*) and intervention*):ti 936
#7 {or #1-#6} 1501
#8
[mh ^"Occupational Exposure"] or [mh ^"Air Pollutants, Occupational"] or [mh ^"Accidents, Occupational"] or [mh "Dermatitis, Occupational"] or [mh ^"Occupational Diseases"] or [mh ^"Occupational Injuries"] or [mh ^"Asthma, Occupational"] or [mh ^"Noise, Occupational"] 1611
#9 [mh ^"Occupational Health"] 666
#10 (worker* or workplace or "work related" or occupation*):ti,kw 9385
#11 ((work* or occupation*) near/3 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)):ti,ab,kw 4919
#12 [mh ^work] 225
#13 [mh ^workplace] 829
#14 [mh ^occupations] 165
#15 {or #8-#14} 11318
#16 [mh ^"Primary Prevention"] 1070
#17 [mh ^"Health Education"] 3823
Page 30 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
#18 [mh ^"Health Promotion"] 5699
#19 [mh ^"Risk Reduction Behavior"] 1708
#20 [mh ^"Safety Management"] 239
#21 [mh ^"Facility Design and Construction"] 30
#22 [mh ^"Personal Protective Equipment"] 14
#23 [mh ^"Occupational Health Services"] 423
#24 (health near/2 (safety or outcome* or benefit* or harm* or effect*)):ti,ab,kw 21303
#25 (prevent* or promot* or reduc* or protect*):ti,kw 148148
#26 ((prevent* or promot* or reduc* or protect*) near/4 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)):ab 45883
#27 {or #16-#26} 191090
#28 #15 and #27 4272
#29 #7 or #28 4857
#30 [mh "age groups"] not ([mh adolescent] or [mh adult]) 14410
#31 #29 not #30 4832
#32 #31 Publication Year from 2008 to 2018, in Cochrane Reviews (Reviews and Protocols), Other Reviews, Technology Assessments and Economic Evaluations 520
Search strategy Epistemonikos.org
Epistemonikos 12 June 2018 Query Results
(advanced_title_en:((worker* OR workplace OR "work related" OR occupation*) AND (disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance) AND (prevent* OR promot* OR reduc* OR protect*)) OR advanced_abstract_en:((worker* OR workplace OR "work related" OR occupation*) AND (disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance) AND (prevent* OR promot* OR reduc* OR protect*))) NOT advanced_title_en:(child* OR infant* OR newborn* OR neonat*) [Filters: protocol=no, classification=systematic-review, min_year=2008, max_year=2018] 926
Search strategy Scopus (Elsevier)
Scopus
12 June 2018
# Search Terms Results Comment
3 TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* )
3,066 document results
Page 31 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
4 TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) )
78,866 document results
5 ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) )
81,302 document results
3 OR 4
6 TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) )
355,097 document results
7 ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) )
1,440 document results
5 AND 6
8 INDEX ( medline ) 23,755,237 document results
9 ( ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) ) ) AND NOT ( INDEX ( medline ) )
396 document results
7 NOT 8
Page 32 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
10
( ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) ) ) AND NOT ( INDEX ( medline ) ) AND ( LIMIT-TO ( PUBYEAR , 2018 ) OR LIMIT-TO ( PUBYEAR , 2017 ) OR LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) OR LIMIT-TO ( PUBYEAR , 2011 ) OR LIMIT-TO ( PUBYEAR , 2010 ) OR LIMIT-TO ( PUBYEAR , 2009 ) OR LIMIT-TO ( PUBYEAR , 2008 ) )
324 document results
2008-2018
Page 33 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 3 – List of excluded full texts
Ineligible study design
Addo MA, Stephen AI, Kirkpatrick P. Acute mental health/psychiatric nurses' experiences of clinical supervision in promoting their wellbeing in their workplace: a systematic review. JBI Libr Syst Rev. 2012;10(56 Suppl):1-16.
Apisarnthanarak A, Uyeki T, Puthavathana P, Kitphati R, Mundy L. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand (Provisional abstract). Infection Control and Hospital Epidemiology [Internet]. 2010 [cited E; 31(10):[996-1003 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22010001963/frame.html.
Baldasseroni A, Olimpi N, Bonaccorsi G. [A systematic review of the effectiveness of workplace safety interventions]. Med Lav. 2009;100(4):268-71.
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med. 2009;48(5):454-61.
Birdi K, Beach J. Management of sensitizer-induced occupational asthma: avoidance or reduction of exposure? Curr Opin Allergy Clin Immunol. 2013;13(2):132-7.
Bruno Garza JL, Young JG. A literature review of the effects of computer input device design on biomechanical loading and musculoskeletal outcomes during computer work. Work. 2015;52(2):217-30.
Bullock SH, Jones BH, Gilchrist J, Marshall SW. Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med. 2010;38(1 Suppl):S156-81.
Burdorf A, Koppelaar E, Evanoff B. Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Occup Environ Med. 2013;70(7):491-7.
Cadth. Respiratory precautions for protection from bioaerosols or infectious agents: a review of the clinical effectiveness and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000193/frame.html.
Cadth. Wear compliance and donning/doffing of respiratory protection for bioaerosols or infectious agents: a review of the effectiveness, safety, and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000192/frame.html.
de Matteis S, Heederik D, Burdorf A, Colosio C, Cullinan P, Henneberger PK, et al. Current and new challenges in occupational lung diseases. Eur. 2017;26(146).
De Sio S, Traversini V, Rinaldo F, Colasanti V, Buomprisco G, Perri R, et al. Ergonomic risk and preventive measures of musculoskeletal disorders in the dentistry environment: an umbrella review. Peerj. 2018;6:e4154.
Flynn JP, Gascon G, Doyle S, Matson Koffman DM, Saringer C, Grossmeier J, et al. Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements. Am J Health Promot. 2018:890117118761887.
Frutiger M, Tuchin PJ. Chiropractic curriculum mapping and congruence of the evidence for workplace interventions in work-related neck pain. J Chiropractic Educ. 2017;31(2):115-24.
Page 34 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Goldgruber J, Ahrens D. Effectiveness of workplace health promotion and primary prevention interventions: A review. J Public Health (Oxf). 2010;18(1):75-88.
Goldgruber J, Ahrens D. Health-related interventions in the workplace : Review of the effectiveness of workplace health promotion and primary prevention. Pravent Gesundheitsforderung. 2009;4(1):83-95.
Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, et al. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46(4):683-97.
Maguire E, Spurr A. Implementation of ultraviolet radiation safety measures for outdoor workers: A Canadian perspective. J Cutaneous Med Surg. 2017;21(2):117-24.
Miguelino ES. A meta-analytic review of the effectiveness of single-layer clothing in preventing exposure from pesticide handling. J. 2014;19(4):373-83.
Mohammadi M, Danaee L, Alizadeh E. Reduction of Radiation Risk to Interventional Cardiologists and Patients during Angiography and Coronary Angioplasty. The Journal of Tehran Heart Center. 2017;12(3):101-6.
Nafees AA, Fatmi Z. Available Interventions for Prevention of Cotton Dust-Associated Lung Diseases Among Textile Workers. J Coll Physicians Surg Pak. 2016;26(8):685-91.
Nicholson PJ, Llewellyn D, English JS, Guidelines Development G. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis. 2010;63(4):177-86.
Parikh JR, Geise RA, Bluth EI, Bender CE, Sze G, Jones AK, et al. Potential Radiation-Related Effects on Radiologists. AJR Am J Roentgenol. 2017;208(3):595-602.
Shiftwork and health risks: possibilities for prevention (Structured abstract). Health Technology Assessment Database [Internet]. 2015 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32016000066/frame.html.
Snodgrass J. Special issue on work-related injuries and illnesses and the role of occupational therapy: implications of a systematic literature review for practice, research, education, and policy. Am J Occup Ther. 2011;65(1):7-9.
Tarlo SM, Lemiere C. Occupational asthma. New Engl J Med. 2014;370(7):640-9.
Theis J, Finkelstein M. Long-term effects of safe patient handling program on staff injuries (Provisional abstract). Rehabilitation Nursing Journal [Internet]. 2014 [cited E; 39(1):[26-35 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22014013150/frame.html.
Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P, et al. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J. 2011;38(4):804-11.
Verbeek J, Ivanov I. Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence. Saf Health Work. 2013;4(2):77-83.
Walden C, Bankard S, Cayer B, Floyd W, Garrison H, Hickey T, et al. Mobilization of the obese patient and prevention of injury (Provisional abstract). Annals of Surgery [Internet]. 2013 [cited E; 258(4):[646-50 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22013045482/frame.html.
Wassell JT. Workplace violence intervention effectiveness: A systematic literature review. Safety Science. 2009;47(8):1049-55.
Page 35 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Westgaard RH, Winkel J. Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review. Appl Ergon. 2011;42(2):261-96.
Westgaard RH. RCTs of ergonomic interventions. Occup Environ Med. 2010;67(4):217-8.
Yassi A, Lockhart K, Sykes M, Buck B, Stime B, Spiegel JM. Effectiveness of joint health and safety committees: a realist review. Am J Ind Med. 2013;56(4):424-38.
Zhou Z, Goh YM, Li Q. Overview and analysis of safety management studies in the construction industry. Safety Science. 2015;72:337-50.
Ineligible document type
Alahmari MAS, Sun Z. A systematic review of the efficiency of radiation protection training in raising awareness of medical staff working in catheterisation laboratory. Curr Med Imaging Rev. 2015;11(3):200-6.
Buchberger B, Heymann R, Huppertz H, Frieportner K, Pomorin N, Wasem J. The effectiveness of interventions in workplace health promotion as to maintain the working capacity of health care personal. GMS Health Technol Assess. 2011;7:Doc06.
de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma: a Cochrane systematic review. Occup Environ Med. 2012;69(5):373-4.
El Dib RP, Mathew JL. Interventions to promote the wearing of hearing protection. Cochrane Database Syst Rev. 2009(4):Cd005234.
Lipscomb HJ, Dement JM. A counterview on data quality and the systematic review process for occupational injury interventions: are we missing the forest for the trees? Am J Prev Med. 2009;36(4):377-8; author reply 8.
Picheansathian W, Chotibang J. Glove utilization in the prevention of cross transmission: a systematic review. JBI Database System Rev Implement Rep. 2015;13(4):188-230.
Verbeek J, Morata T, Ruotsalainen J, Vainio H. Prevention of occupational diseases: implementing the evidence. Cochrane Database Syst Rev [Internet]. 2013 [cited E; (4). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.ED000056/abstract.
Ineligible study population
Nieuwenhuijsen K, Bultmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, van der Feltz-Cornelis CM. Interventions to improve occupational health in depressed people. Cochrane Database Syst Rev. 2008(2):CD006237.
Schaafsma FG, Mahmud N, Reneman MF, Fassier JB, Jungbauer FH. Pre-employment examinations for preventing injury, disease and sick leave in workers. Cochrane Database Syst Rev. 2016(1):CD008881.
Stojanovic MD, Ostojic SM. Preventing ACL Injuries in Team-Sport Athletes: A Systematic Review of Training Interventions. Research in sports medicine (Print). 2012;20(3-4):223-38.
Ineligible intervention
Page 36 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Bercier ML, Maynard BR. Interventions for Secondary Traumatic Stress With Mental Health Workers: A Systematic Review. Res Soc Work Pract. 2015;25(1):81-9.
Bernaldo-De-Quirós M, Labrador FJ, Piccini AT, Mar Gómez M, Cerdeira JC. Workplace violence in prehospital emergency care: A systematic review and outlines of psychological intervention Second prize of the 20th "rafael Burgaleta" Applied Psychology Awards 2013. Clin Salud. 2014;25(1):11-8.
Breeze J, Baxter D, Carr D, Midwinter MJ. Defining combat helmet coverage for protection against explosively propelled fragments. J R Army Med Corps. 2015;161(1):9-13.
Christian MS, Bradley JC, Wallace JC, Burke MJ. Workplace safety: a meta-analysis of the roles of person and situation factors. J Appl Psychol. 2009;94(5):1103-27.
Furlan AD, Gnam WH, Carnide N, Irvin E, Amick BC, 3rd, DeRango K, et al. Systematic review of intervention practices for depression in the workplace. J Occup Rehabil. 2012;22(3):312-21.
Pereira-de-Paiva MH, Calassa-Albuquerque MdC, Latham EE, Furtado-Bezerra C, da-Silva-Sousa A, Cunha-e-Silva-de-Araújo L, et al. Occupational hazards of Brazilian solid waste workers: a systematic literature review. Rev bras med trab. 2017;15(4):364-71.
van Wyk BE, Pillay-Van Wyk V. Preventive staff-support interventions for health workers. Cochrane Database Syst Rev. 2010(3):CD003541.
Ineligible comparison
Moreira RF, Foltran FA, Albuquerque-Sendin F, Mancini MC, Coury HJ. Comparison of randomized and non-randomized controlled trials evidence regarding the effectiveness of workplace exercise on musculoskeletal pain control. Work. 2012;41 Suppl 1:4782-9.
Ineligible outcome
Basu S, Qayyum H, Mason S. Occupational stress in the ED: a systematic literature review. Emerg Med J. 2017;34(7):441-7.
Brand SL, Thompson Coon J, Fleming LE, Carroll L, Bethel A, Wyatt K. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLoS ONE. 2017;12(12):e0188418.
Butler M, Collins R, Drennan J, Halligan P, O'Mathúna DP, Schultz TJ, et al. Hospital nurse staffing models and patient and staff-related outcomes. Cochrane Database Syst Rev [Internet]. 2011 [cited E; (7). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD007019.pub2/abstract.
Cassidy JD, Cote P. Is it time for a population health approach to neck pain? J Manipulative Physiol Ther. 2008;31(6):442-6.
Cooklin A, Joss N, Husser E, Oldenburg B. Integrated Approaches to Occupational Health and Safety: A Systematic Review. Am J Health Promot. 2017;31(5):401-12.
Feltner C, Peterson K, Palmieri Weber R, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. The Effectiveness of Total Worker Health Interventions: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2016;165(4):262-9.
Page 37 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Feltner C, Peterson K, Weber RP, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. Total Worker Health(®)2016 2016/05/None.
Kahn-Marshall J, Gallant M. Making healthy behaviors the easy choice for employees: a review of the literature on environmental and policy changes in worksite health promotion (Structured abstract). Health Education and Behavior [Internet]. 2012 [cited E; 39(6):[752-76 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12013005967/frame.html.
Ker K, Edwards PJ, Felix LM, Blackhall K, Roberts I. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev. 2010(5):CD008508.
Lachance CC, Jurkowski MP, Dymarz AC, Robinovitch SN, Feldman F, Laing AC, et al. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety. PLoS ONE. 2017;12(2):e0171652.
LaMontagne, A. D., Keegel, T., Louie, A. M., Ostry, A., & Landsbergis, P. A. A systematic review of the job-stress intervention evaluation literature, 1990-2005 (International Journal of Occupational and Environmental Health (2007) 13, (268-80)). International Journal of Occupational and Environmental Health. 2008;14(1):24.
Lu ML, Putz-Anderson V, Garg A, Davis KG. Evaluation of the Impact of the Revised National Institute for Occupational Safety and Health Lifting Equation. Hum Factors. 2016;58(5):667-82.
Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. Bmj. 2015;351:h3728.
MacEwen BT, MacDonald DJ, Burr JF. A systematic review of standing and treadmill desks in the workplace. Prev Med. 2015;70:50-8.
Martin A, Sanderson K, Cocker F. Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms. Scand J Work Environ Health. 2009;35(1):7-18.
Neil-Sztramko SE, Pahwa M, Demers PA, Gotay CC. Health-related interventions among night shift workers: a critical review of the literature. Scand J Work Environ Health. 2014;40(6):543-56.
Pachito DV, Eckeli AL, Desouky AS, Corbett MA, Partonen T, Rajaratnam SM, et al. Workplace lighting for improving alertness and mood in daytime workers. The Cochrane database of systematic reviews. 2018;3:CD012243.
Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008. J Occup Environ Med. 2009;51(7):822-37.
Plat MJ, Frings-Dresen MH, Sluiter JK. A systematic review of job-specific workers' health surveillance activities for fire-fighting, ambulance, police and military personnel. Int Arch Occup Environ Health. 2011;84(8):839-57.
Price L, Melone L, McLarnon N, Bunyan D, Kilpatrick C, Flowers P, et al. A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers. Am J Infect Control. 2018;27:27.
Sayapathi BS, Su AT, Koh D. The effectiveness of applying different permissible exposure limits in preserving the hearing threshold level: a systematic review. J Occup Health. 2014;56(1):1-11.
Page 38 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Silva J, Santos Baptista J, Rodrigues C, editors. Use of effectiveness and efficiency concepts in occupational safety management on motorways: A systematic review2016. E: CRC Press/Balkema.
Slanger TE, Gross JV, Pinger A, Morfeld P, Bellinger M, Duhme A-L, et al. Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work. Cochrane Database Syst Rev [Internet]. 2016 [cited E; (8). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD010641.pub2/abstract.
Srigley JA, Corace K, Hargadon DP, Yu D, MacDonald T, Fabrigar L, et al. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. The Journal of hospital infection. 2015;91(3):202-10.
Studnek JR, Infinger AE, Renn ML, Weiss PM, Condle JP, Flickinger KL, et al. Effect of Task Load Interventions on Fatigue in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review. Prehosp Emerg Care. 2018;22(sup1):81-8.
Varatharajan S, Cote P, Shearer HM, Loisel P, Wong JJ, Southerst D, et al. Are work disability prevention interventions effective for the management of neck pain or upper extremity disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. J Occup Rehabil. 2014;24(4):692-708.
Yazdani A, Wells R. Prevention of MSD within OHSMS/IMS: a systematic review of risk assessment strategies. Work. 2012;41 Suppl 1:2765-7.
Full text not retrievable
Bonfiglioli R, Farioli A, Mattioli S, Violante FS. [Evidence based prevention and upper limb work-related musculoskeletal disorders]. G Ital Med Lav Ergon. 2008;30(3 Suppl):26-31.
Buil Cosiales P. Educative techniques and training in weight lifting does not prevent back pain in workers. FMC Formacion Med Continuada Aten Prim. 2008;15(9):626.
Cadth. Hearing protection fit testing systems: clinical and cost-effectiveness and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000305/frame.html.
dos Santos NC, Santos LS, Camelier FWR, Maciel RRBT, Portella DDA. Technologies applied to occupational health promotion: a systematic review. Rev bras med trab. 2017;15(1):113-22.
El Dib RP. A systematic review of hearing protective devises: Types, uses and safety. Deafness, Hearing Loss and the Auditory System: Nova Science Publishers, Inc.; 2011. p. 227-48.
Leas B, Umscheid C. Healthcare worker clothing and infection control (Structured abstract). Health Technology Assessment Database [Internet]. 2011 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32011001593/frame.html.
Parantainen A, Anthoni M, Hellgren UM, Lavoie MC, Valdes A, Verbeek JH. Prevention of percutaneous injuries with risk of hepatitis B, hepatitis C, or other viral infections for health-care workers. Cochrane Database Syst Rev. 2008(2).
Sancini A, Caciari T, Fioravanti M, Tria M, Scimitto L, Fiaschetti M, et al. [Meta-analysis: effectiveness of the preventive interventions in agriculture accidents]. G Ital Med Lav Ergon. 2010;32(4 Suppl):25-30.
Page 39 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Ineligible setting
Awa WL, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010;78(2):184-90.
Gross A, Forget M, St GK, Fraser MM, Graham N, Perry L, et al. Patient education for neck pain. Cochrane Database Syst Rev [Internet]. 2012 [cited E; (3). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005106.pub4/abstract.
Simonelli AP, Almeida IMd, Vilela RAG, Jackson Filho JM. Influence of behavioral safety practices and models of prevention of occupational accidents: a systematic review of the literature. Saúde Soc. 2016;25(2):463-78.
Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. Cmaj. 2016;188(8):567-74.
Zhang YT, Wang LS. Protection education towards needle stick injuries among nursing students in China: A meta-analysis. Chin J Evid-Based Med. 2013;13(6):754-9.
Ineligible study design primary studies
Anger WK, Elliot DL, Bodner T, Olson R, Rohlman DS, Truxillo DM, et al. Effectiveness of Total Worker Health interventions. J Occup Health Psychol. 2015;20(2).
Bambra C, Whitehead M, Sowden A, Akers J, Petticrew M. "A hard day's night?" The effects of Compressed Working Week interventions on the health and work-life balance of shift workers: a systematic review. J Epidemiol Community Health. 2008;62(9):764-77.
Barger LK, Runyon MS, Renn ML, Moore CG, Weiss PM, Condle JP, et al. Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis. Prehosp Emerg Care. 2018;22(sup1):58-68.
Bercier ML. Interventions that help the helpers: A systematic review and meta-analysis of interventions targeting compassion fatigue, secondary traumatic stress and vicarious traumatization in mental health workers. Dissertation Abstracts International Section A: Humanities and Social Sciences. 2014;74(10-A(E)).
Caffaro F, Micheletti Cremasco M, Bagagiolo G, Vigoroso L, Cavallo E. Effectiveness of occupational safety and health training for migrant farmworkers: a scoping review. Public Health. 2018;160:10-7.
Clemes SA, Haslam CO, Haslam RA. What constitutes effective manual handling training? A systematic review. Occup Med (Oxf). 2010;60(2):101-7.
Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016;13(6):22.
Cooke CE, Stephens JM. Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Med Devices (Auckl). 2017;10:225-35.
Crickman R, Finnell D. Systematic Review of Control Measures to Reduce Hazardous Drug Exposure for Health Care Workers. J Nurs Care Qual. 2016;31(2):183-90.
d'Ettorre G, Criscuolo M, Mazzotta M. Managing Formaldehyde indoor pollution in anatomy pathology departments. Work. 2017;56(3):397-402.
Eastlake A, Zumwalde R, Geraci C. Can Control Banding be Useful for the Safe Handling of Nanomaterials? A Systematic Review. J Nanopart Res. 2016;18.
Page 40 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Edwards R, Charani E, Sevdalis N, Alexandrou B, Sibley E, Mullett D, et al. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. The Lancet infectious diseases. 2012;12(4):318-29.
Gulumian M, Verbeek J, Andraos C, Sanabria N, de Jager P. Systematic Review of Screening and Surveillance Programs to Protect Workers from Nanomaterials. PLoS ONE. 2016;11(11):e0166071.
Gurusamy KS, Best LM, Tanguay C, Lennan E, Korva M, Bussieres JF. Closed-system drug-transfer devices plus safe handling of hazardous drugs versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff. Cochrane Database Syst Rev. 2018;3:CD012860.
Jaworska-Burzyńska L, Kanaffa-Kilijańska U, Przysiȩzna E, Szczepańska-Gieracha J. The role of therapy in reducing the risk of job burnout - A systematic review of literature. Arch Psychiatry Psychother. 2016;18(4):43-52.
Kolar C, von Treuer K. Alcohol Misuse Interventions in the Workplace: A Systematic Review of Workplace and Sports Management Alcohol Interventions. Int J Ment Health Addict. 2015;13(5):563-83.
Leider PC, Boschman JS, Frings-Dresen MH, van der Molen HF. Effects of job rotation on musculoskeletal complaints and related work exposures: a systematic literature review. Ergonomics. 2015;58(1):18-32.
Lindsay R, Su Ern Y, Dinanda NK. Non‐pharmacological interventions for preventing venous insufficiency in a standing worker population. Cochrane Database Syst Rev. 2013;10(10):CD006345.
Morphet J, Griffiths D, Beattie J, Velasquez Reyes D, Innes K. Prevention and management of occupational violence and aggression in healthcare: A scoping review. Collegian. 2018.
Myojo T, Nagata T, Verbeek J. The Effectiveness of Specific Risk Mitigation Techniques Used in the Production and Handling of Manufactured Nanomaterials: A Systematic Review. J Uoeh. 2017;39(3):187-99.
Nilsson K. Interventions to reduce injuries among older workers in agriculture: A review of evaluated intervention projects. Work. 2016;55(2):471-80.
Pidd K, Roche AM. How effective is drug testing as a workplace safety strategy? A systematic review of the evidence. Accid Anal Prev. 2014;71:154-65.
Richter K, Acker J, Adam S, Niklewski G. Prevention of fatigue and insomnia in shift workers-a review of non-pharmacological measures. Epma J. 2016;7:16.
Rinder MM, Genaidy A, Salem S, Shell R, Karwowski W. Interventions in the construction industry: A systematic review and critical appraisal. Human Factors and Ergonomics in Manufacturing. 2008;18(2).
Schmidt BM, Engel ME, Abdullahi L, Ehrlich R. Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review. BMC Public Health. 2018;18(1):661.
Sena JS, Girao RJ, Carvalho SM, Tavares RM, Fonseca FL, Silva PB, et al. Occupational skin cancer: Systematic review. Rev Assoc Med Bras. 2016;62(3):280-6.
Smedley J, Williams S, Peel P, Pedersen K, Dermatitis Guideline Development G. Management of occupational dermatitis in healthcare workers: a systematic review. Occupational and environmental medicine. 2012;69(4):276-9.
Page 41 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Surber C, Diepgen TL. Outdoor workers sun-related knowledge, attitudes and protective behaviors: A systemic review of cross-sectional and interventional studies. Dermatol Beruf Umwelt. 2013;61(2):79-86.
Tarigan LH, Cifuentes M, Quinn M, Kriebel D. Prevention of needle-stick injuries in healthcare facilities: a meta-analysis. Infect Control Hosp Epidemiol. 2015;36(7):823-9.
Teeple E, Collins JE, Shrestha S, Dennerlein JT, Losina E, Katz JN. Outcomes of safe patient handling and mobilization programs: A meta-analysis. Work. 2017;58(2):173-84.
Vandenplas O, Dressel H, Nowak D, Jamart J, Asthma ERSTFotMoW-r. What is the optimal management option for occupational asthma? Eur. 2012;21(124):97-104.
Superseded by more comprehensive review
de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ. Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. J Physiother. 2018;64(3):159-65.
Mahmud N, Schonstein E, Lehtola MM, Verbeek JH, Fassier JB, Reneman MF, et al. Health examination for preventing occupational injuries and disease in workers. Cochrane Database Syst Rev. 2008(3)
Excluded due to high risk of bias
Ahola K, Toppinen-Tanner S, Seppänen J. Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Res. 2017;4:1-11.
Alias AN, Karuppiah K, Tamrin SBM, Abidin EZ, Shafiei UKM. A systematic review of intervention to reduce musculoskeletal disorders: Hand and arm disorders. J Teknol. 2015;77(27):105-11.
Bell JA, Burnett A. Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review. J Occup Rehabil. 2009;19(1):8-24.
Breslin FC, Kyle N, Bigelow P, Irvin E, Morassaei S, MacEachen E, et al. Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions. J Occup Rehabil. 2010;20(2):163-79.
Bui DP, Balland S, Giblin C, Jung A, Kramer S, Peng A, et al. Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review. Accident Analysis and Prevention. 2018;115:189-201.
Clough BA, March S, Chan RJ, Casey LM, Phillips R, Ireland MJ. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review. Syst. 2017;6(1):144.
Coury HJCG, Moreira RFC, Dias NB. Evaluation of the effectiveness of workplace exercise in controlling neck, shoulder and low back pain: A systematic review. Rev Bras Fisioterapia. 2009;13(6):461-79.
DeGirolamo KM, Courtemanche DJ, Hill WD, Kennedy A, Skarsgard ED. Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence? Can J Surg. 2013;56(4):263-9.
Page 42 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Demoulin C, Marty M, Genevay S, Vanderthommen M, Mahieu G, Henrotin Y. Effectiveness of preventive back educational interventions for low back pain: A critical review of randomized controlled clinical trials. Eur Spine J. 2012;21(12):2520-30.
Dick FD, Graveling RA, Munro W, Walker-Bone K, Guideline Development G. Workplace management of upper limb disorders: a systematic review. Occupational medicine (Oxford, England). 2011;61(1):19-25.
Graveling R, Crawford J, Cowie H, Amati C, Vohra S. A review of workplace interventions that promote mental wellbeing in the workplace (Provisional abstract). Database of Abstracts of Reviews of Effects [Internet]. 2008 [cited I; (2):[1 p.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12010005953/frame.html.
Hogan DA, Greiner BA, O'Sullivan L. The effect of manual handling training on achieving training transfer, employee's behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review. Ergonomics. 2014;57(1):93-107.
Horsham C, Auster J, Sendall MC, Stoneham M, Youl P, Crane P, et al. Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review. BMC Res Notes. 2014;7:10.
Kennedy CA, Amick BC, 3rd, Dennerlein JT, Brewer S, Catli S, Williams R, et al. Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time. J Occup Rehabil. 2010;20(2):127-62.
Krungkraipetch N, Krungkraipetch K, Kaewboonchoo O, Arphorn S, Sim M. Interventions to prevent musculoskeletal disorders among informal sector workers: a literature review. Southeast Asian J Trop Med Public Health. 2012;43(2):510-25.
Leyshon R, Chalova K, Gerson L, Savtchenko A, Zakrzewski R, Howie A, et al. Ergonomic interventions for office workers with musculoskeletal disorders: a systematic review. Work. 2010;35(3):335-48.
Maricuţoiu LP, Sava FA, Butta O. The effectiveness of controlled interventions on employees' burnout: A meta-analysis. J Occup Organ Psychol. 2016;89(1):1-27.
Mullan B, Smith L, Sainsbury K, Allom V, Paterson H, Lopez A-L. Active behaviour change safety interventions in the construction industry: A systematic review. Safety Science. 2015;79:139-48.
Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010. J Occup Environ Med. 2011;53(11):1310-31.
Ricci F, Chiesi A, Bisio C, Panari C, Pelosi A. Effectiveness of occupational health and safety training: A systematic review with meta-analysis. Journal of Workplace Learning. 2016;28(6).
Shorthouse FM, Roffi V, Tack C. Effectiveness of educational materials to prevent occupational low back pain. Occupational medicine (Oxford, England). 2016.
Skamagki G, King A, Duncan M, Wåhlin C. A systematic review on workplace interventions to manage chronic musculoskeletal conditions. Physiother Res Int. 2018.
Stewart W, Terry L. Reducing burnout in nurses and care workers in secure settings. Nurs Stand. 2014;28(34):37-45.
Tullar JM, Brewer S, Amick BC, 3rd, Irvin E, Mahood Q, Pompeii LA, et al. Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. J Occup Rehabil. 2010;20(2):199-219.
Page 43 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Tuncel S, Genaidy A, Shell R, Salem S, Karwowski W, Darwish M, et al. Research to practice: effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment - critical appraisal and meta-analysis (Provisional abstract). Human Factors and Ergonomics in Manufacturing [Internet]. 2008 [cited I; 18(2):[93-124 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12009103454/frame.html.
Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ, et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med. 2016;73(1):62-70.
van Gils RF, Boot CR, van Gils PF, Bruynzeel D, Coenraads PJ, van Mechelen W, et al. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis. 2011;64(2):63-72.
van Niekerk SM, Louw QA, Hillier S. The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC Musculoskelet Disord. 2012;13:145.
Wardle SL, Greeves JP. Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel. J Sci Med Sport. 2017;20 Suppl 4:S3-S10.
Watt AM, Patkin M, Sinnott MJ, Black RJ, Maddern GJ. Scalpel safety in the operative setting: a systematic review. Surgery. 2010;147(1):98-106.
Yang L, Mullan B. Reducing needle stick injuries in healthcare occupations: an integrative review of the literature. ISRN Nurs. 2011;2011:315432.
Excluded due to unclear risk of bias
Ballout RA, Diab B, Harb AC, Tarabay R, Khamassi S, Akl EA. Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis. BMC Health Serv Res. 2016;16:458.
de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2011(5):CD006308.
Driessen MT, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occupational and Environmental Medicine. 2010;67(4):277.
Montano D, Hoven H, Siegrist J. Effects of organisational-level interventions at work on employees' health: a systematic review. BMC Public Health. 2014;14:135.
Moreira-Silva I, Teixeira PM, Santos R, Abreu S, Moreira C, Mota J. The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Workplace Health Saf. 2016;64(5):210-22.
Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017;65(11):1934-42.
Padula RS, Comper MLC, Sparer EH, Dennerlein JT. Job rotation designed to prevent musculoskeletal disorders and control risk in manufacturing industries: A systematic review. Appl Ergon. 2017;58:386-97.
Page 44 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Shah A, Blackhall K, Ker K, Patel D. Educational interventions for the prevention of eye injuries. Cochrane Database Syst Rev. 2009(4):CD006527.
Tompa E, Kalcevich C, Foley M, McLeod C, Hogg-Johnson S, Cullen K, et al. A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement. Am J Ind Med. 2016;59(11):919-33.
van Holland BJ, Soer R, de Boer MR, Reneman MF, Brouwer S. Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness. Int Arch Occup Environ Health. 2015;88(4):389-402.
Page 45 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 4 – Risk of bias assessment
Table 5 is primarily sorted by overall risk of bias (last column, from low to high) and within the categories alphabetically by first author.
Table5: Risk of bias assessment
Authors, year Title CONCERNS regarding
specification of study eligibility
criteria?
CONCERNS regarding
methods used to identify and/or select studies?
CONCERNS regarding
methods used to collect data and appraise studies
CONCERNS regarding
methods used to synthesize
results
RISK OF BIAS introduced by
methods used to identify and/or select studies?
Aas, R. W.; Tuntland, H.; Holte, K. A.; Roe, C.; Lund, T.; Marklund, S.; Moller, A., 2011
Workplace interventions for neck pain in workers low low low low low
Bauer, A.; Ronsch, H.; Elsner, P.; Dittmar, D.; Bennett, C.; Schuttelaar, M. L. A.; Lukacs, J.; John, S. M.; Williams, H. C., 2018
Interventions for preventing occupational irritant hand dermatitis
low low low low low
Cashman, C. M.; Ruotsalainen, J. H.; Greiner, B. A.; Beirne, P. V.; Verbeek, J. H., 2009
Alcohol and drug screening of occupational drivers for preventing injury
low low low low low
Chen, X.; Coombes, B. K.; Sjogaard, G.; Jun, D.; O'Leary, S.; Johnston, V., 2018
Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis
low low low low low
Crawford, J. O.; Laiou, E.; Spurgeon, A.; McMillan, G., 2008
Musculoskeletal disorders within the telecommunications sector-A systematic review
low low low low low
Freiberg, A.; Euler, U.; Girbig, M.; Nienhaus, A.; Freitag, S.; Seidler, A., 2016
Does the use of small aids during patient handling activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic review
low low low low low
Page 46 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Goodman, G.; Kovach, L.; Fisher, A.; Elsesser, E.; Bobinski, D.; Hansen, J., 2012
Effective interventions for cumulative trauma disorders of the upper extremity in computer users: practice models based on systematic review
low low low low low
Hegewald, J.; Berge, W.; Heinrich, P.; Staudte, R.; Freiberg, A.; Scharfe, J.; Girbig, M.; Nienhaus, A.; Seidler, A., 2018
Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies
low low low low low
Hoe, V. C.; Urquhart, D. M.; Kelsall, H. L.; Sim, M. R., 2012
Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults
low low low low low
Kelly, D.; Shorthouse, F.; Roffi, V.; Tack, C., 2018
Exercise therapy and work-related musculoskeletal disorders in sedentary workers
low high low low low
Lowry, V.; Desjardins-Charbonneau, A.; Roy, J. S.; Dionne, C. E.; Fremont, P.; MacDermid, J. C.; Desmeules, F., 2017
Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis
low low low low low
Lunt, J. A.; Sheffield, D.; Bell, N.; Bennett, V.; Morris, L. A., 2011
Review of preventative behavioural interventions for dermal and respiratory hazards
low low low low low
Luong Thanh, B. Y.; Laopaiboon, M.; Koh, D.; Sakunkoo, P.; Moe, H., 2016
Behavioural interventions to promote workers' use of respiratory protective equipment
low low low low low
Mischke, C.; Verbeek, J. H.; Job, J.; Morata, T. C.; Alvesalo-Kuusi, A.; Neuvonen, K.; Clarke, S.; Pedlow, R. I., 2013
Occupational safety and health enforcement tools for preventing occupational diseases and injuries
low low low low low
Page 47 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Mischke, C.; Verbeek, J. H.; Saarto, A.; Lavoie, M. C.; Pahwa, M.; Ijaz, S., 2014
Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel
low low low low low
Parantainen, A.; Verbeek, J. H.; Lavoie, M. C.; Pahwa, M., 2011
Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff
low low low low low
Rautiainen, R. H.; Lehtola, M. M.; Day, L. M.; Schonstein, E.; Suutarinen, J.; Salminen, S.; Verbeek, J., 2008 Lehtola, M. M.; Rautiainen, R. H.; Day, L. M.; Schonstein, E.; Suutarinen, J.; Salminen, S.; Verbeek, J. H., 2008
Interventions for preventing injuries in the agricultural industry Effectiveness of interventions in preventing injuries in agriculture – a systematic review and meta-analysis
low low low low low
Reddy, V. K.; Lavoie, M. C.; Verbeek, J. H.; Pahwa, M., 2017
Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel
low low low low low
Richardson, A.; McNoe, B.; Derrett, S.; Harcombe, H., 2018
Interventions to prevent and reduce the impact of musculoskeletal injuries among nurses: A systematic review
low low low low low
Stock, S. R.; Nicolakakis, N.; Vezina, N.; Vezina, M.; Gilbert, L.; Turcot, A.; Sultan-Taieb, H.; Sinden, K.; Denis, M. A.; Delga, C.; Beaucage, C., 2018
Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature
low low low low low
Tikka, C.; Verbeek, J. H.; Kateman, E.; Morata, T. C.; Dreschler, W. A.; Ferrite, S., 2017
Interventions to prevent occupational noise-induced hearing loss
low low low low low
Page 48 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
van der Molen, H. F.; Basnet, P.; Hoonakker, P. L.; Lehtola, M. M.; Lappalainen, J.; Frings-Dresen, M. H.; Haslam, R.; Verbeek, J. H., 2018
Interventions to prevent injuries in construction workers
low low low low low
van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR, 2015
Workplace interventions to prevent work disability in workers on sick leave
low low low low low
Verbeek, J. H.; Martimo, K. P.; Karppinen, J.; Kuijer, P. P.; Viikari-Juntura, E.; Takala, E. P., 2011 Verbeek, J. H.; Martimo, K. P.; Kuijer, P. P.; Karppinen, J.; Viikari-Juntura, E.; Takala, E. P., 2012 Verbeek, J.; Martimo, K. P.; Karppinen, J.; Kuijer, P. P.; Takala, E. P.; Viikari-Juntura, E., 2012
Manual material handling advice and assistive devices for preventing and treating back pain in workers Proper manual handling techniques to prevent low back pain, a Cochrane systematic review Manual material handling advice and assistive devices for preventing and treating back pain in workers: a Cochrane Systematic Review
low low low low low
Verbeek, Jos H; Ijaz, Sharea; Mischke, Christina; Ruotsalainen, Jani H; Mäkelä, Erja; Neuvonen, Kaisa; Edmond, Michael B; Sauni, Riitta; Kilinc, Balci F Selcen; Mihalache, Raluca C, 2016
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff
low low low low low
Page 49 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Ballout, R. A.; Diab, B.; Harb, A. C.; Tarabay, R.; Khamassi, S.; Akl, E. A., 2016
Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis
low low low unclear unclear
de Groene, G. J.; Pal, T. M.; Beach, J.; Tarlo, S. M.; Spreeuwers, D.; Frings-Dresen, M. H.; Mattioli, S.; Verbeek, J. H., 2011
Workplace interventions for treatment of occupational asthma
low low unclear low unclear
Driessen, Maurice T.; Proper, Karin I.; van Tulder, Maurits W.; Anema, Johannes R.; Bongers, Paulien M.; van der Beek, Allard J., 2010
The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review
unclear unclear low unclear unclear
Montano, D.; Hoven, H.; Siegrist, J., 2014
Effects of organisational-level interventions at work on employees' health: a systematic review
unclear unclear unclear unclear unclear
Moreira-Silva, I.; Teixeira, P. M.; Santos, R.; Abreu, S.; Moreira, C.; Mota, J., 2016
The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis
low low unclear low unclear
Offeddu, V.; Yung, C. F.; Low, M. S. F.; Tam, C. C., 2017
Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis
low unclear unclear low unclear
Padula, R. S.; Comper, M. L. C.; Sparer, E. H.; Dennerlein, J. T., 2017
Job rotation designed to prevent musculoskeletal disorders and control risk in manufacturing industries: A systematic review
low unclear unclear low unclear
Shah, A.; Blackhall, K.; Ker, K.; Patel, D., 2009
Educational interventions for the prevention of eye injuries
low unclear low low unclear
Page 50 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Tompa, E.; Kalcevich, C.; Foley, M.; McLeod, C.; Hogg-Johnson, S.; Cullen, K.; MacEachen, E.; Mahood, Q.; Irvin, E., 2016
A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement
low unclear low low unclear
van Holland, B. J.; Soer, R.; de Boer, M. R.; Reneman, M. F.; Brouwer, S., 2015
Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness
low unclear low low unclear
Ahola, K.; Toppinen-Tanner, S.; Seppänen J., 2017
Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis
low high high high high
Alias, A. N.; Karuppiah, K.; Tamrin, S. B. M.; Abidin, E. Z.; Shafiei, U. K. M., 2015
A systematic review of intervention to reduce musculoskeletal disorders: Hand and arm disorders
unclear high high high high
Bell, J. A.; Burnett, A., 2009 Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review
low high unclear low high
Breslin, F. C.; Kyle, N.; Bigelow, P.; Irvin, E.; Morassaei, S.; MacEachen, E.; Mahood, Q.; Couban, R.; Shannon, H.; Amick, B. C., 3rd; Small Business Systematic Review, Team, 2010
Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions
low high low high high
Bui, D. P.; Balland, S.; Giblin, C.; Jung, A.; Kramer, S.; Peng, A.; Aquino, M. C. P.; Griffin, S.; French, D. D.; Pollack Porter, K.; Crothers, S.; Burgess, J. L., 2018
Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review
high high high high high
Page 51 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Clough, B. A.; March, S.; Chan, R. J.; Casey, L. M.; Phillips, R.; Ireland, M. J., 2017
Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review
low high unclear low high
Coury, H. J. C. G.; Moreira, R. F. C.; Dias, N. B., 2009
Evaluation of the effectiveness of workplace exercise in controlling neck, shoulder and low back pain: A systematic review
low low high low high
DeGirolamo, K. M.; Courtemanche, D. J.; Hill, W. D.; Kennedy, A.; Skarsgard, E. D., 2013
Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence?
unclear high high high high
Demoulin, C.; Marty, M.; Genevay, S.; Vanderthommen, M.; Mahieu, G.; Henrotin, Y., 2012
Effectiveness of preventive back educational interventions for low back pain: A critical review of randomized controlled clinical trials
low high high low high
Dick, F. D.; Graveling, R. A.; Munro, W.; Walker-Bone, K.; Guideline Development, Group, 2011
Workplace management of upper limb disorders: a systematic review
low high low low high
Graveling, Ra; Crawford, Jo; Cowie, H; Amati, C; Vohra, S, 2008
A review of workplace interventions that promote mental wellbeing in the workplace (Provisional abstract)
low high high low high
Hogan, D. A.; Greiner, B. A.; O'Sullivan, L., 2014
The effect of manual handling training on achieving training transfer, employee's behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review
high high high unclear high
Horsham, C.; Auster, J.; Sendall, M. C.; Stoneham, M.; Youl, P.; Crane, P.; Tenkate, T.; Janda, M.; Kimlin, M., 2014
Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review
low low high high high
Page 52 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Kennedy, C. A.; Amick, B. C., 3rd; Dennerlein, J. T.; Brewer, S.; Catli, S.; Williams, R.; Serra, C.; Gerr, F.; Irvin, E.; Mahood, Q.; Franzblau, A.; Van Eerd, D.; Evanoff, B.; Rempel, D., 2010
Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time
low high low unclear high
Krungkraipetch, N.; Krungkraipetch, K.; Kaewboonchoo, O.; Arphorn, S.; Sim, M., 2012
Interventions to prevent musculoskeletal disorders among informal sector workers: a literature review
low unclear low high high
Leyshon, R.; Chalova, K.; Gerson, L.; Savtchenko, A.; Zakrzewski, R.; Howie, A.; Shaw, L., 2010
Ergonomic interventions for office workers with musculoskeletal disorders: a systematic review
unclear high high high high
Maricuţoiu, L. P.; Sava, F. A.; Butta, O., 2016
The effectiveness of controlled interventions on employees' burnout: A meta-analysis
low high high low high
Mullan, B.; Smith, L.; Sainsbury, K.; Allom, V.; Paterson, H.; Lopez, AL, 2015
Active behaviour change safety interventions in the construction industry: A systematic review
unclear high high unclear high
Pelletier, K. R., 2011 A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010
high high high high high
Ricci, F.; Chiesi, A.; Bisio, C.; Panari, C.; Pelosi, A., 2016
Effectiveness of occupational health and safety training: A systematic review with meta-analysis
unclear high unclear unclear high
Shorthouse, F. M.; Roffi, V.; Tack, C., 2016
Effectiveness of educational materials to prevent occupational low back pain
low high low low high
Page 53 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Skamagki, G.; King, A.; Duncan, M.; Wåhlin, C., 2018
A systematic review on workplace interventions to manage chronic musculoskeletal conditions
low low high low high
Stewart, W.; Terry, L., 2014 Reducing burnout in nurses and care workers in secure settings
low high high low high
Tullar, J. M.; Brewer, S.; Amick, B. C., 3rd; Irvin, E.; Mahood, Q.; Pompeii, L. A.; Wang, A.; Van Eerd, D.; Gimeno, D.; Evanoff, B., 2010
Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector
low high low low high
Tuncel, S; Genaidy, A; Shell, R; Salem, S; Karwowski, W; Darwish, M; Noe, F; Singh, D, 2008
Research to practice: effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment - critical appraisal and meta-analysis (Provisional abstract)
low unclear unclear unclear high
Van Eerd, D.; Munhall, C.; Irvin, E.; Rempel, D.; Brewer, S.; van der Beek, A. J.; Dennerlein, J. T.; Tullar, J.; Skivington, K.; Pinion, C.; Amick, B., 2016
Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence
low high low unclear high
van Gils, R. F.; Boot, C. R.; van Gils, P. F.; Bruynzeel, D.; Coenraads, P. J.; van Mechelen, W.; Riphagen, II; Anema, J. R., 2011
Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature
low high low low high
van Niekerk, S. M.; Louw, Q. A.; Hillier, S., 2012
The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review
low high unclear low high
Wardle, S. L.; Greeves, J. P., 2017
Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel
high high high high high
Page 54 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Watt, A. M.; Patkin, M.; Sinnott, M. J.; Black, R. J.; Maddern, G. J., 2010
Scalpel safety in the operative setting: a systematic review
high unclear high high high
Yang, L.; Mullan, B., 2011 Reducing needle stick injuries in healthcare occupations: an integrative review of the literature
unclear high high high high
Page 55 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 5 – Characteristics of included studies
Table 4: Characteristics of included studies
Author, year Risk of bias
Interventions Outcomes
Prevention of musculoskeletal disorders
Multi-component interventions for musculoskeletal disorders
Aas et al. 2011 [22] Low Single-component and multi-component workplace interventions (includes, e.g. mental health education, physical education, workplace adjustments, relaxation breaks)
Pain severity, pain prevalence, sickness absence
Chen et al. 2018 [23] Low Exercise interventions, ergonomic interventions, breaks, cognitive behaviour therapy, education, myofeedback
Neck pain intensity
Goodman et al. 2012 [24]
Low Forearm supports, ergonomic keyboards, ergonomic mice, ergonomic training, workout or rest breaks
Symptoms of cumulative trauma disorders of the upper extremity
Lowry et al. 2017 [25]
Low Workplace exercise programmes, ergonomic interventions
Intensity of shoulder pain
Richardson et al. 2018 [26]
Low Patient lift systems, patient handling training, cognitive behavioural interventions, unstable shoes
Musculoskeletal pain, injuries, sickness absence
Exercises at the workplace
Kelly et al. 2018 [27] Low Exercise therapy Pain and functionality in work-related diseases of the upper extremities
Work organisational interventions (work organisation, work environment, job rotation) for musculoskeletal disorders
Stock et al. 2018 [28] Low Supplementary pauses, participatory ergonomic interventions, participatory organisational intervention, interventions to reduce patient lifting (safe lifting programmes and equipment), feedback about computer workstation setup and psychosocial aspects of work
Musculoskeletal symptom intensity, prevalence of various musculoskeletal pains
Educational interventions for musculoskeletal disorders
Crawford et al. 2008 [29]
Low Training in workstation adjustment and posture, Muscle Learning Therapy
Musculoskeletal symptoms
Ergonomic interventions
Hoe et al. 2012 [30] Low Ergonomically designed equipment, such as a specially designed computer mouse or arm support; ergonomically designed work environment (including workplace and work design); ergonomic training; ergonomic training combined with ergonomic equipment
Frequency of neck/shoulder diseases or complaints, musculoskeletal disorders, diseases or complaints of the right upper extremity, wrist complaints
Manual handling of loads
Freiberg et al. 2016 [31]
Low Provision of small aids and intensive education on how to handle patients
Prevalence of low back pain, upper arm pain, shoulder pain
Hegewald et al. 2018 [32]
Low Technical patient handling equipment, also in combination with education/training
Musculoskeletal injuries, back pain, repeated musculoskeletal injuries, cervical spine injuries, shoulder pain
Verbeek et al. 2011 [33]
Low Training, professional education, video, use of a back belt, exercise, training plus lifting aids
Incidence, intensity of back pain
Page 56 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Author, year Risk of bias
Interventions Outcomes
Prevention of occupational injuries
Prevention of occupational injuries in the agricultural sector and the construction industry
Rautiainen et al. 2008 [34]
Low Educational interventions, insurance premium discount programme, legislation banning Endosulfan pesticides, legislation on rollover protection structures or safety cabs for tractors
Injuries, poisoning
van der Molen et al. 2018 [35]
Low Training programmes, health and safety laws (e.g. vertical fall arrest standard, trench and excavation standard) and inspections, subsidy for scaffolds, safety campaign, drug-free workplace programme
Fatal and non-fatal injuries
Alcohol and drug screening of professional drivers
Cashman et al. 2009 [36]
Low Mandatory random and for-cause alcohol tests, mandatory random drug tests
Injuries levels (immediate and long-term)
Safety products and practices in the health sector
Mischke et al. 2014 [37]
Low Increase in the number of glove layers, use of thick gloves or gloves manufactured with special protective materials, use of glove puncture indication systems to warn staff about glove perforations
Glove perforations, frequency of blood contamination
Parantainen et al. 2011 [38]
Low Use of blunt suture needles compared to sharp needles
Glove perforations, number of self-reported needle stick injuries
Reddy et al. 2017 [39]
Low Safety-engineered devices for blood collection, safe intravenous systems, safety-engineered devices for injection fluids, use of multiple safety devices, containers for collecting sharps, introduction of legislation
Needle stick injuries, blood splashes
Verbeek et al. 2016 [40]
Low Comparison of types of personal protective equipment (PPE); procedures for the donning and doffing of PPE; training to improve PPE compliance
Contamination of skin or clothing, compliance
Prevention of skin and lung diseases
Lunt et al. 2011 [41] Low Training for behavioural change Exposure to occupational health hazards
Luong Thanh et al. 2016 [42]
Low Behavioural interventions (education and training to improve the use of respiratory protective equipment)
Frequency and correctness of respiratory protective equipment use
Bauer et al. 2018 [43]
Low Barrier creams, moisturisers, barrier creams plus moisturisers, skin protection education
Signs of occupational irritant hand dermatitis
Prevention of occupational hearing loss
Tikka et al. 2017 [44]
Low Hearing loss prevention programmes, exposure information, earmuff, earplugs, instructions for wearing hearing protection, legislation on hearing protection, combinations of the abovementioned interventions
Hearing loss, noise exposure/noise level reduction, noise attenuation
General occupational health and safety interventions
Mischke et al. 2013 [45]
Low Inspections of health and safety regulations with or without penalty
Fatal and non-fatal injuries, physical workload
van Vilsteren et al. 2015 [46]
Low Workplace interventions to prevent work disability in workers on sick leave: changes to the workplace and equipment, changes of work design and organisations, changes to working conditions, changes to work environment, case management with the worker and employer (supervisor)
Time until first return-to-work, time until lasting return-to-work, cumulative duration of sickness absence, risk of recurrences of sick leave, functional status (Roland disability questionnaire), depression, pain
Page 57 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 6 – Overview of results
Table 6: Overview of behavioural interventions to prevent diseases of the musculoskeletal system
Intervention Comparison Number of studies; study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Combined stretching and endurance training for the neck
No intervention 1 RCT Office workers Individual study
Neck pain High Chen et al. 2018 [23]
Manual material handling advice
No intervention 7 RCTs Varying professions MA Back pain Moderate Verbeek et al. 2011 [33]
Exercise therapy No intervention 9 RCTs, 2 SR
Computer users, office workers, computer screen workers
Narrative
A: Pain in work-related upper limb disorders B: Functional outcomes in work-related upper limb disorders
A: B:
Moderate Kelly et al. 2018 [27]
Group education No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]
Whole-body light resistance exercise
No intervention 1 RCT Office workers Individual study
Neck pain Moderate Chen et al. 2018 [23]
Myofeedback No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]
Neck/shoulder strengthening exercise
1: No intervention 2: Physiotherapy
10 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain 1A: 1B: 2B:
Moderate Chen et al. 2018 [23]
Qi Gong No intervention 1 RCT Office workers Individual study
Neck pain Moderate Chen et al. 2018 [23]
Extensive manual material handling training
One-time video training
3 cohort studies
Varying professions MA Back pain Moderate Verbeek et al. 2011 [33]
General fitness exercise No intervention 4 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain A: B:
Low to Moderate
Chen et al. 2018 [23]
Page 58 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number of studies; study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Muscle Learning Therapy
n. a. 1 RCT
Call center workers, telemarketers, engineers, assembly workers
Narrative Muskel-Skelett-Symptome
Limited1 to Moderate
Crawford et al. 2008 [29]
Training in workstation adjustment and posture
n. a. 2 RCTs
Call center workers, telemarketers, engineers, assembly workers
Individual studies
Musculoskeletal disorders
Limited1 to Moderate
Crawford et al. 2008 [29]
Physical education No intervention 2 RCTs Office workers Individual study
Pain severity Low Aas et al. 2011 [22]
Manual material handling advice and devices
Advice only or no intervention
1 RCT Varying professions Individual study
Back pain Low Verbeek et al. 2011 [33]
Manual material handling advice
Back belt use 2 cohort studies
Varying professions MA Back pain Low Verbeek et al. 2011 [33]
Education for mental health
No intervention 1 RCT Office workers MA Pain prevalence Low Aas et al. 2011 [22]
Cognitive behavioural therapy
No intervention 1 RCT Office workers Individual study
Neck pain Low Chen et al. 2018 [23]
Workplace exercise programmes
Counselling or no intervention
5 RCTs Varying professions (symptomatic and asymptomatic)
MA Shoulder pain intensity Low Lowry et al. 2017 [25]
Workplace exercise programmes
Workplace modifications
1 RCT Varying professions Individual study
Shoulder pain intensity Low Lowry et al. 2017 [25]
Safe and no strenuous lifting
Usual practice 1 RCT Office workers Individual study
Shoulder symptoms Low Hoe et al. 2012 [30]
Manual material handling advice
Professional education
1 cohort study
Varying professions MA Back pain Very low Verbeek et al. 2011 [33]
Page 59 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number of studies; study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Ergonomic training No intervention 2 RCTs Office workers MA
Neck/shoulder and wrist/hand symptoms, upper extremity symptoms
Very low Hoe et al. 2012 [30]
Neck/shoulder stretching exercise
No intervention 1 RCT Office workers Individual study
Neck pain Very low Chen et al. 2018 [23]
Cognitive behavioural interventions
n. a. 1 RCT Nurses Individual study
Pain n. a. Richardson et al. 2018 [26]
Patient handling training
n. a.
2 cohort studies with control group
Nurses Individual studies
A: Back pain B: Physical discomfort
A: B:
n. a. Richardson et al. 2018 [26]
Abbreviations: MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials; SR = systematic review
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Defined as: limited or contradictory evidence, produced by one scientific study or inconsistent findings in multiple scientific studies.
Page 60 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 7: Overview of relational interventions to prevent diseases of the musculoskeletal system
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Ergonomic mouse Conventional mouse
2 RCTs, 1 prospective parallel group design
Office workers Individual studies
Upper extremity discomfort
High Goodman et al. 2012 [24]
Ergonomic keyboards n. a. 1 quasi-expe-rimental design, 1 RCT
Office workers Individual studies
A: Phalen-test results B: Decrease of symptoms C: Endonitis and carpal tunnel syndrome D: Pain intensity
A: B: C: D:
High Goodman et al. 2012 [24]
Forearm supports n. a.
1 RCT, 1 prospective parallel group design
Office workers Individual studies
A: Neck/shoulder pain B: Short term hand/arm pain C: Long term hand/arm pain D: Risk rates for disorders in the left upper extremities
A: B: C: D:
High Goodman et al. 2012 [24]
Alternative mouse Conventional mouse
2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders
Moderate Hoe et al. 2012 [30]
Alternative mouse Conventional mouse
2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]
Alternative mouse with arm support
Conventional mouse with arm support
2 RCTs Office workers MA
A: Incidence of neck/shoulder and right upper limb disorders B: Neck/shoulder discomfort C: Right upper limb discomfort
A: B: C:
A: Moderate B: Low C: Low
Hoe et al. 2012 [30]
Page 61 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Conventional mouse with arm support
Conventional mouse without arm support
2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders
Moderate Hoe et al. 2012 [30]
Alternative mouse with arm support
Conventional mouse without arm support
2 RCTs Office workers MA
A: Neck/shoulder disorders B: Incidence of right upper limb disorders C: Upper body disorders (neck, shoulder, and upper extremity) D: Incidence of neck/shoulder and right upper limb disorders
A: B: C:
A: Moderate B: Moderate C: Moderate
Hoe et al. 2012 [30]
Interventions targeting the work-rest cycle through supplementary pauses
Conventional pause schedule
4 RCTs Varying professions
Narrativee
A: Intensity of musculoskeletal symptoms in general B: Musculoskeletal symptom intensity separately for the neck, back, shoulder/upper arm and forearm/wrist/hand
A: B:
Moderate Stock et al. 2018 [28]
A: Technical aids to prevent strenuous lifting B: Small aids
No intervention 1 RCT Healthcare personnel
Individual study
1-week shoulder pain ratings
Low Hegewald et a. 2018 [32]
Workplace modifications
Advice, brochure or no intervention
5 RCTs
Varying professions (symptomatic and asymptomatic)
MA Shoulder pain intensity Low Lowry et al. 2017 [25]
Arm support Conventional mouse
3 RCTs Office workers Narrativee Neck pain Low Chen et al. 2018 [23]
Page 62 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Alternative mouse with arm support
Conventional mouse without arm support
2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders
Low Hoe et al. 2012 [30]
Feedback about computer workstation set-up & psychosocial aspects of work
Work as usual 1 RCT Computer workers
Narrativee one-month prevalence of any musculoskeletal pain
Low Stock et al. 2018 [28]
Lower monitor angle High monitor angle 1 RCT Office workers Individual study
Neck pain Low Chen et al. 2018 [23]
Interventions to reduce patient lifting in a hospital setting through safe lifting programs and equipment
Usual practice 1 RCT Healthcare workers
Narrativee
A: Frequency of work-related shoulder pain and of work-related low back pain B: Compensated musculoskeletal work injury rates and time loss injury rates
A: B:
Low Stock et al. 2018 [28]
Supplementary breaks or reduced work hours
Conventional breaks and normal work hours
2 RCTs Office workers MA Upper-extremity symptoms or pain, discomfort, work ability
Low Hoe et al. 2012 [30]
Ergonomic adjustments (eg, keyboard, monitor, mouse)
No intervention 4 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain A: B:
Low to very low
Chen et al. 2018 [23]
Technical patient handling equipment
No intervention 2 CBAs Healthcare personnel
MA Back pain at 1-year follow-up
Very low Hegewald et al. 2018 [32]
Supplementary work breaks
Conventional work breaks
3 RCTs
A: Office workers in general B: Office workers symptomatic
MA Neck pain A: B:
Very low Chen et al. 2018 [23]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 63 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 8: Overview of mixed interventions/programmes to prevent diseases of the musculoskeletal system
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Education/ergonomics training, workplace modification
No intervention 1 quasi-experimental design
Office workers Individual study
Work-related musculoskeletal disorders
High Goodman et al. 2012 [24]
Workplace interventions with several components (including exercise, workplace modifications, breaks)
No intervention 5 RCTs Computer users Individual studies1
Pain prevalence or pain severity, sick leave
Low to Moderate
Aas et al. 2011 [22]
Participatory ergonomic interventions based on training groups of workers to analyze work, identify problems and propose solutions
Work as usual 4 RCTs, 1 non-RCT
Varying professions
Narrative
A: Three-month prevalence of neck pain and low-back pain B: Back pain intensity C: Number of days with any musculoskeletal pain D: Three-month prevalence of musculoskeletal sick leave
A: B: C: D:
A: Very low B: Low C: Low D: Low
Stock et al. 2018 [28]
Provision of and education in patient handling with small aids
No intervention or usual practice
1 non-RCT Nurses, nursing aids, teachers
Individual study
A: 1-month prevalence of low back pain B: 1-month prevalence of upper arm pain C: 1-year follow-up: 7-day prevalence of low back pain and shoulder pain
A: B: C:
Very low to low
Freiberg et al. 2016 [31]
Small aids Mechanical aids 1 RCT Nurses, nursing aids, teachers
Individual study
1-year follow-up: 7-day prevalence of low back pain and shoulder pain
Very low to low
Freiberg et al. 2016 [31]
Page 64 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Ergonomic training and equipment
No intervention 1 RCT Office workers Individual study
Frequency and intensity of neck, shoulder, or wrist/hand ache or pain
Very low Hoe et al. 2012 [30]
Provision of and education in patient handling with small aids
One‑time
ergonomic education
1 non-RCT Nurses, nursing aids, teachers
Individual study
12-month prevalence of low back pain
Very low Freiberg et al. 2016 [31]
Technical patient handling equipment (i.e., nursing beds, low nursing home beds, bed movers, mobile lifts, wall lifts, overhead lifts, ceiling lifts, day care chairs, or mechanical position change aids); as a solitary measure or as part of a multimodal intervention
No intervention A) 4 CBAs B) 1 CBA C) 2 CBAs
Gesundheits-personal
A: MA B: Individual study C: Individual studies
A: Musculoskeletal injury claims B: Repeated musculoskeletal injuries (follow-up: 2 years) C: Cervical spine (neck) injuries
A: B: C:
Very low Hegewald et al. 2018 [32]
Multi-component interventions (e.g. training, guidelines for patient transfer, physical exercise, ergonomic interventions)
n. a.
2 cohort studies with control group, 1 RCT
Healthcare personnel
Individual study
A: Pain B: Sickness absence C: Accidents
A: B: C:
n. a. Richardson et al. 2018 [26]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Results of all five RCTs were described separately; one RCT had positive effects, all others showed no significant effects. Pooled results of two studies also show no effect.
Page 65 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 9: Overview of behavioural interventions for the prevention of occupational injuries
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Active training (face-to-face instruction)
Passive training (folders or videos)
1 retrospective cohort study
Health or hospital staff
Individual study
Noncompliance with PPE use
Very low Verbeek et al. 2016 [40]
Active training (face-to-face instruction)
Passive training (folders or videos)
1 retrospective cohort study
Health or hospital staff
Individual study
Noncompliance with doffing guidance
Very low Verbeek et al. 2016 [40]
Drug-free workplace programme
No intervention 1 ITS Construction workers
Individual study
A: non-fatal injuries in the year following implementation B: non-fatal injuries in the years thereafter
A: B:
Very low van der Molen et al. 2018 [35]
Safety campaign No intervention 1 ITS Construction workers
Individual study
A: initial decrease in injuries at the company level B: sustained decrease in injuries at the company level C: initial decrease in injuries at the regional level D: sustained decrease in injuries at the regional level
A: B: C: D:
Very low van der Molen et al. 2018 [35]
Safety training interventions
No intervention 1 ITS, 1 CBA Construction workers
Individual studies
A: non-fatal injuries, immediate effect B: non-fatal injuries, trend
A: B:
Very low van der Molen et al. 2018 [35]
Educational interventions
No intervention 3 RCTs Agricultural workers
MA Injuries n. a. Rautiainen et al. 2008 [34]
Insurance premium discount program
No intervention 1 ITS Agricultural workers
Individual study
A: Injuries, immediate effect B: Injuries, progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 66 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Page 67 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 10: Overview of relational interventions for the prevention of occupational injuries
Page 68 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Blunt suture needles Sharp suture needles
10 RCTs Surgical staff MA Glove perforations per surgeon per operation
High Parantainen et al. 2011 [38]
Double gloves Single gloves 8 RCTs Healthcare personnel
MA Dexterity: outer glove perforations – number of perforations
Moderate Mischke et al. 2014 [37]
Double gloves Single gloves 12 RCTs Healthcare personnel
MA A: Inner glove perforations B: Blood stains on the skin
A: B:
A: Moderate B: Moderate
Mischke et al. 2014 [37]
Double indicator gloves Double standard gloves
2 RCTs Healthcare personnel
MA Inner glove perforations Moderate Mischke et al. 2014 [37]
Triple special gloves Double standard gloves
2 RCTs Healthcare personnel
MA Inner glove perforations Moderate Mischke et al.
2014 [37]
Blunt suture needles Sharp suture needles
4 RCTs Surgical staff MA Self-reported needle stick injuries
Moderate Parantainen et al. 2011 [38]
Legislation - Interruption
No legislation 2 ITS Healthcare personnel
MA
Percutaneous exposure injuries caused by needles: A: Change in level B: Change in slope
A: B:
A: Moderate B: Very low
Reddy et al. 2017 [39]
Legislation - Gradual introduction
No legislation 1 ITS Healthcare personnel
Individual study
Percutaneous exposure injuries caused by needles: A: Change in level B: Change in slope
A: B:
A: Low B: Low
Reddy et al. 2017 [39]
Thicker gloves Thinner gloves 2 RCTs Healthcare personnel
MA Inner glove perforations Low Mischke et al. 2014 [37]
One fabric glove over one normal glove
Two normal gloves 3 RCTs Healthcare personnel
MA Inner glove perforations Low Mischke et al. 2014 [37]
Double indicator gloves Standard gloves (single or double)
2 RCTs Healthcare personnel
MA Inner glove perforations Low Mischke et al. 2014 [37]
Triple gloves Double gloves 1 RCT Healthcare personnel
Individual study
Inner glove perforations Low Mischke et al. 2014 [37]
Safe passive injection systems
Safe active injection systems
1 ITS Healthcare personnel
Individual study
Needlestick injuries Low Reddy et al.
2017 [39]
Safe active intravenous systems
Regular systems 4 RCTs Healthcare personnel
MA Incidences of blood contamination
Low Reddy et al. 2017 [39]
Page 69 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Safe active intravenous systems
Regular systems 1 RCT Healthcare personnel
Individual study
Incidence of blood leakage Low Reddy et al.
2017 [39]
Safe passive intravenous systems
Regular systems 2 RCTs Healthcare personnel
MA Incidences of blood contamination
Low Reddy et al. 2017 [39]
Double gloving method Single gloving method
1 cross-over simulation study
Healthcare personnel
Individual study
A: Contamination B: Noncompliance with guidance
A: B:
A: Very low B. Very low
Verbeek et al. 2016 [40]
Centers for Disease Control and Prevention recommended doffing
Individual doffing 1 RCT Healthcare personnel
Individual study
Contamination
Very low Verbeek et al. 2016 [40]
European and national safety and health regulations and standards for construction sites
Not applicable 5 ITS Construction workers
MA
A: Fatal injuries, change in level B: Fatal injuries, change in slope C: Non-fatal injuries, change in level D: Non-fatal injuries, change in slope
A: B: C: D:
Very low van der Molen et al. 2018 [35]
Gowns Aprons
1 Randomised cross-over simulation study
Healthcare personnel
Individual study
Contamination
Very low Verbeek et al. 2016 [40]
Multiple safe devices Not applicable 2 ITS Healthcare personnel
MA Percutaneous exposure injuries caused by needles
Very low Reddy et al. 2017 [39]
Multiple safe devices Regular devices 1 CBA Healthcare personnel
Individual study
Percutaneous exposure injuries caused by needles
Very low Reddy et al. 2017 [39]
PPE with Powered Air Purifying Respirator Attire
Enhanced respiratory and contact precautions attire
1 RCT Healthcare personnel
Individual study
A: Any contamination B: Noncompliance with donning guidance C: Noncompliance with doffing guidance
A: B: C:
A: Very low B: Very low C: Very low
Verbeek et al. 2016 [40]
Safe blood collection systems
Regular systems 1 RCT Healthcare personnel
Individual study
A: Needlestick injuries im-mediate follow up B: Blood splashes
A: B:
A: Very low B: Very low
Reddy et al. 2017 [39]
Page 70 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Safe blood collection systems
Not applicable 2 ITS Healthcare personnel
Individual studies
Number of reported sharps injuries: A: Change in level B: Change in slope
A: B:
A, B: Very low
Reddy et al. 2017 [39]
Safe injection systems Regular systems 1 RCT, 1 CBA Healthcare personnel
Individual studies
Needlestick injuries Very low Reddy et al.
2017 [39]
Safe intravenous systems
Regular systems 1 RCT, 1 CBA Healthcare personnel
Individual studies
Needlestick injuries Very low Reddy et al.
2017 [39]
Safe intravenous systems
Regular systems 2 ITS Healthcare personnel
Individual studies
Number of reported sharps injuries: A: Change in level B: Change in slope
A: B:
A, B: Very low
Reddy et al. 2017 [39]
Sharps containers Not applicable 2 ITS Healthcare
personnel Individual studies
Number of reported sharps injuries
Very low Reddy et al. 2017 [39]
Sharps containers No containers 1 CBA Healthcare
personnel Individual study
Number of reported sharps injuries
Very low Reddy et al. 2017 [39]
Safety inspections and sanctions for violations
No intervention 1 ITS Construction workers
Individual study
A: Non-fatal injuries, change in level B: Non-fatal injuries, change in slope
A: B:
Very low van der Molen et al. 2018 [35]
Subsidy for scaffolding No intervention 1 CBA Construction
workers Individual study
Injuries A: Very low van der Molen et al. 2018 [35]
Mandatory random and for-cause alcohol testing programme
Not applicable 2 ITS Occupational drivers
Narrative A: Level of injuries, immediate effect B: Level of injuries, long-term trend
A: B:
Limited1 Cashman et al. 2009 [36]
Mandatory random drug testing programme
Not applicable 2 ITS Occupational drivers
Narrative A: Level of injuries, immediate effect B: Level of injuries, long-term trend
A: B:
Limited1 Cashman et al. 2009 [36]
PPE made of more breathable material
Regular PPE 1 exposure simulation studiy
Healthcare personnel
Individual study
A: Contamination
A:
A: Very low
Verbeek et al. 2016 [40]
Double gloves Single gloves 2 RCTs Healthcare personnel
MA Needlestick injuries n. a. Mischke et al. 2014 [37]
Page 71 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Legislation on rollover protective structures or Safety Cabins on new tractors
Not applicable 1 ITS Agricultural workers
MA Fatal injuries: A: immediate effect B: progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Legislation on rollover protective structures or Safety Cabins on all tractors
Not applicable 1 ITS Agricultural workers
MA Fatal injuries: A: immediate effect B: progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Legislation banning Endosulfan pesticide
Not applicable 1 ITS Agricultural workers
Individual study
Injuries: A: immediate effect B: progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Defined as: Limited evidence - one low quality RCT or one CBA study or one ITS
Table 11: Overview of mixed interventions/programmes for the prevention of occupational injuries
Intervention Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome Result Quality of evidence
Author and year
Occupational health and safety services
n. a. 1 CBA Construction workers
Individual study
Injuries n. a. van der Molen et al. 2018 [35]
Abbreviations: CBA = controlled before-after studies; n. a. = not available
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 72 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 12: Overview of behavioural interventions to prevent skin and lung diseases
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Educational intervention No intervention 1 RCT, 4 CBA Farm and construction workers
Partially narrative, partially MA
Self-reported respiratory protective equipment use
Very low Luong Thanh et al. 2016 [42]
Skin protection education No intervention 3 Cluster-RCTs Varying professions MA Signs of occupational irritant hand dermatitis
Very low Bauer et al. 2018 [43]
Conventional training with additions (biosimulated vision training, program active or passive teaching, computer-simulated training)
Conventional training (lectures, books)
1 Cluster-RCT 2 RCTs
Health workers, adults (not specified)
Narrative Correct use of respiratory protective equipment
Very low Luong Thanh et al. 2016 [42]
Trainings based on motivating interviews
Conventional lectures
1 CBA Production line workers
Narrative Use of respiratory protective equipment
Very low Luong Thanh et al. 2016 [42]
Training for the correct use of respiratory masks or personal protective equipment
No training 1 CBA Hospital workers Narrative Proportion of correctly used respirators
Very low Luong Thanh et al. 2016 [42]
Training for behavioural change: interventions intended to affect worker’s behavioural compliance (by affecting actions that workers take to comply with health and safety precautions)
n. a. 5 RCTs, 3 CBA, 1 multiple baseline study
Varying professions Narrative Exposure to occupational health hazards
n. a. Lunt et al. 2011 [41]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 73 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 13: Overview of relational interventions to prevent skin and lung diseases
Intervention Comparison Number and study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Barrier creams No intervention 4 RCTs, 1 Cluster-RCT
Varying professions MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 [43]
Barrier cream plus moisturizers
No intervention 3 RCTs, 1 Cluster-RCT
Varying professions MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 [43]
Moisturizers No intervention 3 RCTs, 1 Cluster-RCT
Varying professions MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 [43]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 14: Overview of behavioural interventions to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Earplugs with instruction
Earplugs without instruction
2 RCTs Varying professions MA Attenuation of noise
Moderate Tikka et al. 2017 [44]
Abbreviations: MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 15: Overview of relational interventions to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Exposure information Training as usual 1 RCT Construction workers
Individual study Mean noise level
Low Tikka et al. 2017 [44]
Use of hearing protection 1
n. a. 1 RCT, 3 CBA
n. a. n. a. Noise exposure Low Tikka et al. 2017 [44]
Page 74 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
New stricter legislation Not applicable 1 ITS Coal mines Individual study
Median personal noise exposure A: Immediate effect B: Long-term trend
A: B:
Very low Tikka et al. 2017 [44]
Earmuffs Earplug 2 CBA Workers with noise exposition above 88–94 dB(A)
MA Hearing loss Very low Tikka et al. 2017 [44]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1Total result on hearing protection devices only mentioned in Abstract, no further information given in review
Table 16: Overview of mixed interventions/programmes to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Hearing loss prevention programme
Audiometric testing 1 RCT Agricultural students involved in farm work
Individual study Hearing loss average
Moderate Tikka et al. 2017 [44]
Well-implemented hearing loss prevention programme
Less well-implemented HLPP for hearing loss
4 CBA Varying professions MA Hearing loss STS Very low Tikka et al. 2017 [44]
Hearing loss prevention programme
Non-exposed workers
3 CBA Varying professions MA Hearing loss average
Very low Tikka et al. 2017 [44]
Hearing loss prevention programme with exposure information
Hearing loss prevention programme without exposure information
1 CBA Various workers of an aluminium smelter
Individual study Hearing loss average
Very low Tikka et al. 2017 [44]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials; STS: standard threshold shift,
Page 75 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 17: Overview of general behavioural occupational health and safety interventions
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Occupational safety and health inspections
No inspections 1 RCT, 2 CBA, 1 ITS
Motor carrier drivers in ITS; various industries in other studies
Individual studies
Fatal and non-fatal injuries A: Short- and medium-term (Ø 21 and 24 months) B: Long-term (Ø 36 and 48 months)
A: B:
Low Mischke et al. 2013 [45]
Occupational safety and health inspections
No inspections 1 RCT Varying professions Individual study
Physical workload Low Mischke et al. 2013 [45]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 18: Overview of general mixed occupational health and safety interventions/programmes
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Workplace interventions Usual care 8 RCTs Varying professions, after sickness absence
MA
Cumulative duration of sickness absence A: Total B: Persons with musculoskeletal disorders
A: B: C:
High
van Vilsteren et al. 2015 [46]
Page 76 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
C: Persons with mental health problems
Workplace interventions Usual care 5 RCTs Varying professions, after sickness absence
MA Pain High
van Vilsteren et al. 2015 [46]
Workplace interventions Usual care 5 RCTs Varying professions, after sickness absence
MA Time until first return-to-work
Moderate
van Vilsteren et al. 2015 [46]
Workplace interventions Usual care 1 RCT Varying professions, after sickness absence
Individual study
Risk of recurrences of sick leave
Moderate
van Vilsteren et al. 2015 [46]
Workplace interventions Usual care 6 RCTs Varying professions, after sickness absence
MA Functional status (Roland disability questionnaire)
Moderate
van Vilsteren et al. 2015 [46]
Workplace interventions Usual care 6 RCTs Varying professions, after sickness absence
MA
Time until lasting return-to-work A: Total B: Persons with musculoskeletal disorders C: Persons with mental health problems D: Persons with cancer
A: B: C: D:
Very low
van Vilsteren et al. 2015 [46]
Workplace interventions Usual care 4 RCTs Varying professions, after sickness absence
MA Depression Very low van Vilsteren et
Page 77 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
al. 2015 [46]
Abbreviations: MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 78 of 78
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review onlyEvidence-based occupational health and safety
interventions: a comprehensive overview of reviews
Journal: BMJ Open
Manuscript ID bmjopen-2019-032528.R2
Article Type: Original research
Date Submitted by the Author: 05-Nov-2019
Complete List of Authors: Teufer, Birgit; Danube University Krems, Department for Evidence-based Medicine and EvaluationEbenberger, Agnes; Danube University Krems, Department for Evidence-based Medicine and EvaluationAffengruber, Lisa; Danube University Krems, Department for Evidence-based Medicine and EvaluationKien, Christina; Danube University Krems, Department for Evidence-based Medicine and EvaluationKlerings, Irma; Danube University Krems, Department for Evidence-based Medicine and EvaluationSzelag, Monika; Danube University Krems, Department for Evidence-based Medicine and EvaluationGrillich, Ludwig; Danube University Krems, Department for Evidence-based Medicine and EvaluationGriebler, Ursula; Danube University Krems, Department for Evidence-based Medicine and Evaluation
<b>Primary Subject Heading</b>: Occupational and environmental medicine
Secondary Subject Heading: Evidence based practice, Health policy
Keywords: overview of reviews, occupational injuries, occupational diseases, occupational health and safety, OHS
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open on A
ugust 10, 2021 by guest. Protected by copyright.
http://bmjopen.bm
j.com/
BM
J Open: first published as 10.1136/bm
jopen-2019-032528 on 11 Decem
ber 2019. Dow
nloaded from
For peer review only
1 Evidence-based occupational health and 2 safety interventions: a comprehensive 3 overview of reviews4 Authors:
5 Birgit Teufer (corresponding author),
6 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
7 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
9 phone: 0043 2732 893 2918
10 ORCID-ID: https://orcid.org/0000-0002-3324-0639
11
12 Agnes Ebenberger,
13 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
14 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
16
17 Lisa Affengruber,
18 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
19 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
21
22 Christina Kien
23 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
24 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
Page 1 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
26
27 Irma Klerings,
28 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
29 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
31
32 Monika Szelag,
33 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
34 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
36
37 Ludwig Grillich,
38 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
39 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
41
42 Ursula Griebler,
43 University for Continuing Education Krems (Danube University Krems), Department for Evidence-
44 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria
46
47
48 Word count: 4814 (including Competing interests, Funding statements, Differences between protocol
49 and review, Data availability, Acknowledgments, and author contributions)
50
Page 2 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
51 Abstract
52 Objectives: Occupational injuries and diseases are a huge public health problem and cause extensive
53 suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS)
54 guidelines are still not based on the best available evidence. In the last decade, numerous systematic
55 reviews on behavioural, relational and mixed interventions to reduce occupational injuries and
56 diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this
57 overview of reviews is to provide a comprehensive basis to inform evidence-based decision-making
58 about interventions in the field of OHS.
59 Methods: We conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library
60 (Wiley), Epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between
61 January 2008 and June 2018. Two authors independently screened abstracts and full-text
62 publications and determined the risk of bias of the included systematic reviews with the ROBIS tool.
63 Results: We screened 2287 abstracts and 200 full texts for eligibility. Finally, we included 25
64 systematic reviews with a low risk of bias for data synthesis and analysis. We identified systematic
65 reviews on the prevention of occupational injuries, musculoskeletal, skin and lung diseases,
66 occupational hearing impairment and interventions without specific target diseases. Several
67 interventions led to consistently positive results on individual diseases; other interventions did not
68 show any effects, or the studies are contradictory. We provide detailed results on all included
69 interventions.
70 Discussion: To our knowledge, this is the first comprehensive overview of behavioural, relational and
71 mixed interventions and their effectiveness in preventing occupational injuries and diseases. It
72 provides policy makers with an important basis for making evidence-based decisions on interventions
73 in this field.
74 Systematic review registration: PROSPERO CRD42018100341
75 Keywords: overview of reviews, occupational injuries, occupational diseases, occupational health 76 and safety, OHS
Page 3 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
77 ARTICLE SUMMARY
78 Strengths and limitations of this study
79 To our knowledge, this is the first comprehensive overview of reviews on behavioural,
80 relational and mixed interventions to prevent injuries at work and occupational diseases.
81 We based our overview of reviews on an extensive, comprehensive and systematic literature
82 search.
83 Two scientists independently carried out all the essential steps in the preparation of this
84 review.
85 A secondary literature analysis may result in evidence base gaps, either due to periods not
86 covered by the included systematic reviews (SRs) or to further limitations in the SRs.
87 We considered only SRs with a low risk of bias for the data extraction analysis to ensure
88 validity but on the contrary, this approach may have led to a loss of information in topics
89 where only SRs with a high or unclear risk of bias were available.
90
91
92
Page 4 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
93 BACKGROUND
94 Occupational injuries and diseases cause extensive suffering and loss of productivity. The
95 World Health Organization (WHO) estimates that, globally, there are 1.2 million deaths per year
96 attributable to occupational risks, which relates to 2.1% of all deaths in the general population[1, 2].
97 Estimates from the Workplace Safety and Health Institute, Singapore, in cooperation with the
98 International Labour Organization (ILO) are even higher, with nearly 2.8 million deaths annually being
99 attributed to work, and another 374 million to non-fatal occupational accidents[3]. Although the
100 estimation of occupationally related mortality and morbidity worldwide varies widely due to
101 methodological problems, the general conclusion is that occupational diseases and injuries are a
102 huge public health problem[4]. Not only do social and ethical arguments support preventive
103 occupational health and safety (OHS) services[5] but so do the monetary consequences of ill health
104 at work[6].
105 Decisions on which interventions to implement are usually dominated by negotiations
106 between unions, employers and government representatives[7]. However, expert advice can be
107 seriously biased[8], leading to wide variations in expert judgments[9].
108 The WHO states that the principle that all their guidelines must be based on systematic and
109 comprehensive assessment of potential benefits and harms[10]. Nevertheless, many OHS guidelines
110 are still not based on the best available evidence[11]. Healthcare providers and policy makers are
111 confronted with an unmanageable amount of information[12], and there is a large amount of
112 systematic reviews on interventions to prevent single occupational diseases or injuries according to
113 very specific risks available (e.g. on work.cochrane.org). Systematic reviews are regarded as the most
114 appropriate method to avoid bias in synthesising the best available evidence. Because so many
115 systematic reviews are already available, we conducted an overview of reviews. That means we
116 compiled the results from multiple systematic reviews (SRs), addressing the effects of interventions
117 for a health problem or condition according to a predefined procedure. We appraised their quality
118 and summarized their evidence for important outcomes[13]. The aim of this overview of reviews is to
Page 5 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
119 provide a comprehensive basis for making evidence-based decisions on interventions in the OHS field
120 by answering the following research question:
121 ‘What effects do interventions in the workplace setting have on working conditions,
122 exposure to disease-causing factors and the behaviour of employees as well as on accidents at work
123 and the development of occupational diseases?’
124 To our knowledge, this is the first comprehensive overview of reviews on behavioural,
125 relational and mixed interventions to prevent injuries at work and occupational diseases, based on a
126 comprehensive and systematic search, critical appraisal and the synthesis of SRs. It enables
127 prioritisation between different interventions based on the quality of evidence (QoE).
128 METHODS
129 We have registered the protocol of the overview of reviews at the International Prospective
130 Register of Systematic Reviews (PROSPERO), registration number CRD42018100341. We adhered to
131 the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement[14]
132 throughout this manuscript (PRISMA checklist see Appendix 1).
133 Study design
134 We conducted an overview of reviews following the guidance provided in the Cochrane
135 Handbook[12].
136 Information sources and literature search
137 An information specialist conducted the database search in MEDLINE (Ovid), the Cochrane Library
138 (Wiley), Epistemonikos.org and Scopus (Elsevier) in June 2018. The usefulness of SRs also depends on
139 their actuality, but there is no consensus on when SRs are obsolete and when an update is
140 necessary[15]. To prevent us from relying on outdated evidence, we limited the search to SRs
141 published since 2008. The full search strategies are reported in Appendix 2.
142 Additionally, we checked the bibliographies of the included SRs and relevant articles for further
143 references to eligible reviews. To ensure that the evidence is up to date, we conducted forward
Page 6 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
144 citation tracking of selected SRs using Scopus (Elsevier). We also checked the websites of the
145 Cochrane Work Group1, the ILO2, the Occupational Safety and Health Administration (OSHA)3, the
146 WHO4 and the European Agency for Safety and Health at Work (EU-OSHA)5.
147 Eligibility criteria
148 You can find a detailed description of the inclusion and exclusion criteria in Table 1. We provide
149 additional information and definitions thereafter.
150 Table 1: Eligibility criteria for the overview of reviews on OHS interventions
Inclusion criteria Exclusion criteria
Study design Systematic reviews (with or without meta-analysis) of randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBA studies) and/or interrupted time series (ITS)
Systematic reviews of other study designs only if they reported a subgroup analysis on the study designs listed above, or at least 50% of included studies corresponded to those study designs
Primary studies, narrative reviews, editorials, opinion papers
Population Any kind of employees aged 15 or over, who were not self-employed
Mixed population of employed and self-employed employees only if at least 50% employed
Exclusively self-employed persons
Specific occupations (i.e. teachers or sex workers)
Intervention All types of workplace-related interventions designed to protect against occupational injuries and for the primary prevention of occupational diseases:
Organisational-level workplace interventions according to Montano et al. [16]: 1) material conditions, 2) work time-related conditions, 3) work organisation conditions
Provision of educational materials (e.g. brochures, films)
Training, counselling or workshops aimed at multipliers or directly at employees and workers
Legislation
Vaccinations at the workplace
1 https://work.cochrane.org/cochrane-reviews-about-occupational-safety-and-health2 https://www.ilo.org/global/lang--en/index.htm3 https://www.osha.gov/pls/publications/publication.AthruZ?pType=Types4 http://www.who.int/occupational_health/publications/en/5 https://osha.europa.eu/en/tools-and-publications
Page 7 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Audits by the health and safety executive
Comparison Another intervention (active control) or no intervention
Outcomes Prevalence, incidence and severity of occupational diseases, occupational injuries, physical disability, physical symptoms (e.g. pain experience)
Sickness absence rates
Risk factors that can lead to occupational injuries or diseases
Surrogate parameters (e.g. high blood pressure)
Quality changes at organisational level (e.g. in production)
Cost efficiency Job satisfaction or work
motivation
Setting Interventions at the workplace Studies conducted in OECD (Organisation for
Economic Cooperation and Development) countries (at least 50% of included studies in SR)
Interventions in: Leisure time School Non-OECD countries
151
152 We defined systematic review according to the Cochrane Handbook as ‘a literature review that
153 attempts to collate all empirical evidence using a) clearly stated objectives and pre-defined eligibility
154 criteria, b) an explicit reproducible methodology, c) a systematic search, d) an assessment of the
155 validity of the findings of the included studies, and e) a systematic presentation, and synthesis, of the
156 characteristics and findings of the included studies’[12]. In addition, to be included in this overview of
157 reviews, SRs had to conduct the search in at least two scientific databases and perform abstract and
158 full-text screening by two independent reviewers.
159 We included SRs of all types of workplace-related interventions designed to protect against
160 occupational injuries and for the primary prevention of occupational diseases, including legislation
161 and audits by the health and safety executive as well as organisational-level workplace interventions.
162 According to Montano et al.[16], interventions that modify working conditions can be described in
163 three broad categories: material condition (physical and chemical agents needed during work), work
164 time-related condition (amount of working time and intensity of work) and work organisation
165 conditions (psychological factors and processes and procedures necessary for the completion of work
166 tasks).
Page 8 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
167 We defined occupational diseases in accordance with the definition of the ILO[17] that groups
168 occupational diseases caused by exposure to agents arising from work activities (caused by chemical
169 agents, physical agents, biological agents or infectious or parasitic diseases), by target organ systems
170 (respiratory diseases, skin diseases, musculoskeletal disorders and mental and behavioural disorders)
171 and occupational cancer.
172 Work-related injuries are injuries which are causally, locally and temporally related to the insured
173 occupation and which lead to physical injury[18]. Risk factors that can lead to occupational injuries or
174 diseases were defined as changes in environmental conditions, changes in exposure to disease-
175 causing factors (e.g. noise, extreme temperatures) and changes at the employees’ or workers’
176 behavioural level (e.g. wearing protective equipment).
177 Study selection
178 The reviewer team consisted of five persons with experience in conducting systematic reviews (BT,
179 AE, LA, UG, MS). Each study was independently assessed by two reviewers from this team in two
180 consecutive steps (abstract and full-text selection) based on the previously defined inclusion criteria.
181 Conflicts between reviewers were resolved through discussion and consensus or by involving a third
182 person from the reviewer team. We used the software Covidence (https://www.covidence.org/) for
183 the study selection process.
184 Risk of bias assessment and certainty of evidence
185 Two independent reviewers appraised the quality of the SRs with the ROBIS (Risk of Bias in
186 Systematic Reviews) tool[19]. This assesses four dimensions of SRs: ‘study eligibility criteria’,
187 ‘identification and selection of studies’, ‘data collection and study appraisal’ and ‘synthesis and
188 findings’. The result is an assessment of the risk of bias of each SR using the categories low, unclear
189 and high (see Table 2). Disagreements in appraisal between reviewers were resolved through
190 discussion and consensus or by involving a third person.
Page 9 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
191 Table 2: Definition and interpretation of risk of bias[19]
Risk of bias InterpretationLow risk of bias The findings of the review are likely to be reliable. No concerns with the review
process, or concerns were appropriately considered in the review conclusions. The conclusions were supported by the evidence and included consideration of the relevance of included studies.
High risk of bias One or more of the concerns raised during the assessment was not addressed in the review conclusions, the review conclusions were not supported by the evidence or the conclusions did not consider the relevance of the included studies to the review question.
Unclear risk of bias There is insufficient information reported to make a judgment on risk of bias.192
193 Data synthesis and analysis
194 We synthesised data narratively and in forms of evidence tables. Due to the large number of SRs
195 available and to ensure validity, we excluded SRs with a high or unclear risk of bias for our data
196 synthesis and analysis.
197 For SRs with a low risk of bias we extracted the following data:
198 - Details of the SR (author, title, year of publication, aim of the SR)
199 - Details of the included studies (number of studies and persons included, risk of bias of
200 studies)
201 - Details of the population (age, gender, type of occupation)
202 - Details of the intervention (duration, type of measures)
203 - Details of the results (time of outcome measurement, results for each endpoint)
204 - Quality of evidence (if reported in the included SR)
205 Several institutions (e.g. Cochrane, WHO, BMJ Clinical Evidence and many more[20]) and the
206 researchers of several included SRs use the GRADE approach (Grading of Recommendations,
207 Assessments, Developments and Evaluations) or modifications thereof to assess the QoE. Table 3
208 presents the significance of the four levels of evidence.
209 Table 3: Significance of the four levels of evidence[21]
Quality level Definition
Page 10 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
high
We are very confident that the true effect lies close to that of the estimate of the effect
moderate
We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
low
Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
very low
We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
210 If the researchers of the included SRs used evidence assessment tools other than the GRADE
211 approach, we provide the definition of the used levels of evidence in a footnote.
212 We did not extract data from primary studies. If information was not apparent from the included
213 review, it was presented as ‘not available’ (n.a.). If the SR was an update of an older version, we only
214 extracted data of the most recent version. We did not find SRs that answered the exact same
215 research question; therefore, we did not check for overlap in the included primary studies.
216 Patient and Public Involvement
217 There were no funds or time allocated for patient or public involvement so we were unable to
218 involve patients. If, after consultation with the sponsor, further dissemination of the results takes
219 place, we will invite representatives of the public to help us write a plain language summary.
220 RESULTS
221 We identified 2215 citations from electronic database searches after the removal of duplicates, and
222 we found another 72 citations from additional searches (reference list checking and forward citation
223 tracking). All potentially relevant systematic reviews (SRs) on the searched web pages (see
224 “Information sources and literature search”) were cross-checked with hits from the previous
225 database search. Because the database search had already covered all relevant SRs, we did not
226 identify any new references in this step. Overall, 2287 citations were screened by title and abstract
227 and, subsequently, we assessed 200 full texts for eligibility. From the 71 SRs (74 records) that met
Page 11 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
228 our eligibility criteria, we appraised 32 with a high risk of bias and 10 with an unclear risk of bias.
229 Four of the included SRs were updates from previous versions. Finally, we included 25 SRs reported
230 in 28 publications for data synthesis and analysis. Figure 1 shows the details of the study selection
231 process. We provide a list of excluded full-text articles with reasons for exclusion as well as a detailed
232 risk of bias assessment (including SRs with a high or unclear risk of bias) in online appendices 3 and 4.
233 Please insert Figure 1 here
234 Figure 1: PRISMA Flowchart of the study selection process
235
236 Description of included studies
237 Appendix 5 provides an overview of the included SRs, summarising the interventions, description of
238 measured outcomes and risk of bias rating.
239 From the 25 included SRs, a considerable number of studies (12 SRs) dealt with research questions
240 on the topic of the prevention of musculoskeletal disorders, seven investigated the efficacy of
241 interventions for the prevention of occupational injuries, and three reviews studied interventions for
242 the prevention of occupational skin and lung diseases. One review examined the efficacy of
243 interventions for the prevention of occupational hearing loss, and another two SRs dealt with diverse
244 interventions about occupational health and safety (OHS) without limiting to a specific target
245 disease. Detailed information about all above mentioned SRs including the interventions, control
246 interventions, included studies, setting, method of data synthesis and a graphical presentation of the
247 results can be found in the online-only supplementary material (Appendix 5).
248 Prevention of musculoskeletal disorders
249 Overall, 12 SRs reported on different interventions for the prevention of musculoskeletal disorders.
250 They included mixed interventions with several different components[22-26], physical exercises at
251 the workplace[27], work organisation and psychosocial working environment[28], educational
Page 12 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
252 interventions for the prevention of musculoskeletal disorders[29], ergonomic interventions[30] and
253 interventions in the area of manual handling of loads[31-33].
254 Strengthening exercises or fitness training had a positive effect on musculoskeletal disorders in
255 general as well as in the shoulder and neck area and on back pain in various occupational groups[23,
256 25, 27]. The QoE varied widely between outcomes. See online appendix 6 for further details.
257 Lowry et al.[25] found a significant reduction in the prevalence of shoulder pain with workplace
258 adjustments (QoE: low). Additional breaks compared to conventional break schedules seem to
259 reduce symptom intensity in different body regions (QoE: moderate)[28]. Both SRs included a wide
260 range of occupational groups.
261 Educational interventions alone (e.g. training) showed no effect on the reduction of musculoskeletal
262 disorders (QoE: very low to moderate)([26, 28, 29],[33] only on training for manual material
263 transfer).
264 The results of ergonomic interventions on musculoskeletal disorders are mixed and varied but, in
265 general, tend to result in some form of pain reduction. Chen et al.[23] found evidence of low quality
266 for the efficacy of ergonomic interventions on neck pain. The use of an arm support with alternative
267 computer mice reduces the incidence of musculoskeletal disorders in the neck/shoulder but not in
268 the right upper extremity (QoE: moderate)[30]. There is no difference for musculoskeletal disorders
269 in the neck/shoulder and right upper extremity between alternative and conventional computer mice
270 with and without arm support (QoE: moderate)[30]. Richardson et al.[26] found a positive effect of
271 unstable shoes on pain in nurses (QoE: n.a.). No effect of physiotherapist or ergonomist feedback
272 sessions on the optimal design of computer workstations, work techniques and the psychosocial
273 aspects of work could be observed (QoE: low)[28]. Goodman et al.[24] concluded that not a single
274 measure but a combination of measures (included interventions, e.g. education, work station
275 adjustments, exercise, rest breaks, specific ergonomic equipment) is most effective in addressing
276 cumulative trauma disorder (CTD) symptoms.
Page 13 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
277 Aids for patient transfer (both small aids such as bed steps, anti-slip mats, etc., and mechanical aids
278 such as mechanical transport devices for patients) led to positive effects on pain and/or injuries of
279 the musculoskeletal system in two SRs (QoE: very low to low)[31, 32]. Stock et al.[28] showed that
280 ‘lifting programmes’ as well as multi-component interventions on safe patient handling in hospitals
281 had no effect on several outcomes measured (e.g. the prevalence of neck/shoulder pain,
282 forearm/wrist pain, lower back pain and musculoskeletal pain in any body region; upper extremity or
283 back-related functional status; musculoskeletal work injury rates and time loss injury rates; QoE: very
284 low to low) except for two outcomes: they found low-quality evidence that a safe lifting programme
285 is more effective than usual practice in reducing the frequency of work-related shoulder pain and
286 work-related low back pain (QoE: low)[28].
287 Prevention of occupational injuries
288 Overall, seven SRs investigated interventions for the prevention of occupational injuries. One review
289 dealt with different interventions for the prevention of occupational injuries in the agricultural
290 sector[34], one SR examined the effects of interventions for the prevention of occupational injuries
291 in the construction industry[35], and another review examined the effects of alcohol and drug
292 screening of professional drivers on accidents[36]. Four SRs searched for safety products and
293 practices in the health sector to prevent occupational injuries[37-40].
294 Rautiainen et al.[34] found no effect of education on the prevention of injuries in the agricultural
295 sector. Financial incentives (insurance premium discounts) showed a short-term positive effect but
296 no long-term progressive improvement. Legislation banning Endosulfan pesticides showed a
297 progressive reduction in deaths by poisoning. Regulations for the use of rollover protection
298 structures showed contradictory results. For all outcomes, no QoE was stated.
299 Van der Molen et al.[35] found contradictory evidence on the impact of regulations and inspections
300 to prevent injuries in construction workers. Regional safety campaigns, training, inspections or the
301 introduction of occupational health services are unlikely to reduce the number of non-fatal injuries in
Page 14 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
302 construction companies, while company-oriented measures, such as safety campaigns, a drug
303 workplace programme or subsidies for safe scaffolding, can have a positive effect (QoE: very low for
304 all outcomes).
305 Cashman et al.[36] investigated the effects of alcohol and drug screening of occupational drivers on
306 accidents and injuries. This review included two ITS studies which analysed data over a period of 13
307 and 14 years, respectively. Binding alcohol tests brought with them fewer accidents in the short term
308 but had no effect on the long-term trend. With regard to mandatory drug tests, the studies did not
309 show a uniform picture of the short-term effects but a uniform strengthening of the long-term trend
310 towards declining accident rates. The authors of the study judged the QoE as limited, which was
311 defined as ‘one low quality RCT or one CBA study or one ITS’[36].
312 Four SRs investigated for safety products and practices in the health sector to prevent occupational
313 injuries. Parantainen et al.[38] showed that the use of blunt surgical suture needles reduced the risk
314 of glove perforation (QoE: high) and the number of self-reported needle stick injuries (QoE:
315 moderate) compared to sharp suture needles. Reddy et al.[39] found that the use of safe blood
316 collection systems showed inconsistent effects on the number of needle stick injuries (QoE: very
317 low). The use of safe passive intravenous systems showed a decrease in needle stick injuries and a
318 reduction in the incidence of blood splashes (QoE: very low). However, evidence of moderate quality
319 was found that active systems might increase exposure to blood. For safe injection devices (QoE:
320 very low to low), the introduction of several safety products (QoE: very low) or safety containers
321 (QoE: very low) showed inconsistent results, or there was no clear evidence of benefit. Two ITS
322 studies showed that interrupted introduction of legislation on the use of safety-engineered devices
323 reduced the rate of needle stick injuries among healthcare workers (QoE: moderate), whereas one
324 ITS with low-quality evidence showed an increase in the level of needle stick injuries with gradual
325 introduction. Evidence showed varying results in the trend over time for needle stick injury rates
326 (QoE: very low to low)[39].
Page 15 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
327 Mischke et al.[37] reported that there is moderate-quality evidence that double gloves reduce
328 perforations and bloodstains on the skin compared to single gloves during surgery, which may mean
329 a decrease in percutaneous exposure events. Triple gloves and the use of special gloves can further
330 reduce the risk of glove perforations compared to double gloves made of normal material (QoE: low).
331 Verbeek et al.[40] found very low-quality evidence that more breathable types of PPE would not lead
332 to more contamination with body fluids. Double gloves and the Center for Disease Control and
333 Prevention (CDC) doffing guidelines reduced the risk of contamination with body fluids, and more
334 active training in PPE use could reduce PPE errors and PPE doffing errors more than passive training
335 (QoE: very low). However, the data all come from individual studies with a high risk of bias, so there
336 is uncertainty about the estimates of the effects.
337 Prevention of occupational skin and lung diseases
338 Three SRs included studies about the efficacy of interventions to prevent occupational skin and lung
339 diseases[41-43].
340 Lunt et al.[41] found low positive effects of behavioural interventions at the workplace (training for
341 behavioural changes or for influencing knowledge and attitudes about health and safety precautions)
342 on exposure to occupational health hazards for workers exposed to dermal and respiratory hazards
343 (QoE: n.a.). Luong Than et al.[42] found evidence of low to very low quality that behavioural
344 interventions (education and training to improve the use of respiratory protective equipment) did
345 not largely contribute to workers using protective equipment correctly or more frequently. Bauer et
346 al.[43] found that moisturisers used alone or in combination with barrier creams can provide
347 clinically relevant protection against irritant hand dermatitis (QoE: low). For advanced training
348 interventions for skin protection, the results of the individual studies varied considerably. Altogether,
349 they showed no clinically relevant effect (QoE: very low)[43].
350 Prevention of occupational hearing loss
Page 16 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
351 We identified one SR which examined the effect of interventions for the prevention of occupational
352 hearing loss[44]. On average, wearing hearing protection reduced noise exposure by about 20 dB(A)
353 (QoE: low), and more noise was attenuated with instruction on how to use hearing protection than
354 without instruction (QoE: moderate). With regard to hearing impairment, there was no difference
355 between ear protectors and earplugs at noise levels above 89 dB(A) (QoE: very low). Implementing
356 stricter legislation to protect against occupational hearing loss (multiple components, e.g. prioritising
357 technical and administrative controls, setting a threshold) led to an immediate reduction in the mean
358 personal noise exposure in coal construction and a further positive, but statistically not significant,
359 trend in the reduction of the noise dose (QoE: very low). Furthermore, the authors found no
360 statistically significant differences between on-site training and information online (QoE: low),
361 information about personal noise exposure and no information about it (QoE: low), intensive hearing
362 loss prevention programmes (HLPP) compared to pure audiometry (QoE: moderate) and HLPP with
363 personal noise exposure information compared to HLPP without this information (QoE: very low).
364 General occupational health and safety interventions
365 We included one SR that examined the effects of laws and regulations on occupational safety and
366 health[45] and one SR dealt with interventions for the prevention of the inability to work after sick
367 leave[46]
368 Mischke et al.[45] found positive effects of compliance inspections on injuries at work (QoE: low).
369 However, the effects only became apparent in the long term (mean 36 and 48 months follow-up),
370 and no statistically significant risk reductions could be observed in the short term (mean 21–24
371 months). Inspections also had no statistically significant effect on employees’ physical workload
372 (QoE: low).
373 Van Vilsteren et al.[46] showed that interventions to prevent work disability in workers on sick leave
374 shortened the time to first return-to-work of workers with musculoskeletal disorders (QoE:
375 moderate) and the time to lasting return-to-work (Qoe: very low) for this group of workers but not
Page 17 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
376 for people with mental illness or cancer (QoE: very low). Workplace interventions reduced the
377 cumulative sickness duration by an average of 33 days (QoE: high). Significant results were only
378 shown for persons with musculoskeletal disorders but not for persons with mental illnesses.
379 However, the risk of sick leave recurrences for persons with musculoskeletal disease was higher for
380 workplace interventions (QoE: moderate). In addition, the authors found positive effects on the
381 functional status of employees with musculoskeletal disorders (QoE: moderate) and pain (QoE: high)
382 but no significant effect on depression (QoE: very low). Overall, the SR found evidence for the
383 positive effects of workplace interventions to prevent work disability in workers on sick leave with
384 musculoskeletal disorders (QoE: moderate) but no effects on persons with mental illnesses or cancer
385 (QoE: low)[46].
386 DISCUSSION
387 This overview of reviews provides a comprehensive overview of behavioural, relational and mixed
388 interventions and their effectiveness in preventing occupational injuries and diseases. We identified
389 SRs on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational
390 hearing impairment and interventions without specific target diseases.
391 Almost half of all the included reviews refer to work-related illnesses of the musculoskeletal system,
392 which demonstrates the importance of this topic and is in accordance with the fact that
393 musculoskeletal disorders are one of the main causes for work-related mortality and morbidity[47].
394 Several interventions (e.g. strengthening exercises, individual ergonomic interventions and patient
395 transfer aids) led to consistently positive results on individual musculoskeletal system diseases. Other
396 interventions (e.g. educational and cognitive behavioural interventions) targeting illnesses of the
397 musculoskeletal system did not show any effects, or the studies are contradictory.
398 With regard to the prevention of occupational accidents and the reduction of exposure to risk
399 factors, legislation and regulations as well as inspections can be effective (e.g. ban on Endosulfan
400 pesticides, legislation on the use of safety-engineered devices in the healthcare sector etc.). In some
Page 18 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
401 cases, however, studies showed contradictory results (e.g. regulations on the use of rollover
402 protection structures) or no effects (e.g. inspections in the construction sector). Financial incentives
403 such as insurance premium discounts and subsidies for safe scaffolding showed positive effects.
404 Company-oriented interventions such as safety campaigns, awareness-raising campaigns or drug
405 workplace programmes appear to have positive effects on injuries at work and compliance with
406 rules. The evidence for the effectiveness of training and education interventions, in general, is mixed
407 and must be considered specifically by target disease or intervention.
408 In the medical field, there is partly good evidence for the use of safety products (e.g. blunt needles,
409 double gloves, etc.), but inconsistent effects have been observed for other safety products and
410 practices (e.g. use of safe blood collection systems, safe injection needles, etc.). With regard to skin
411 and lung diseases, there is some good evidence of the efficacy of various interventions (e.g.
412 moisturisers, barrier creams, protective gloves, etc.). There are also effective interventions to
413 prevent work-related hearing loss (e.g. wearing hearing protection, well-implemented HLPP).
414 A strength of this overview of reviews is the extensive literature search. The search strategy was not
415 restricted to specific target diseases or interventions to obtain the most comprehensive results
416 possible. Through the use of several additional search strategies, such as reviewing multiple
417 organisational websites and backward and forward citation tracking, further SRs could be identified.
418 Nonetheless, there remains a residual risk of not having found all relevant reviews. As a
419 methodological limitation, it can be stated that a secondary literature analysis may result in evidence
420 base gaps, either due to periods not covered by the included SRs or to further limitations in the SRs,
421 such as limitations on study design or included interventions[48]. Due to the overview of reviews
422 method, we did not extract data from the individual studies included in the SRs. Therefore, we have
423 taken over the assessment of the Quality of Evidence (QoE) from the authors of the reviews. Almost
424 all included reviews used the GRADE system for the QoE evaluation and assessed the QoE dually.
425 Therefore, we are quite confident that we can rely on the reviewers' assessment of QoE, but we are
426 aware that these assessments may be subject to subjective influences of the respective systematic
Page 19 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
427 review authors. Besides further criticism of the grading systems[49], there is also the danger of an
428 undiscovered small study effect. Small study effects refer to the fact that trials with smaller sample
429 sizes are more likely to report larger beneficial effects than large trials[50]. Even the capabilities of
430 bias identification methods, such as funnel plots, are limited when recommendations or meta-
431 analyses are based on a limited number of small trials[51] or even only one available trial. Therefore,
432 the danger of over-estimating effects of small studies and assessments of high quality of evidence
433 remains where only a few small studies exist. The assessment of the QoE must be interpreted with
434 particular caution in interventions where only a few studies are available. In this overview of reviews
435 this may be observed for some ergonomics interventions for computer users, where review authors
436 have arrived at a high or moderate quality of evidence in their assessment, although in some cases
437 only one or two small studies were available (Appendix 6).
438 Our approach of considering only SRs with a low risk of bias for the data extraction analysis may be
439 seen as ensuring validity in topics where good SRs were available. On the contrary, this approach
440 may have led to a loss of information in topics where only SRs with a high or unclear risk of bias were
441 available, such as mental diseases. However, the large number of identified SRs with a high or
442 unclear risk of bias highlights the need for more reviews in the field of OHS that apply rigorous
443 methods. A further strength of this overview of reviews is that two scientists independently carried
444 out all the essential steps in the preparation of this review. This ensures that both the screening of
445 the references and the assessment of the risk of bias of the included reviews minimized subjective
446 influences.
447 CONCLUSION
448 Several examined OHS interventions led to consistently positive results on individual diseases; other
449 interventions did not show any effects, or the studies are contradictory. Policy makers and other
450 authorities must therefore carefully consider the interventions to which the limited resources
451 available shall be applied. While the included reviews covered many relevant endpoints, cancer and
452 circulatory diseases were not mentioned in any of them. On one hand, this may result from the
Page 20 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
453 limitation of certain primary study designs—such as RCTs or CBA studies—which are considered
454 robust but may not be suitable to assess effects on diseases that are relatively rare and develop in
455 the long term, such as cancer. On the other hand, this may be interpreted as a demonstration of an
456 important gap in the research literature, especially as cancer and circulatory diseases are two of the
457 main causes for work-related mortality and morbidity[47].
458 To our knowledge, this is the first comprehensive overview of reviews on interventions to prevent
459 injuries at work and occupational diseases. It provides policy makers with an important basis for
460 making evidence-based decisions on interventions in this field.
461 COMPETING INTERESTS
462 All authors declare that they have no competing interests.
463 FUNDING
464 This overview of reviews was funded by the Austrian General Accident Insurance Institution
465 (Allgemeine Unfallversicherung, AUVA). The funding source had no role in the collection, analysis or
466 interpretation of data.
467 DIFFERENCES BETWEEN PROTOCOL AND REVIEW
468 The protocol allowed for the inclusion of all systematic reviews that fulfilled our eligibility criteria
469 regardless of their quality (risk of bias). Due to the large number of available reviews, we decided to
470 include for data extraction only systematic reviews with a low risk of bias.
471 DATA AVAILABILITY
472 Data are available upon reasonable request. No new data was collected in this overview of reviews.
473 Full data extraction from included systematic reviews is available upon request from the main
474 author.
Page 21 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
475 ACKNOWLEDGMENTS
476 We wish to thank Danielle Eder-Linder from the University of Continuing Education (Danube
477 University Krems) for administrative support.
478 AUTHOR CONTRIBUTIONS
479 CK drafted the research protocol, and BT, UG and LG provided substantial contributions to the
480 protocol. BT coordinated the reviewing process. BT, AE, LA, UG and MS contributed to the abstract
481 and full-text screening, data extraction and risk of bias assessment of the reviews. IK developed the
482 search strategy, performed the search and contributed to the data extraction. All authors wrote
483 substantial parts of the first draft of the manuscript and revised it critically for important intellectual
484 content, and all approved the final manuscript.
485 REFERENCES
486 1. Stanaway JD, Afshin A, Gakidou E, et al. Global, regional, and national comparative risk 487 assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of 488 risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of 489 Disease Study 2017. The Lancet. 2018;392(10159):1923-94.490 2. Wolf J, Prüss-Ustün A, Ivanov I, et al. Preventing disease through a healthier and safer 491 workplace. Geneva: World Health Organization; 2018.492 3. Hämäläinen P, Takala J, Kiat TB. Global estimates of occupational accidents and work-related 493 illnesses 2017. World. 2017;2017:3-4.494 4. Rushton L. The global burden of occupational disease. Current environmental health reports. 495 2017;4(3):340-8.496 5. World Health Organization. Declaration on Occupational Health for All: approved at the 497 Second Meeting of the WHO Collaborating Centres in Occupational Health, Beijing, China, 11-14 498 October 1994. Geneva: World Health Organization; 1994.499 6. Stewart WF, Ricci JA, Chee E, et al. Lost productive work time costs from health conditions in 500 the United States: results from the American Productivity Audit. Journal of occupational and 501 environmental medicine. 2003;45(12):1234-46.502 7. Verbeek J, Morata T, Ruotsalainen J, et al. Prevention of occupational diseases: implementing 503 the evidence. Cochrane Database Syst Rev [Internet]. 2013 [cited E; (4). Available from: 504 http://cochranelibrary-wiley.com/doi/10.1002/14651858.ED000056/abstract.505 8. Michaels D. Doubt is their product, how industry’s assault on science threatens your health. 506 New York: Oxford University Press; 2008.507 9. Sutherland WJ, Burgman M. Policy advice: Use experts wisely. Nature. 2015;526(7573):317-8.508 10. World Health Organization. WHO Handbook for Guideline Development. 2nd edition. 509 Geneva: World Health Organization; 2014.510 11. Verbeek J. Could we have better occupational health guidelines, please? Scand J Work 511 Environ Health. 2018;44(5):441-2.
Page 22 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
512 12. Green S, Higgins JP, Alderson P, et al. Cochrane Handbook for Systematic Reviews of 513 Interventions; CHAPTER 1: INTRODUCTION training.cochrane.org/handbook: The Cochrane 514 Collaboration; 2011 [5.1:[515 13. Higgins J, S G. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 516 [updated March 2011] Chapter 22: Overviews of reviews: The Cochrane Collaboration; 2011 517 [Available from: www.handbook.cochrane.org.518 14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 519 meta-analyses: the PRISMA statement. International journal of surgery (London, England). 520 2010;8(5):336-41.521 15. Moher D, Tsertsvadze A, Tricco A, et al. When and how to update systematic reviews. 522 Cochrane Database Syst Rev. 2008(1).523 16. Montano D, Hoven H, Siegrist J. Effects of organisational-level interventions at work on 524 employees' health: a systematic review. BMC Public Health. 2014;14:135.525 17. International Labour Organization (ILO). ILO List of Occupational Diseases (revised 2010) 526 2010 [10. August 2017]. Available from: http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---527 protrav/---safework/documents/publication/wcms_125137.pdf.528 18. Allgemeine Unvfallversicherungsanstalt (AUVA). Liste der Berufskrankheiten, Inkrafttreten: 529 01.01.2014 2014 [Available from: https://www.auva.at/cdscontent/load?contentid=10008.541831.530 19. Whiting P, Savovic J, Higgins JP, et al. ROBIS: A new tool to assess risk of bias in systematic 531 reviews was developed. J Clin Epidemiol. 2016;69:225-34.532 20. Green S, Higgins JP, Alderson P, et al. Cochrane Handbook for Systematic Reviews of 533 Interventions; PART 2; 12.2.1 The GRADE approach training.cochrane.org/handbook: The Cochrane 534 Collaboration; 2011 [5.1:[535 21. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of 536 evidence. J Clin Epidemiol. 2011;64(4):401-6.537 22. Aas RW, Tuntland H, Holte KA, et al. Workplace interventions for neck pain in workers. 538 Cochrane Database Syst Rev. 2011(4):CD008160.539 23. Chen X, Coombes BK, Sjogaard G, et al. Workplace-Based Interventions for Neck Pain in 540 Office Workers: Systematic Review and Meta-Analysis. Phys Ther. 2018;98(1):40-62.541 24. Goodman G, Kovach L, Fisher A, et al. Effective interventions for cumulative trauma disorders 542 of the upper extremity in computer users: practice models based on systematic review. Work. 543 2012;42(1):153-72.544 25. Lowry V, Desjardins-Charbonneau A, Roy JS, et al. Efficacy of workplace interventions for 545 shoulder pain: A systematic review and meta-analysis. J Rehabil Med. 2017;49(7):529-42.546 26. Richardson A, McNoe B, Derrett S, et al. Interventions to prevent and reduce the impact of 547 musculoskeletal injuries among nurses: A systematic review. Int J Nurs Stud. 2018;82:58-67.548 27. Kelly D, Shorthouse F, Roffi V, et al. Exercise therapy and work-related musculoskeletal 549 disorders in sedentary workers. Occupational Medicine. 2018;68(4):262-72.550 28. Stock SR, Nicolakakis N, Vezina N, et al. Are work organization interventions effective in 551 preventing or reducing work-related musculoskeletal disorders? A systematic review of the 552 literature. Scand J Work Environ Health. 2018;44(2):113-33.553 29. Crawford JO, Laiou E, Spurgeon A, et al. Musculoskeletal disorders within the 554 telecommunications sector-A systematic review. Int J Ind Ergon. 2008;38(1):56-72.555 30. Hoe VC, Urquhart DM, Kelsall HL, et al. Ergonomic design and training for preventing work-556 related musculoskeletal disorders of the upper limb and neck in adults. Cochrane Database Syst Rev. 557 2012(8):CD008570.558 31. Freiberg A, Euler U, Girbig M, et al. Does the use of small aids during patient handling 559 activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic 560 review. Int Arch Occup Environ Health. 2016;89(4):547-59.561 32. Hegewald J, Berge W, Heinrich P, et al. Do Technical Aids for Patient Handling Prevent 562 Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies. 563 Int J Environ Res Public Health. 2018;15(3):09.
Page 23 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
564 33. Verbeek JH, Martimo KP, Karppinen J, et al. Manual material handling advice and assistive 565 devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 566 2011(6):CD005958.567 34. Rautiainen RH, Lehtola MM, Day LM, et al. Interventions for preventing injuries in the 568 agricultural industry. Cochrane Database Syst Rev. 2008(1):CD006398.569 35. van der Molen HF, Basnet P, Hoonakker PL, et al. Interventions to prevent injuries in 570 construction workers. Cochrane Database Syst Rev. 2018;2:CD006251.571 36. Cashman CM, Ruotsalainen JH, Greiner BA, et al. Alcohol and drug screening of occupational 572 drivers for preventing injury. Cochrane Database Syst Rev. 2009(2):CD006566.573 37. Mischke C, Verbeek JH, Saarto A, et al. Gloves, extra gloves or special types of gloves for 574 preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev. 575 2014(3):CD009573.576 38. Parantainen A, Verbeek JH, Lavoie MC, et al. Blunt versus sharp suture needles for preventing 577 percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev. 2011(11):CD009170.578 39. Reddy VK, Lavoie MC, Verbeek JH, et al. Devices for preventing percutaneous exposure 579 injuries caused by needles in healthcare personnel. Cochrane Database Syst Rev. 2017;11:CD009740.580 40. Verbeek JH, Ijaz S, Mischke C, et al. Personal protective equipment for preventing highly 581 infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane 582 Database Syst Rev [Internet]. 2016 [cited I; (4). Available from: http://cochranelibrary-583 wiley.com/doi/10.1002/14651858.CD011621.pub2/abstract.584 41. Lunt JA, Sheffield D, Bell N, et al. Review of preventative behavioural interventions for 585 dermal and respiratory hazards. Occup Med (Oxf). 2011;61(5):311-20.586 42. Luong Thanh BY, Laopaiboon M, Koh D, et al. Behavioural interventions to promote workers' 587 use of respiratory protective equipment. Cochrane Database Syst Rev. 2016;12:CD010157.588 43. Bauer A, Ronsch H, Elsner P, et al. Interventions for preventing occupational irritant hand 589 dermatitis. Cochrane Database Syst Rev. 2018;4:CD004414.590 44. Tikka C, Verbeek JH, Kateman E, et al. Interventions to prevent occupational noise-induced 591 hearing loss. Cochrane Database Syst Rev. 2017;7:CD006396.592 45. Mischke C, Verbeek JH, Job J, et al. Occupational safety and health enforcement tools for 593 preventing occupational diseases and injuries. Cochrane Database Syst Rev. 2013(8):CD010183.594 46. van Vilsteren M, van Oostrom SH, de Vet HC, et al. Workplace interventions to prevent work 595 disability in workers on sick leave. Cochrane Database Syst Rev. 2015(10):CD006955.596 47. Elsler D, Takala J, Remes J. An International Comparison of the Cost or Work-Related 597 Accidents and Illnesses. European Agency for Safety and Health at Work: Bilbao, Spain. 2017.598 48. Piso B, Semlitsch T, Reinsperger I, et al. Practical experience with overviews of reviews–599 valuable decision aid or academic exercise? Zeitschrift für Evidenz, Fortbildung und Qualität im 600 Gesundheitswesen. 2015;109(4):300-8.601 49. Irving, M., Eramudugolla, R., Cherbuin, N., & Anstey, K. J. A critical review of grading systems: 602 implications for public health policy. Evaluation & the health professions. 2017;40.2:244-262.603 50. Zhang, Z., Xu, X., & Ni, H. Small studies may overestimate the effect sizes in critical care 604 meta-analyses: a meta-epidemiological study. Critical care. 2013;17(1):R2.605 51. Egger, M., Smith, G. D., Schneider, M., & Minder, C. Bias in meta-analysis detected by a 606 simple, graphical test. Bmj. 1997;315(7109):629-634.607
Page 24 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
PRISMA Flowchart of the study selection process
Page 25 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Section/topic # Checklist item Reported on page #
TITLE
Title 1 Identify the report as a systematic review, meta-analysis, or both. 3
Identified as “Overview of reviews”
ABSTRACT
Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
50-73
INTRODUCTION
Rationale 3 Describe the rationale for the review in the context of what is already known. 92-126
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
120-122
METHODS
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
128-129
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered,
language, publication status) used as criteria for eligibility, giving rationale.
146-175
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
135-145
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
Appendix 1
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable,
included in the meta-analysis).
176-182
Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
192-214
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
196-203
Risk of bias in individual studies
12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
183-191
Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means). 193
Page 26 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
192-195; 211-214
Page 1 of 2
Section/topic # Checklist item Reported on page #
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
Not applicable for Overviews of reviews
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
Not applicable for Overviews of reviews
RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
221-232
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
Table 4 (Appendix 2)
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). Appendix 4
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Appendix 5 and line 245-383
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency. Not applicable for narrative synthesis
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15). Not applicable for Overviews of reviews
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]). Not applicable for
Page 27 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Overviews of reviews
DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
387-413
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
418-441
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research. 448-460
FUNDING
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
464-466
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097
For more information, visit: www.prisma-statement.org.
Page 2 of 2
Page 28 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 2 – Search strategies
Search strategy MEDLINE (Ovid)
Ovid MEDLINE(R) 1946 to May Week 5 2018, Ovid MEDLINE(R) Epub Ahead of Print June 11, 2018, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations June 11, 2018, Ovid MEDLINE(R) Daily Update June 11, 2018
# Searches Results
1 Occupational Diseases/pc [Prevention & Control] 16456
2 Occupational Exposure/pc [Prevention & Control] 6085
3 Accidents, Occupational/pc [Prevention & Control] 5270
4 Occupational Injuries/pc [Prevention & Control] 686
5 Occupational Health/ed, lj, st [Education, Legislation & Jurisprudence, Standards] 3238
6 ((worker* or workplace or work related or occupation*) and intervention*).ti. 2050
7 or/1-6 30483
8
Occupational Exposure/ or Air Pollutants, Occupational/ or Accidents, Occupational/ or Dermatitis, Occupational/ or Occupational Diseases/ or Occupational Injuries/ or Asthma, Occupational/ or Noise, Occupational/ 149967
9 Occupational Health/ 30516
10 (worker* or workplace or work related or occupation*).ti. 116658
11 ((work* or occupation*) adj3 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)).ti,ab. 87656
12 *Work/ 15722
13 *Workplace/ 9376
14 *Occupations/ 9517
15 or/8-14 279210
16 Primary Prevention/ 16807
17 Health Education/ 57758
18 Health Promotion/ 66696
19 Risk Reduction Behavior/ 10752
20 Safety Management/ 18827
21 "Facility Design and Construction"/ 8866
22 Personal Protective Equipment/ 240
23 Occupational Health Services/ 10302
24 (health adj2 (safety or outcome? or benefit? or harm? or effect?)).ti,ab. 109219
25 (prevent* or promot* or reduc* or protect*).ti. 843783
26 ((prevent* or promot* or reduc* or protect*) adj4 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)).ab. 364870
27 or/16-26 1360949
28 15 and 27 47978
29 7 or 28 64546
30 exp age groups/ not (adolescent/ or exp adult/) 1190456
31 29 not 30 63888
32 review.pt. 2393987
Page 29 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only33
(medline or medlars or embase or pubmed or cochrane or (scisearch or psychinfo or psycinfo) or (psychlit or psyclit) or cinahl or ((hand adj2 search$) or (manual$ adj2 search$)) or (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$) or (pooling or pooled or mantel haenszel) or (peto or dersimonian or der simonian or fixed effect)).tw,sh. or (retraction of publication or retracted publication).pt. 270445
34 32 and 33 135062
35
meta-analysis.pt. or meta-analysis.sh. or (meta-analys$ or meta analys$ or metaanalys$).tw,sh. or (systematic$ adj5 review$).tw,sh. or (systematic$ adj5 overview$).tw,sh. or (quantitativ$ adj5 review$).tw,sh. or (quantitativ$ adj5 overview$).tw,sh. or (quantitativ$ adj5 synthesis$).tw,sh. or (methodologic$ adj5 review$).tw,sh. or (methodologic$ adj5 overview$).tw,sh. or (integrative research review$ or research integration).tw. 244993
36 34 or 35 296663
37 31 and 36 1349
38 limit 37 to yr="2008 -Current" 1071
Search strategy the Cochrane Library (Wiley)
Cochrane Library 12 June 2018 ID Search Hits
#1 [mh ^"Occupational Diseases"/pc] 448
#2 [mh ^"Occupational Exposure"/pc] 106
#3 [mh ^"Accidents, Occupational"/pc] 81
#4 [mh ^"Occupational Injuries"/pc] 29
#5 [mh ^"Occupational Health"/ed,lj,st] 32
#6 ((worker* or workplace or work related or occupation*) and intervention*):ti 936
#7 {or #1-#6} 1501
#8
[mh ^"Occupational Exposure"] or [mh ^"Air Pollutants, Occupational"] or [mh ^"Accidents, Occupational"] or [mh "Dermatitis, Occupational"] or [mh ^"Occupational Diseases"] or [mh ^"Occupational Injuries"] or [mh ^"Asthma, Occupational"] or [mh ^"Noise, Occupational"] 1611
#9 [mh ^"Occupational Health"] 666
#10 (worker* or workplace or "work related" or occupation*):ti,kw 9385
#11 ((work* or occupation*) near/3 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)):ti,ab,kw 4919
#12 [mh ^work] 225
#13 [mh ^workplace] 829
#14 [mh ^occupations] 165
#15 {or #8-#14} 11318
#16 [mh ^"Primary Prevention"] 1070
#17 [mh ^"Health Education"] 3823
Page 30 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
#18 [mh ^"Health Promotion"] 5699
#19 [mh ^"Risk Reduction Behavior"] 1708
#20 [mh ^"Safety Management"] 239
#21 [mh ^"Facility Design and Construction"] 30
#22 [mh ^"Personal Protective Equipment"] 14
#23 [mh ^"Occupational Health Services"] 423
#24 (health near/2 (safety or outcome* or benefit* or harm* or effect*)):ti,ab,kw 21303
#25 (prevent* or promot* or reduc* or protect*):ti,kw 148148
#26 ((prevent* or promot* or reduc* or protect*) near/4 (disease* or expos* or disorder* or risk* or accident* or injur* or hazard* or illness* or compliance)):ab 45883
#27 {or #16-#26} 191090
#28 #15 and #27 4272
#29 #7 or #28 4857
#30 [mh "age groups"] not ([mh adolescent] or [mh adult]) 14410
#31 #29 not #30 4832
#32 #31 Publication Year from 2008 to 2018, in Cochrane Reviews (Reviews and Protocols), Other Reviews, Technology Assessments and Economic Evaluations 520
Search strategy Epistemonikos.org
Epistemonikos 12 June 2018 Query Results
(advanced_title_en:((worker* OR workplace OR "work related" OR occupation*) AND (disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance) AND (prevent* OR promot* OR reduc* OR protect*)) OR advanced_abstract_en:((worker* OR workplace OR "work related" OR occupation*) AND (disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance) AND (prevent* OR promot* OR reduc* OR protect*))) NOT advanced_title_en:(child* OR infant* OR newborn* OR neonat*) [Filters: protocol=no, classification=systematic-review, min_year=2008, max_year=2018] 926
Search strategy Scopus (Elsevier)
Scopus
12 June 2018
# Search Terms Results Comment
3 TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* )
3,066 document results
Page 31 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
4 TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) )
78,866 document results
5 ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) )
81,302 document results
3 OR 4
6 TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) )
355,097 document results
7 ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) )
1,440 document results
5 AND 6
8 INDEX ( medline ) 23,755,237 document results
9 ( ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) ) ) AND NOT ( INDEX ( medline ) )
396 document results
7 NOT 8
Page 32 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
10
( ( ( TITLE ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) AND intervention* ) ) OR ( TITLE-ABS-KEY ( ( ( worker* OR workplace OR "work related" OR occupation* OR employee* ) W/3 ( disease* OR exposure* OR disorder* OR risk OR risks OR accident OR accidents OR injury OR injouries OR hazard OR hazards OR illness* OR compliance ) ) AND ( prevent* OR promot* OR reduc* OR protect* ) ) ) ) AND ( TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) ) ) ) AND NOT ( INDEX ( medline ) ) AND ( LIMIT-TO ( PUBYEAR , 2018 ) OR LIMIT-TO ( PUBYEAR , 2017 ) OR LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) OR LIMIT-TO ( PUBYEAR , 2011 ) OR LIMIT-TO ( PUBYEAR , 2010 ) OR LIMIT-TO ( PUBYEAR , 2009 ) OR LIMIT-TO ( PUBYEAR , 2008 ) )
324 document results
2008-2018
Page 33 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 3 – List of excluded full texts
Ineligible study design
Addo MA, Stephen AI, Kirkpatrick P. Acute mental health/psychiatric nurses' experiences of clinical supervision in promoting their wellbeing in their workplace: a systematic review. JBI Libr Syst Rev. 2012;10(56 Suppl):1-16.
Apisarnthanarak A, Uyeki T, Puthavathana P, Kitphati R, Mundy L. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand (Provisional abstract). Infection Control and Hospital Epidemiology [Internet]. 2010 [cited E; 31(10):[996-1003 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22010001963/frame.html.
Baldasseroni A, Olimpi N, Bonaccorsi G. [A systematic review of the effectiveness of workplace safety interventions]. Med Lav. 2009;100(4):268-71.
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med. 2009;48(5):454-61.
Birdi K, Beach J. Management of sensitizer-induced occupational asthma: avoidance or reduction of exposure? Curr Opin Allergy Clin Immunol. 2013;13(2):132-7.
Bruno Garza JL, Young JG. A literature review of the effects of computer input device design on biomechanical loading and musculoskeletal outcomes during computer work. Work. 2015;52(2):217-30.
Bullock SH, Jones BH, Gilchrist J, Marshall SW. Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med. 2010;38(1 Suppl):S156-81.
Burdorf A, Koppelaar E, Evanoff B. Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Occup Environ Med. 2013;70(7):491-7.
Cadth. Respiratory precautions for protection from bioaerosols or infectious agents: a review of the clinical effectiveness and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000193/frame.html.
Cadth. Wear compliance and donning/doffing of respiratory protection for bioaerosols or infectious agents: a review of the effectiveness, safety, and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000192/frame.html.
de Matteis S, Heederik D, Burdorf A, Colosio C, Cullinan P, Henneberger PK, et al. Current and new challenges in occupational lung diseases. Eur. 2017;26(146).
De Sio S, Traversini V, Rinaldo F, Colasanti V, Buomprisco G, Perri R, et al. Ergonomic risk and preventive measures of musculoskeletal disorders in the dentistry environment: an umbrella review. Peerj. 2018;6:e4154.
Flynn JP, Gascon G, Doyle S, Matson Koffman DM, Saringer C, Grossmeier J, et al. Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements. Am J Health Promot. 2018:890117118761887.
Frutiger M, Tuchin PJ. Chiropractic curriculum mapping and congruence of the evidence for workplace interventions in work-related neck pain. J Chiropractic Educ. 2017;31(2):115-24.
Page 34 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Goldgruber J, Ahrens D. Effectiveness of workplace health promotion and primary prevention interventions: A review. J Public Health (Oxf). 2010;18(1):75-88.
Goldgruber J, Ahrens D. Health-related interventions in the workplace : Review of the effectiveness of workplace health promotion and primary prevention. Pravent Gesundheitsforderung. 2009;4(1):83-95.
Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, et al. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46(4):683-97.
Maguire E, Spurr A. Implementation of ultraviolet radiation safety measures for outdoor workers: A Canadian perspective. J Cutaneous Med Surg. 2017;21(2):117-24.
Miguelino ES. A meta-analytic review of the effectiveness of single-layer clothing in preventing exposure from pesticide handling. J. 2014;19(4):373-83.
Mohammadi M, Danaee L, Alizadeh E. Reduction of Radiation Risk to Interventional Cardiologists and Patients during Angiography and Coronary Angioplasty. The Journal of Tehran Heart Center. 2017;12(3):101-6.
Nafees AA, Fatmi Z. Available Interventions for Prevention of Cotton Dust-Associated Lung Diseases Among Textile Workers. J Coll Physicians Surg Pak. 2016;26(8):685-91.
Nicholson PJ, Llewellyn D, English JS, Guidelines Development G. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis. 2010;63(4):177-86.
Parikh JR, Geise RA, Bluth EI, Bender CE, Sze G, Jones AK, et al. Potential Radiation-Related Effects on Radiologists. AJR Am J Roentgenol. 2017;208(3):595-602.
Shiftwork and health risks: possibilities for prevention (Structured abstract). Health Technology Assessment Database [Internet]. 2015 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32016000066/frame.html.
Snodgrass J. Special issue on work-related injuries and illnesses and the role of occupational therapy: implications of a systematic literature review for practice, research, education, and policy. Am J Occup Ther. 2011;65(1):7-9.
Tarlo SM, Lemiere C. Occupational asthma. New Engl J Med. 2014;370(7):640-9.
Theis J, Finkelstein M. Long-term effects of safe patient handling program on staff injuries (Provisional abstract). Rehabilitation Nursing Journal [Internet]. 2014 [cited E; 39(1):[26-35 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22014013150/frame.html.
Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P, et al. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J. 2011;38(4):804-11.
Verbeek J, Ivanov I. Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence. Saf Health Work. 2013;4(2):77-83.
Walden C, Bankard S, Cayer B, Floyd W, Garrison H, Hickey T, et al. Mobilization of the obese patient and prevention of injury (Provisional abstract). Annals of Surgery [Internet]. 2013 [cited E; 258(4):[646-50 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cleed/articles/NHSEED-22013045482/frame.html.
Wassell JT. Workplace violence intervention effectiveness: A systematic literature review. Safety Science. 2009;47(8):1049-55.
Page 35 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Westgaard RH, Winkel J. Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review. Appl Ergon. 2011;42(2):261-96.
Westgaard RH. RCTs of ergonomic interventions. Occup Environ Med. 2010;67(4):217-8.
Yassi A, Lockhart K, Sykes M, Buck B, Stime B, Spiegel JM. Effectiveness of joint health and safety committees: a realist review. Am J Ind Med. 2013;56(4):424-38.
Zhou Z, Goh YM, Li Q. Overview and analysis of safety management studies in the construction industry. Safety Science. 2015;72:337-50.
Ineligible document type
Alahmari MAS, Sun Z. A systematic review of the efficiency of radiation protection training in raising awareness of medical staff working in catheterisation laboratory. Curr Med Imaging Rev. 2015;11(3):200-6.
Buchberger B, Heymann R, Huppertz H, Frieportner K, Pomorin N, Wasem J. The effectiveness of interventions in workplace health promotion as to maintain the working capacity of health care personal. GMS Health Technol Assess. 2011;7:Doc06.
de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma: a Cochrane systematic review. Occup Environ Med. 2012;69(5):373-4.
El Dib RP, Mathew JL. Interventions to promote the wearing of hearing protection. Cochrane Database Syst Rev. 2009(4):Cd005234.
Lipscomb HJ, Dement JM. A counterview on data quality and the systematic review process for occupational injury interventions: are we missing the forest for the trees? Am J Prev Med. 2009;36(4):377-8; author reply 8.
Picheansathian W, Chotibang J. Glove utilization in the prevention of cross transmission: a systematic review. JBI Database System Rev Implement Rep. 2015;13(4):188-230.
Verbeek J, Morata T, Ruotsalainen J, Vainio H. Prevention of occupational diseases: implementing the evidence. Cochrane Database Syst Rev [Internet]. 2013 [cited E; (4). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.ED000056/abstract.
Ineligible study population
Nieuwenhuijsen K, Bultmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, van der Feltz-Cornelis CM. Interventions to improve occupational health in depressed people. Cochrane Database Syst Rev. 2008(2):CD006237.
Schaafsma FG, Mahmud N, Reneman MF, Fassier JB, Jungbauer FH. Pre-employment examinations for preventing injury, disease and sick leave in workers. Cochrane Database Syst Rev. 2016(1):CD008881.
Stojanovic MD, Ostojic SM. Preventing ACL Injuries in Team-Sport Athletes: A Systematic Review of Training Interventions. Research in sports medicine (Print). 2012;20(3-4):223-38.
Ineligible intervention
Page 36 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Bercier ML, Maynard BR. Interventions for Secondary Traumatic Stress With Mental Health Workers: A Systematic Review. Res Soc Work Pract. 2015;25(1):81-9.
Bernaldo-De-Quirós M, Labrador FJ, Piccini AT, Mar Gómez M, Cerdeira JC. Workplace violence in prehospital emergency care: A systematic review and outlines of psychological intervention Second prize of the 20th "rafael Burgaleta" Applied Psychology Awards 2013. Clin Salud. 2014;25(1):11-8.
Breeze J, Baxter D, Carr D, Midwinter MJ. Defining combat helmet coverage for protection against explosively propelled fragments. J R Army Med Corps. 2015;161(1):9-13.
Christian MS, Bradley JC, Wallace JC, Burke MJ. Workplace safety: a meta-analysis of the roles of person and situation factors. J Appl Psychol. 2009;94(5):1103-27.
Furlan AD, Gnam WH, Carnide N, Irvin E, Amick BC, 3rd, DeRango K, et al. Systematic review of intervention practices for depression in the workplace. J Occup Rehabil. 2012;22(3):312-21.
Pereira-de-Paiva MH, Calassa-Albuquerque MdC, Latham EE, Furtado-Bezerra C, da-Silva-Sousa A, Cunha-e-Silva-de-Araújo L, et al. Occupational hazards of Brazilian solid waste workers: a systematic literature review. Rev bras med trab. 2017;15(4):364-71.
van Wyk BE, Pillay-Van Wyk V. Preventive staff-support interventions for health workers. Cochrane Database Syst Rev. 2010(3):CD003541.
Ineligible comparison
Moreira RF, Foltran FA, Albuquerque-Sendin F, Mancini MC, Coury HJ. Comparison of randomized and non-randomized controlled trials evidence regarding the effectiveness of workplace exercise on musculoskeletal pain control. Work. 2012;41 Suppl 1:4782-9.
Ineligible outcome
Basu S, Qayyum H, Mason S. Occupational stress in the ED: a systematic literature review. Emerg Med J. 2017;34(7):441-7.
Brand SL, Thompson Coon J, Fleming LE, Carroll L, Bethel A, Wyatt K. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLoS ONE. 2017;12(12):e0188418.
Butler M, Collins R, Drennan J, Halligan P, O'Mathúna DP, Schultz TJ, et al. Hospital nurse staffing models and patient and staff-related outcomes. Cochrane Database Syst Rev [Internet]. 2011 [cited E; (7). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD007019.pub2/abstract.
Cassidy JD, Cote P. Is it time for a population health approach to neck pain? J Manipulative Physiol Ther. 2008;31(6):442-6.
Cooklin A, Joss N, Husser E, Oldenburg B. Integrated Approaches to Occupational Health and Safety: A Systematic Review. Am J Health Promot. 2017;31(5):401-12.
Feltner C, Peterson K, Palmieri Weber R, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. The Effectiveness of Total Worker Health Interventions: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2016;165(4):262-9.
Page 37 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Feltner C, Peterson K, Weber RP, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. Total Worker Health(®)2016 2016/05/None.
Kahn-Marshall J, Gallant M. Making healthy behaviors the easy choice for employees: a review of the literature on environmental and policy changes in worksite health promotion (Structured abstract). Health Education and Behavior [Internet]. 2012 [cited E; 39(6):[752-76 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12013005967/frame.html.
Ker K, Edwards PJ, Felix LM, Blackhall K, Roberts I. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev. 2010(5):CD008508.
Lachance CC, Jurkowski MP, Dymarz AC, Robinovitch SN, Feldman F, Laing AC, et al. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety. PLoS ONE. 2017;12(2):e0171652.
LaMontagne, A. D., Keegel, T., Louie, A. M., Ostry, A., & Landsbergis, P. A. A systematic review of the job-stress intervention evaluation literature, 1990-2005 (International Journal of Occupational and Environmental Health (2007) 13, (268-80)). International Journal of Occupational and Environmental Health. 2008;14(1):24.
Lu ML, Putz-Anderson V, Garg A, Davis KG. Evaluation of the Impact of the Revised National Institute for Occupational Safety and Health Lifting Equation. Hum Factors. 2016;58(5):667-82.
Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. Bmj. 2015;351:h3728.
MacEwen BT, MacDonald DJ, Burr JF. A systematic review of standing and treadmill desks in the workplace. Prev Med. 2015;70:50-8.
Martin A, Sanderson K, Cocker F. Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms. Scand J Work Environ Health. 2009;35(1):7-18.
Neil-Sztramko SE, Pahwa M, Demers PA, Gotay CC. Health-related interventions among night shift workers: a critical review of the literature. Scand J Work Environ Health. 2014;40(6):543-56.
Pachito DV, Eckeli AL, Desouky AS, Corbett MA, Partonen T, Rajaratnam SM, et al. Workplace lighting for improving alertness and mood in daytime workers. The Cochrane database of systematic reviews. 2018;3:CD012243.
Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008. J Occup Environ Med. 2009;51(7):822-37.
Plat MJ, Frings-Dresen MH, Sluiter JK. A systematic review of job-specific workers' health surveillance activities for fire-fighting, ambulance, police and military personnel. Int Arch Occup Environ Health. 2011;84(8):839-57.
Price L, Melone L, McLarnon N, Bunyan D, Kilpatrick C, Flowers P, et al. A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers. Am J Infect Control. 2018;27:27.
Sayapathi BS, Su AT, Koh D. The effectiveness of applying different permissible exposure limits in preserving the hearing threshold level: a systematic review. J Occup Health. 2014;56(1):1-11.
Page 38 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Silva J, Santos Baptista J, Rodrigues C, editors. Use of effectiveness and efficiency concepts in occupational safety management on motorways: A systematic review2016. E: CRC Press/Balkema.
Slanger TE, Gross JV, Pinger A, Morfeld P, Bellinger M, Duhme A-L, et al. Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work. Cochrane Database Syst Rev [Internet]. 2016 [cited E; (8). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD010641.pub2/abstract.
Srigley JA, Corace K, Hargadon DP, Yu D, MacDonald T, Fabrigar L, et al. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. The Journal of hospital infection. 2015;91(3):202-10.
Studnek JR, Infinger AE, Renn ML, Weiss PM, Condle JP, Flickinger KL, et al. Effect of Task Load Interventions on Fatigue in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review. Prehosp Emerg Care. 2018;22(sup1):81-8.
Varatharajan S, Cote P, Shearer HM, Loisel P, Wong JJ, Southerst D, et al. Are work disability prevention interventions effective for the management of neck pain or upper extremity disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. J Occup Rehabil. 2014;24(4):692-708.
Yazdani A, Wells R. Prevention of MSD within OHSMS/IMS: a systematic review of risk assessment strategies. Work. 2012;41 Suppl 1:2765-7.
Full text not retrievable
Bonfiglioli R, Farioli A, Mattioli S, Violante FS. [Evidence based prevention and upper limb work-related musculoskeletal disorders]. G Ital Med Lav Ergon. 2008;30(3 Suppl):26-31.
Buil Cosiales P. Educative techniques and training in weight lifting does not prevent back pain in workers. FMC Formacion Med Continuada Aten Prim. 2008;15(9):626.
Cadth. Hearing protection fit testing systems: clinical and cost-effectiveness and guidelines (Structured abstract). Health Technology Assessment Database [Internet]. 2014 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32015000305/frame.html.
dos Santos NC, Santos LS, Camelier FWR, Maciel RRBT, Portella DDA. Technologies applied to occupational health promotion: a systematic review. Rev bras med trab. 2017;15(1):113-22.
El Dib RP. A systematic review of hearing protective devises: Types, uses and safety. Deafness, Hearing Loss and the Auditory System: Nova Science Publishers, Inc.; 2011. p. 227-48.
Leas B, Umscheid C. Healthcare worker clothing and infection control (Structured abstract). Health Technology Assessment Database [Internet]. 2011 [cited E; (4). Available from: http://cochranelibrary-wiley.com/o/cochrane/clhta/articles/HTA-32011001593/frame.html.
Parantainen A, Anthoni M, Hellgren UM, Lavoie MC, Valdes A, Verbeek JH. Prevention of percutaneous injuries with risk of hepatitis B, hepatitis C, or other viral infections for health-care workers. Cochrane Database Syst Rev. 2008(2).
Sancini A, Caciari T, Fioravanti M, Tria M, Scimitto L, Fiaschetti M, et al. [Meta-analysis: effectiveness of the preventive interventions in agriculture accidents]. G Ital Med Lav Ergon. 2010;32(4 Suppl):25-30.
Page 39 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Ineligible setting
Awa WL, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010;78(2):184-90.
Gross A, Forget M, St GK, Fraser MM, Graham N, Perry L, et al. Patient education for neck pain. Cochrane Database Syst Rev [Internet]. 2012 [cited E; (3). Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005106.pub4/abstract.
Simonelli AP, Almeida IMd, Vilela RAG, Jackson Filho JM. Influence of behavioral safety practices and models of prevention of occupational accidents: a systematic review of the literature. Saúde Soc. 2016;25(2):463-78.
Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. Cmaj. 2016;188(8):567-74.
Zhang YT, Wang LS. Protection education towards needle stick injuries among nursing students in China: A meta-analysis. Chin J Evid-Based Med. 2013;13(6):754-9.
Ineligible study design primary studies
Anger WK, Elliot DL, Bodner T, Olson R, Rohlman DS, Truxillo DM, et al. Effectiveness of Total Worker Health interventions. J Occup Health Psychol. 2015;20(2).
Bambra C, Whitehead M, Sowden A, Akers J, Petticrew M. "A hard day's night?" The effects of Compressed Working Week interventions on the health and work-life balance of shift workers: a systematic review. J Epidemiol Community Health. 2008;62(9):764-77.
Barger LK, Runyon MS, Renn ML, Moore CG, Weiss PM, Condle JP, et al. Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis. Prehosp Emerg Care. 2018;22(sup1):58-68.
Bercier ML. Interventions that help the helpers: A systematic review and meta-analysis of interventions targeting compassion fatigue, secondary traumatic stress and vicarious traumatization in mental health workers. Dissertation Abstracts International Section A: Humanities and Social Sciences. 2014;74(10-A(E)).
Caffaro F, Micheletti Cremasco M, Bagagiolo G, Vigoroso L, Cavallo E. Effectiveness of occupational safety and health training for migrant farmworkers: a scoping review. Public Health. 2018;160:10-7.
Clemes SA, Haslam CO, Haslam RA. What constitutes effective manual handling training? A systematic review. Occup Med (Oxf). 2010;60(2):101-7.
Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016;13(6):22.
Cooke CE, Stephens JM. Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Med Devices (Auckl). 2017;10:225-35.
Crickman R, Finnell D. Systematic Review of Control Measures to Reduce Hazardous Drug Exposure for Health Care Workers. J Nurs Care Qual. 2016;31(2):183-90.
d'Ettorre G, Criscuolo M, Mazzotta M. Managing Formaldehyde indoor pollution in anatomy pathology departments. Work. 2017;56(3):397-402.
Eastlake A, Zumwalde R, Geraci C. Can Control Banding be Useful for the Safe Handling of Nanomaterials? A Systematic Review. J Nanopart Res. 2016;18.
Page 40 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Edwards R, Charani E, Sevdalis N, Alexandrou B, Sibley E, Mullett D, et al. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. The Lancet infectious diseases. 2012;12(4):318-29.
Gulumian M, Verbeek J, Andraos C, Sanabria N, de Jager P. Systematic Review of Screening and Surveillance Programs to Protect Workers from Nanomaterials. PLoS ONE. 2016;11(11):e0166071.
Gurusamy KS, Best LM, Tanguay C, Lennan E, Korva M, Bussieres JF. Closed-system drug-transfer devices plus safe handling of hazardous drugs versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff. Cochrane Database Syst Rev. 2018;3:CD012860.
Jaworska-Burzyńska L, Kanaffa-Kilijańska U, Przysiȩzna E, Szczepańska-Gieracha J. The role of therapy in reducing the risk of job burnout - A systematic review of literature. Arch Psychiatry Psychother. 2016;18(4):43-52.
Kolar C, von Treuer K. Alcohol Misuse Interventions in the Workplace: A Systematic Review of Workplace and Sports Management Alcohol Interventions. Int J Ment Health Addict. 2015;13(5):563-83.
Leider PC, Boschman JS, Frings-Dresen MH, van der Molen HF. Effects of job rotation on musculoskeletal complaints and related work exposures: a systematic literature review. Ergonomics. 2015;58(1):18-32.
Lindsay R, Su Ern Y, Dinanda NK. Non‐pharmacological interventions for preventing venous insufficiency in a standing worker population. Cochrane Database Syst Rev. 2013;10(10):CD006345.
Morphet J, Griffiths D, Beattie J, Velasquez Reyes D, Innes K. Prevention and management of occupational violence and aggression in healthcare: A scoping review. Collegian. 2018.
Myojo T, Nagata T, Verbeek J. The Effectiveness of Specific Risk Mitigation Techniques Used in the Production and Handling of Manufactured Nanomaterials: A Systematic Review. J Uoeh. 2017;39(3):187-99.
Nilsson K. Interventions to reduce injuries among older workers in agriculture: A review of evaluated intervention projects. Work. 2016;55(2):471-80.
Pidd K, Roche AM. How effective is drug testing as a workplace safety strategy? A systematic review of the evidence. Accid Anal Prev. 2014;71:154-65.
Richter K, Acker J, Adam S, Niklewski G. Prevention of fatigue and insomnia in shift workers-a review of non-pharmacological measures. Epma J. 2016;7:16.
Rinder MM, Genaidy A, Salem S, Shell R, Karwowski W. Interventions in the construction industry: A systematic review and critical appraisal. Human Factors and Ergonomics in Manufacturing. 2008;18(2).
Schmidt BM, Engel ME, Abdullahi L, Ehrlich R. Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review. BMC Public Health. 2018;18(1):661.
Sena JS, Girao RJ, Carvalho SM, Tavares RM, Fonseca FL, Silva PB, et al. Occupational skin cancer: Systematic review. Rev Assoc Med Bras. 2016;62(3):280-6.
Smedley J, Williams S, Peel P, Pedersen K, Dermatitis Guideline Development G. Management of occupational dermatitis in healthcare workers: a systematic review. Occupational and environmental medicine. 2012;69(4):276-9.
Page 41 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Surber C, Diepgen TL. Outdoor workers sun-related knowledge, attitudes and protective behaviors: A systemic review of cross-sectional and interventional studies. Dermatol Beruf Umwelt. 2013;61(2):79-86.
Tarigan LH, Cifuentes M, Quinn M, Kriebel D. Prevention of needle-stick injuries in healthcare facilities: a meta-analysis. Infect Control Hosp Epidemiol. 2015;36(7):823-9.
Teeple E, Collins JE, Shrestha S, Dennerlein JT, Losina E, Katz JN. Outcomes of safe patient handling and mobilization programs: A meta-analysis. Work. 2017;58(2):173-84.
Vandenplas O, Dressel H, Nowak D, Jamart J, Asthma ERSTFotMoW-r. What is the optimal management option for occupational asthma? Eur. 2012;21(124):97-104.
Superseded by more comprehensive review
de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ. Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. J Physiother. 2018;64(3):159-65.
Mahmud N, Schonstein E, Lehtola MM, Verbeek JH, Fassier JB, Reneman MF, et al. Health examination for preventing occupational injuries and disease in workers. Cochrane Database Syst Rev. 2008(3)
Excluded due to high risk of bias
Ahola K, Toppinen-Tanner S, Seppänen J. Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Res. 2017;4:1-11.
Alias AN, Karuppiah K, Tamrin SBM, Abidin EZ, Shafiei UKM. A systematic review of intervention to reduce musculoskeletal disorders: Hand and arm disorders. J Teknol. 2015;77(27):105-11.
Bell JA, Burnett A. Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review. J Occup Rehabil. 2009;19(1):8-24.
Breslin FC, Kyle N, Bigelow P, Irvin E, Morassaei S, MacEachen E, et al. Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions. J Occup Rehabil. 2010;20(2):163-79.
Bui DP, Balland S, Giblin C, Jung A, Kramer S, Peng A, et al. Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review. Accident Analysis and Prevention. 2018;115:189-201.
Clough BA, March S, Chan RJ, Casey LM, Phillips R, Ireland MJ. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review. Syst. 2017;6(1):144.
Coury HJCG, Moreira RFC, Dias NB. Evaluation of the effectiveness of workplace exercise in controlling neck, shoulder and low back pain: A systematic review. Rev Bras Fisioterapia. 2009;13(6):461-79.
DeGirolamo KM, Courtemanche DJ, Hill WD, Kennedy A, Skarsgard ED. Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence? Can J Surg. 2013;56(4):263-9.
Page 42 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Demoulin C, Marty M, Genevay S, Vanderthommen M, Mahieu G, Henrotin Y. Effectiveness of preventive back educational interventions for low back pain: A critical review of randomized controlled clinical trials. Eur Spine J. 2012;21(12):2520-30.
Dick FD, Graveling RA, Munro W, Walker-Bone K, Guideline Development G. Workplace management of upper limb disorders: a systematic review. Occupational medicine (Oxford, England). 2011;61(1):19-25.
Graveling R, Crawford J, Cowie H, Amati C, Vohra S. A review of workplace interventions that promote mental wellbeing in the workplace (Provisional abstract). Database of Abstracts of Reviews of Effects [Internet]. 2008 [cited I; (2):[1 p.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12010005953/frame.html.
Hogan DA, Greiner BA, O'Sullivan L. The effect of manual handling training on achieving training transfer, employee's behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review. Ergonomics. 2014;57(1):93-107.
Horsham C, Auster J, Sendall MC, Stoneham M, Youl P, Crane P, et al. Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review. BMC Res Notes. 2014;7:10.
Kennedy CA, Amick BC, 3rd, Dennerlein JT, Brewer S, Catli S, Williams R, et al. Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time. J Occup Rehabil. 2010;20(2):127-62.
Krungkraipetch N, Krungkraipetch K, Kaewboonchoo O, Arphorn S, Sim M. Interventions to prevent musculoskeletal disorders among informal sector workers: a literature review. Southeast Asian J Trop Med Public Health. 2012;43(2):510-25.
Leyshon R, Chalova K, Gerson L, Savtchenko A, Zakrzewski R, Howie A, et al. Ergonomic interventions for office workers with musculoskeletal disorders: a systematic review. Work. 2010;35(3):335-48.
Maricuţoiu LP, Sava FA, Butta O. The effectiveness of controlled interventions on employees' burnout: A meta-analysis. J Occup Organ Psychol. 2016;89(1):1-27.
Mullan B, Smith L, Sainsbury K, Allom V, Paterson H, Lopez A-L. Active behaviour change safety interventions in the construction industry: A systematic review. Safety Science. 2015;79:139-48.
Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010. J Occup Environ Med. 2011;53(11):1310-31.
Ricci F, Chiesi A, Bisio C, Panari C, Pelosi A. Effectiveness of occupational health and safety training: A systematic review with meta-analysis. Journal of Workplace Learning. 2016;28(6).
Shorthouse FM, Roffi V, Tack C. Effectiveness of educational materials to prevent occupational low back pain. Occupational medicine (Oxford, England). 2016.
Skamagki G, King A, Duncan M, Wåhlin C. A systematic review on workplace interventions to manage chronic musculoskeletal conditions. Physiother Res Int. 2018.
Stewart W, Terry L. Reducing burnout in nurses and care workers in secure settings. Nurs Stand. 2014;28(34):37-45.
Tullar JM, Brewer S, Amick BC, 3rd, Irvin E, Mahood Q, Pompeii LA, et al. Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. J Occup Rehabil. 2010;20(2):199-219.
Page 43 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Tuncel S, Genaidy A, Shell R, Salem S, Karwowski W, Darwish M, et al. Research to practice: effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment - critical appraisal and meta-analysis (Provisional abstract). Human Factors and Ergonomics in Manufacturing [Internet]. 2008 [cited I; 18(2):[93-124 pp.]. Available from: http://cochranelibrary-wiley.com/o/cochrane/cldare/articles/DARE-12009103454/frame.html.
Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ, et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med. 2016;73(1):62-70.
van Gils RF, Boot CR, van Gils PF, Bruynzeel D, Coenraads PJ, van Mechelen W, et al. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis. 2011;64(2):63-72.
van Niekerk SM, Louw QA, Hillier S. The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC Musculoskelet Disord. 2012;13:145.
Wardle SL, Greeves JP. Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel. J Sci Med Sport. 2017;20 Suppl 4:S3-S10.
Watt AM, Patkin M, Sinnott MJ, Black RJ, Maddern GJ. Scalpel safety in the operative setting: a systematic review. Surgery. 2010;147(1):98-106.
Yang L, Mullan B. Reducing needle stick injuries in healthcare occupations: an integrative review of the literature. ISRN Nurs. 2011;2011:315432.
Excluded due to unclear risk of bias
Ballout RA, Diab B, Harb AC, Tarabay R, Khamassi S, Akl EA. Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis. BMC Health Serv Res. 2016;16:458.
de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2011(5):CD006308.
Driessen MT, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occupational and Environmental Medicine. 2010;67(4):277.
Montano D, Hoven H, Siegrist J. Effects of organisational-level interventions at work on employees' health: a systematic review. BMC Public Health. 2014;14:135.
Moreira-Silva I, Teixeira PM, Santos R, Abreu S, Moreira C, Mota J. The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Workplace Health Saf. 2016;64(5):210-22.
Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017;65(11):1934-42.
Padula RS, Comper MLC, Sparer EH, Dennerlein JT. Job rotation designed to prevent musculoskeletal disorders and control risk in manufacturing industries: A systematic review. Appl Ergon. 2017;58:386-97.
Page 44 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Shah A, Blackhall K, Ker K, Patel D. Educational interventions for the prevention of eye injuries. Cochrane Database Syst Rev. 2009(4):CD006527.
Tompa E, Kalcevich C, Foley M, McLeod C, Hogg-Johnson S, Cullen K, et al. A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement. Am J Ind Med. 2016;59(11):919-33.
van Holland BJ, Soer R, de Boer MR, Reneman MF, Brouwer S. Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness. Int Arch Occup Environ Health. 2015;88(4):389-402.
Page 45 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 4 – Risk of bias assessment
Table 1 is primarily sorted by overall risk of bias (last column, from low to high) and within the categories alphabetically by first
author. Table1: Risk of bias assessment
Authors, year Title CONCERNS regarding
specification of study eligibility
criteria?
CONCERNS regarding
methods used to identify and/or select studies?
CONCERNS regarding
methods used to collect data and appraise studies
CONCERNS regarding
methods used to synthesize
results
RISK OF BIAS introduced by
methods used to identify and/or select studies?
Aas, R. W.; Tuntland, H.; Holte, K. A.; Roe, C.; Lund, T.; Marklund, S.; Moller, A., 2011
Workplace interventions for neck pain in workers low low low low low
Bauer, A.; Ronsch, H.; Elsner, P.; Dittmar, D.; Bennett, C.; Schuttelaar, M. L. A.; Lukacs, J.; John, S. M.; Williams, H. C., 2018
Interventions for preventing occupational irritant hand dermatitis
low low low low low
Cashman, C. M.; Ruotsalainen, J. H.; Greiner, B. A.; Beirne, P. V.; Verbeek, J. H., 2009
Alcohol and drug screening of occupational drivers for preventing injury
low low low low low
Chen, X.; Coombes, B. K.; Sjogaard, G.; Jun, D.; O'Leary, S.; Johnston, V., 2018
Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis
low low low low low
Crawford, J. O.; Laiou, E.; Spurgeon, A.; McMillan, G., 2008
Musculoskeletal disorders within the telecommunications sector-A systematic review
low low low low low
Freiberg, A.; Euler, U.; Girbig, M.; Nienhaus, A.; Freitag, S.; Seidler, A., 2016
Does the use of small aids during patient handling activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic review
low low low low low
Page 46 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Goodman, G.; Kovach, L.; Fisher, A.; Elsesser, E.; Bobinski, D.; Hansen, J., 2012
Effective interventions for cumulative trauma disorders of the upper extremity in computer users: practice models based on systematic review
low low low low low
Hegewald, J.; Berge, W.; Heinrich, P.; Staudte, R.; Freiberg, A.; Scharfe, J.; Girbig, M.; Nienhaus, A.; Seidler, A., 2018
Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies
low low low low low
Hoe, V. C.; Urquhart, D. M.; Kelsall, H. L.; Sim, M. R., 2012
Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults
low low low low low
Kelly, D.; Shorthouse, F.; Roffi, V.; Tack, C., 2018
Exercise therapy and work-related musculoskeletal disorders in sedentary workers
low high low low low
Lowry, V.; Desjardins-Charbonneau, A.; Roy, J. S.; Dionne, C. E.; Fremont, P.; MacDermid, J. C.; Desmeules, F., 2017
Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis
low low low low low
Lunt, J. A.; Sheffield, D.; Bell, N.; Bennett, V.; Morris, L. A., 2011
Review of preventative behavioural interventions for dermal and respiratory hazards
low low low low low
Luong Thanh, B. Y.; Laopaiboon, M.; Koh, D.; Sakunkoo, P.; Moe, H., 2016
Behavioural interventions to promote workers' use of respiratory protective equipment
low low low low low
Mischke, C.; Verbeek, J. H.; Job, J.; Morata, T. C.; Alvesalo-Kuusi, A.; Neuvonen, K.; Clarke, S.; Pedlow, R. I., 2013
Occupational safety and health enforcement tools for preventing occupational diseases and injuries
low low low low low
Page 47 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Mischke, C.; Verbeek, J. H.; Saarto, A.; Lavoie, M. C.; Pahwa, M.; Ijaz, S., 2014
Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel
low low low low low
Parantainen, A.; Verbeek, J. H.; Lavoie, M. C.; Pahwa, M., 2011
Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff
low low low low low
Rautiainen, R. H.; Lehtola, M. M.; Day, L. M.; Schonstein, E.; Suutarinen, J.; Salminen, S.; Verbeek, J., 2008 Lehtola, M. M.; Rautiainen, R. H.; Day, L. M.; Schonstein, E.; Suutarinen, J.; Salminen, S.; Verbeek, J. H., 2008
Interventions for preventing injuries in the agricultural industry Effectiveness of interventions in preventing injuries in agriculture – a systematic review and meta-analysis
low low low low low
Reddy, V. K.; Lavoie, M. C.; Verbeek, J. H.; Pahwa, M., 2017
Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel
low low low low low
Richardson, A.; McNoe, B.; Derrett, S.; Harcombe, H., 2018
Interventions to prevent and reduce the impact of musculoskeletal injuries among nurses: A systematic review
low low low low low
Stock, S. R.; Nicolakakis, N.; Vezina, N.; Vezina, M.; Gilbert, L.; Turcot, A.; Sultan-Taieb, H.; Sinden, K.; Denis, M. A.; Delga, C.; Beaucage, C., 2018
Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature
low low low low low
Tikka, C.; Verbeek, J. H.; Kateman, E.; Morata, T. C.; Dreschler, W. A.; Ferrite, S., 2017
Interventions to prevent occupational noise-induced hearing loss
low low low low low
Page 48 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
van der Molen, H. F.; Basnet, P.; Hoonakker, P. L.; Lehtola, M. M.; Lappalainen, J.; Frings-Dresen, M. H.; Haslam, R.; Verbeek, J. H., 2018
Interventions to prevent injuries in construction workers
low low low low low
van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR, 2015
Workplace interventions to prevent work disability in workers on sick leave
low low low low low
Verbeek, J. H.; Martimo, K. P.; Karppinen, J.; Kuijer, P. P.; Viikari-Juntura, E.; Takala, E. P., 2011 Verbeek, J. H.; Martimo, K. P.; Kuijer, P. P.; Karppinen, J.; Viikari-Juntura, E.; Takala, E. P., 2012 Verbeek, J.; Martimo, K. P.; Karppinen, J.; Kuijer, P. P.; Takala, E. P.; Viikari-Juntura, E., 2012
Manual material handling advice and assistive devices for preventing and treating back pain in workers Proper manual handling techniques to prevent low back pain, a Cochrane systematic review Manual material handling advice and assistive devices for preventing and treating back pain in workers: a Cochrane Systematic Review
low low low low low
Verbeek, Jos H; Ijaz, Sharea; Mischke, Christina; Ruotsalainen, Jani H; Mäkelä, Erja; Neuvonen, Kaisa; Edmond, Michael B; Sauni, Riitta; Kilinc, Balci F Selcen; Mihalache, Raluca C, 2016
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff
low low low low low
Page 49 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Ballout, R. A.; Diab, B.; Harb, A. C.; Tarabay, R.; Khamassi, S.; Akl, E. A., 2016
Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis
low low low unclear unclear
de Groene, G. J.; Pal, T. M.; Beach, J.; Tarlo, S. M.; Spreeuwers, D.; Frings-Dresen, M. H.; Mattioli, S.; Verbeek, J. H., 2011
Workplace interventions for treatment of occupational asthma
low low unclear low unclear
Driessen, Maurice T.; Proper, Karin I.; van Tulder, Maurits W.; Anema, Johannes R.; Bongers, Paulien M.; van der Beek, Allard J., 2010
The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review
unclear unclear low unclear unclear
Montano, D.; Hoven, H.; Siegrist, J., 2014
Effects of organisational-level interventions at work on employees' health: a systematic review
unclear unclear unclear unclear unclear
Moreira-Silva, I.; Teixeira, P. M.; Santos, R.; Abreu, S.; Moreira, C.; Mota, J., 2016
The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis
low low unclear low unclear
Offeddu, V.; Yung, C. F.; Low, M. S. F.; Tam, C. C., 2017
Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis
low unclear unclear low unclear
Padula, R. S.; Comper, M. L. C.; Sparer, E. H.; Dennerlein, J. T., 2017
Job rotation designed to prevent musculoskeletal disorders and control risk in manufacturing industries: A systematic review
low unclear unclear low unclear
Shah, A.; Blackhall, K.; Ker, K.; Patel, D., 2009
Educational interventions for the prevention of eye injuries
low unclear low low unclear
Page 50 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Tompa, E.; Kalcevich, C.; Foley, M.; McLeod, C.; Hogg-Johnson, S.; Cullen, K.; MacEachen, E.; Mahood, Q.; Irvin, E., 2016
A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement
low unclear low low unclear
van Holland, B. J.; Soer, R.; de Boer, M. R.; Reneman, M. F.; Brouwer, S., 2015
Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness
low unclear low low unclear
Ahola, K.; Toppinen-Tanner, S.; Seppänen J., 2017
Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis
low high high high high
Alias, A. N.; Karuppiah, K.; Tamrin, S. B. M.; Abidin, E. Z.; Shafiei, U. K. M., 2015
A systematic review of intervention to reduce musculoskeletal disorders: Hand and arm disorders
unclear high high high high
Bell, J. A.; Burnett, A., 2009 Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review
low high unclear low high
Breslin, F. C.; Kyle, N.; Bigelow, P.; Irvin, E.; Morassaei, S.; MacEachen, E.; Mahood, Q.; Couban, R.; Shannon, H.; Amick, B. C., 3rd; Small Business Systematic Review, Team, 2010
Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions
low high low high high
Bui, D. P.; Balland, S.; Giblin, C.; Jung, A.; Kramer, S.; Peng, A.; Aquino, M. C. P.; Griffin, S.; French, D. D.; Pollack Porter, K.; Crothers, S.; Burgess, J. L., 2018
Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review
high high high high high
Page 51 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Clough, B. A.; March, S.; Chan, R. J.; Casey, L. M.; Phillips, R.; Ireland, M. J., 2017
Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review
low high unclear low high
Coury, H. J. C. G.; Moreira, R. F. C.; Dias, N. B., 2009
Evaluation of the effectiveness of workplace exercise in controlling neck, shoulder and low back pain: A systematic review
low low high low high
DeGirolamo, K. M.; Courtemanche, D. J.; Hill, W. D.; Kennedy, A.; Skarsgard, E. D., 2013
Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence?
unclear high high high high
Demoulin, C.; Marty, M.; Genevay, S.; Vanderthommen, M.; Mahieu, G.; Henrotin, Y., 2012
Effectiveness of preventive back educational interventions for low back pain: A critical review of randomized controlled clinical trials
low high high low high
Dick, F. D.; Graveling, R. A.; Munro, W.; Walker-Bone, K.; Guideline Development, Group, 2011
Workplace management of upper limb disorders: a systematic review
low high low low high
Graveling, Ra; Crawford, Jo; Cowie, H; Amati, C; Vohra, S, 2008
A review of workplace interventions that promote mental wellbeing in the workplace (Provisional abstract)
low high high low high
Hogan, D. A.; Greiner, B. A.; O'Sullivan, L., 2014
The effect of manual handling training on achieving training transfer, employee's behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review
high high high unclear high
Horsham, C.; Auster, J.; Sendall, M. C.; Stoneham, M.; Youl, P.; Crane, P.; Tenkate, T.; Janda, M.; Kimlin, M., 2014
Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review
low low high high high
Page 52 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Kennedy, C. A.; Amick, B. C., 3rd; Dennerlein, J. T.; Brewer, S.; Catli, S.; Williams, R.; Serra, C.; Gerr, F.; Irvin, E.; Mahood, Q.; Franzblau, A.; Van Eerd, D.; Evanoff, B.; Rempel, D., 2010
Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time
low high low unclear high
Krungkraipetch, N.; Krungkraipetch, K.; Kaewboonchoo, O.; Arphorn, S.; Sim, M., 2012
Interventions to prevent musculoskeletal disorders among informal sector workers: a literature review
low unclear low high high
Leyshon, R.; Chalova, K.; Gerson, L.; Savtchenko, A.; Zakrzewski, R.; Howie, A.; Shaw, L., 2010
Ergonomic interventions for office workers with musculoskeletal disorders: a systematic review
unclear high high high high
Maricuţoiu, L. P.; Sava, F. A.; Butta, O., 2016
The effectiveness of controlled interventions on employees' burnout: A meta-analysis
low high high low high
Mullan, B.; Smith, L.; Sainsbury, K.; Allom, V.; Paterson, H.; Lopez, AL, 2015
Active behaviour change safety interventions in the construction industry: A systematic review
unclear high high unclear high
Pelletier, K. R., 2011 A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010
high high high high high
Ricci, F.; Chiesi, A.; Bisio, C.; Panari, C.; Pelosi, A., 2016
Effectiveness of occupational health and safety training: A systematic review with meta-analysis
unclear high unclear unclear high
Shorthouse, F. M.; Roffi, V.; Tack, C., 2016
Effectiveness of educational materials to prevent occupational low back pain
low high low low high
Page 53 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Skamagki, G.; King, A.; Duncan, M.; Wåhlin, C., 2018
A systematic review on workplace interventions to manage chronic musculoskeletal conditions
low low high low high
Stewart, W.; Terry, L., 2014 Reducing burnout in nurses and care workers in secure settings
low high high low high
Tullar, J. M.; Brewer, S.; Amick, B. C., 3rd; Irvin, E.; Mahood, Q.; Pompeii, L. A.; Wang, A.; Van Eerd, D.; Gimeno, D.; Evanoff, B., 2010
Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector
low high low low high
Tuncel, S; Genaidy, A; Shell, R; Salem, S; Karwowski, W; Darwish, M; Noe, F; Singh, D, 2008
Research to practice: effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment - critical appraisal and meta-analysis (Provisional abstract)
low unclear unclear unclear high
Van Eerd, D.; Munhall, C.; Irvin, E.; Rempel, D.; Brewer, S.; van der Beek, A. J.; Dennerlein, J. T.; Tullar, J.; Skivington, K.; Pinion, C.; Amick, B., 2016
Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence
low high low unclear high
van Gils, R. F.; Boot, C. R.; van Gils, P. F.; Bruynzeel, D.; Coenraads, P. J.; van Mechelen, W.; Riphagen, II; Anema, J. R., 2011
Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature
low high low low high
van Niekerk, S. M.; Louw, Q. A.; Hillier, S., 2012
The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review
low high unclear low high
Wardle, S. L.; Greeves, J. P., 2017
Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel
high high high high high
Page 54 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Watt, A. M.; Patkin, M.; Sinnott, M. J.; Black, R. J.; Maddern, G. J., 2010
Scalpel safety in the operative setting: a systematic review
high unclear high high high
Yang, L.; Mullan, B., 2011 Reducing needle stick injuries in healthcare occupations: an integrative review of the literature
unclear high high high high
Page 55 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 5 – Characteristics of included studies
Table 1: Characteristics of included studies
Author, year Risk of bias
Interventions Outcomes
Prevention of musculoskeletal disorders
Multi-component interventions for musculoskeletal disorders
Aas et al. 2011 [22] Low Single-component and multi-component workplace interventions (includes, e.g. mental health education, physical education, workplace adjustments, relaxation breaks)
Pain severity, pain prevalence, sickness absence
Chen et al. 2018 [23] Low Exercise interventions, ergonomic interventions, breaks, cognitive behaviour therapy, education, myofeedback
Neck pain intensity
Goodman et al. 2012 [24]
Low Forearm supports, ergonomic keyboards, ergonomic mice, ergonomic training, workout or rest breaks
Symptoms of cumulative trauma disorders of the upper extremity
Lowry et al. 2017 [25]
Low Workplace exercise programmes, ergonomic interventions
Intensity of shoulder pain
Richardson et al. 2018 [26]
Low Patient lift systems, patient handling training, cognitive behavioural interventions, unstable shoes
Musculoskeletal pain, injuries, sickness absence
Exercises at the workplace
Kelly et al. 2018 [27] Low Exercise therapy Pain and functionality in work-related diseases of the upper extremities
Work organisational interventions (work organisation, work environment, job rotation) for musculoskeletal disorders
Stock et al. 2018 [28] Low Supplementary pauses, participatory ergonomic interventions, participatory organisational intervention, interventions to reduce patient lifting (safe lifting programmes and equipment), feedback about computer workstation setup and psychosocial aspects of work
Musculoskeletal symptom intensity, prevalence of various musculoskeletal pains
Educational interventions for musculoskeletal disorders
Crawford et al. 2008 [29]
Low Training in workstation adjustment and posture, Muscle Learning Therapy
Musculoskeletal symptoms
Ergonomic interventions
Hoe et al. 2012 [30] Low Ergonomically designed equipment, such as a specially designed computer mouse or arm support; ergonomically designed work environment (including workplace and work design); ergonomic training; ergonomic training combined with ergonomic equipment
Frequency of neck/shoulder diseases or complaints, musculoskeletal disorders, diseases or complaints of the right upper extremity, wrist complaints
Manual handling of loads
Freiberg et al. 2016 [31]
Low Provision of small aids and intensive education on how to handle patients
Prevalence of low back pain, upper arm pain, shoulder pain
Hegewald et al. 2018 [32]
Low Technical patient handling equipment, also in combination with education/training
Musculoskeletal injuries, back pain, repeated musculoskeletal injuries, cervical spine injuries, shoulder pain
Verbeek et al. 2011 [33]
Low Training, professional education, video, use of a back belt, exercise, training plus lifting aids
Incidence, intensity of back pain
Page 56 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Author, year Risk of bias
Interventions Outcomes
Prevention of occupational injuries
Prevention of occupational injuries in the agricultural sector and the construction industry
Rautiainen et al. 2008 [34]
Low Educational interventions, insurance premium discount programme, legislation banning Endosulfan pesticides, legislation on rollover protection structures or safety cabs for tractors
Injuries, poisoning
van der Molen et al. 2018 [35]
Low Training programmes, health and safety laws (e.g. vertical fall arrest standard, trench and excavation standard) and inspections, subsidy for scaffolds, safety campaign, drug-free workplace programme
Fatal and non-fatal injuries
Alcohol and drug screening of professional drivers
Cashman et al. 2009 [36]
Low Mandatory random and for-cause alcohol tests, mandatory random drug tests
Injuries levels (immediate and long-term)
Safety products and practices in the health sector
Mischke et al. 2014 [37]
Low Increase in the number of glove layers, use of thick gloves or gloves manufactured with special protective materials, use of glove puncture indication systems to warn staff about glove perforations
Glove perforations, frequency of blood contamination
Parantainen et al. 2011 [38]
Low Use of blunt suture needles compared to sharp needles
Glove perforations, number of self-reported needle stick injuries
Reddy et al. 2017 [39]
Low Safety-engineered devices for blood collection, safe intravenous systems, safety-engineered devices for injection fluids, use of multiple safety devices, containers for collecting sharps, introduction of legislation
Needle stick injuries, blood splashes
Verbeek et al. 2016 [40]
Low Comparison of types of personal protective equipment (PPE); procedures for the donning and doffing of PPE; training to improve PPE compliance
Contamination of skin or clothing, compliance
Prevention of skin and lung diseases
Lunt et al. 2011 [41] Low Training for behavioural change Exposure to occupational health hazards
Luong Thanh et al. 2016 [42]
Low Behavioural interventions (education and training to improve the use of respiratory protective equipment)
Frequency and correctness of respiratory protective equipment use
Bauer et al. 2018 [43]
Low Barrier creams, moisturisers, barrier creams plus moisturisers, skin protection education
Signs of occupational irritant hand dermatitis
Prevention of occupational hearing loss
Tikka et al. 2017 [44]
Low Hearing loss prevention programmes, exposure information, earmuff, earplugs, instructions for wearing hearing protection, legislation on hearing protection, combinations of the abovementioned interventions
Hearing loss, noise exposure/noise level reduction, noise attenuation
General occupational health and safety interventions
Mischke et al. 2013 [45]
Low Inspections of health and safety regulations with or without penalty
Fatal and non-fatal injuries, physical workload
van Vilsteren et al. 2015 [46]
Low Workplace interventions to prevent work disability in workers on sick leave: changes to the workplace and equipment, changes of work design and organisations, changes to working conditions, changes to work environment, case management with the worker and employer (supervisor)
Time until first return-to-work, time until lasting return-to-work, cumulative duration of sickness absence, risk of recurrences of sick leave, functional status (Roland disability questionnaire), depression, pain
Page 57 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Appendix 6 – Overview of results
Table 1: Overview of behavioural interventions to prevent diseases of the musculoskeletal system
Intervention
Comparison
Number of studies; study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Combined stretching and endurance training for the neck
No intervention
1 RCT
Office workers Individual study
Neck pain
High Chen et al. 2018 [23]
Manual material handling advice
No intervention 7 RCTs Varying professions MA Back pain Moderate Verbeek et al. 2011 [33]
Exercise therapy
No intervention
9 RCTs, 2 SR
Computer users, office workers, computer screen workers
Narrative
A: Pain in work-related upper limb disorders B: Functional outcomes in work-related upper limb disorders
A: B:
Moderate
Kelly et al. 2018 [27]
Group education No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]
Whole-body light resistance exercise
No intervention 1 RCT Office workers Individual study
Neck pain Moderate Chen et al. 2018 [23]
Myofeedback No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]
Neck/shoulder strengthening exercise
1: No intervention 2: Physiotherapy
10 RCTs
A: Office workers in general B: Office workers symptomatic
MA
Neck pain 1A: 1B: 2B:
Moderate
Chen et al. 2018 [23]
Qi Gong No intervention 1 RCT Office workers Individual study
Neck pain Moderate Chen et al. 2018 [23]
Extensive manual material handling training
One-time video training
3 cohort studies
Varying professions
MA
Back pain
Moderate
Verbeek et al. 2011 [33]
General fitness exercise
No intervention
4 RCTs
A: Office workers in general B: Office workers symptomatic
MA
Neck pain
A: B:
Low to Moderate
Chen et al. 2018 [23]
Page 58 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number of studies; study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Muscle Learning Therapy
n. a.
1 RCT
Call center workers, telemarketers, engineers, assembly workers
Narrative
Musculoskeletal disorders
Limited1 to Moderate
Crawford et al. 2008 [29]
Training in workstation adjustment and posture
n. a.
2 RCTs
Call center workers, telemarketers, engineers, assembly workers
Individual studies
Musculoskeletal disorders
Limited1 to Moderate
Crawford et al. 2008 [29]
Physical education No intervention 2 RCTs Office workers Individual study
Pain severity Low Aas et al. 2011 [22]
Manual material handling advice and devices
Advice only or no intervention
1 RCT
Varying professions
Individual study
Back pain
Low
Verbeek et al. 2011 [33]
Manual material handling advice
Back belt use 2 cohort studies
Varying professions MA Back pain Low Verbeek et al. 2011 [33]
Education for mental health
No intervention 1 RCT Office workers MA Pain prevalence Low Aas et al. 2011 [22]
Cognitive behavioural therapy
No intervention 1 RCT Office workers Individual study
Neck pain Low Chen et al. 2018 [23]
Workplace exercise programmes
Counselling or no intervention
5 RCTs
Varying professions (symptomatic and asymptomatic)
MA
Shoulder pain intensity
Low
Lowry et al. 2017 [25]
Workplace exercise programmes
Workplace modifications
1 RCT Varying professions Individual study
Shoulder pain intensity Low Lowry et al. 2017 [25]
Safe and no strenuous lifting
Usual practice 1 RCT Office workers Individual study
Shoulder symptoms Low Hoe et al. 2012 [30]
Manual material handling advice
Professional education
1 cohort study
Varying professions MA Back pain Very low Verbeek et al. 2011 [33]
Page 59 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number of studies; study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Ergonomic training
No intervention
2 RCTs
Office workers
MA
Neck/shoulder and wrist/hand symptoms, upper extremity symptoms
Very low
Hoe et al. 2012 [30]
Neck/shoulder stretching exercise
No intervention 1 RCT Office workers Individual study
Neck pain Very low Chen et al. 2018 [23]
Cognitive behavioural interventions
n. a. 1 RCT Nurses Individual study
Pain n. a. Richardson et al. 2018 [26]
Patient handling training
n. a.
2 cohort studies with control group
Nurses
Individual studies
A: Back pain B: Physical discomfort
A: B:
n. a.
Richardson et al. 2018 [26]
Abbreviations: MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials; SR = systematic review
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Defined as: limited or contradictory evidence, produced by one scientific study or inconsistent findings in multiple scientific studies.
Page 60 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 2: Overview of relational interventions to prevent diseases of the musculoskeletal system
Intervention
Comparison
Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Ergonomic mouse
Conventional mouse
2 RCTs, 1 prospective parallel group design
Office workers
Individual studies
Upper extremity discomfort
High
Goodman et al. 2012 [24]
Ergonomic keyboards
n. a.
1 quasi-expe- rimental design, 1 RCT
Office workers
Individual studies
A: Phalen-test results B: Decrease of symptoms C: Endonitis and carpal tunnel syndrome D: Pain intensity
A: B:
C:
D:
High
Goodman et al. 2012 [24]
Forearm supports
n. a.
1 RCT, 1 prospective parallel group design
Office workers
Individual studies
A: Neck/shoulder pain B: Short term hand/arm pain C: Long term hand/arm pain D: Risk rates for disorders in the left upper extremities
A:
B:
C: D:
High
Goodman et al. 2012 [24]
Alternative mouse
Conventional mouse
2 RCTs
Office workers
MA
Incidence of neck/shoulder and right upper limb disorders
Moderate
Hoe et al. 2012 [30]
Alternative mouse Conventional mouse
2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]
Alternative mouse with arm support
Conventional mouse with arm support
2 RCTs
Office workers
MA
A: Incidence of neck/shoulder and right upper limb disorders B: Neck/shoulder discomfort C: Right upper limb discomfort
A: B: C:
A: Moderate B: Low C: Low
Hoe et al. 2012 [30]
Page 61 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Conventional mouse with arm support
Conventional mouse without arm support
2 RCTs
Office workers
MA
Incidence of neck/shoulder and right upper limb disorders
Moderate
Hoe et al. 2012 [30]
Alternative mouse with arm support
Conventional mouse without arm support
2 RCTs
Office workers
MA
A: Neck/shoulder disorders B: Incidence of right upper limb disorders C: Upper body disorders (neck, shoulder, and upper extremity) D: Incidence of neck/shoulder and right upper limb disorders
A:
B: C:
A: Moderate B: Moderate C: Moderate
Hoe et al. 2012 [30]
Interventions targeting the work-rest cycle through supplementary pauses
Conventional pause schedule
4 RCTs
Varying professions
Narrativee
A: Intensity of musculoskeletal symptoms in general B: Musculoskeletal symptom intensity separately for the neck, back, shoulder/upper arm and forearm/wrist/hand
A: B:
Moderate
Stock et al. 2018 [28]
A: Technical aids to prevent strenuous lifting B: Small aids
No intervention
1 RCT
Healthcare personnel
Individual study
1-week shoulder pain ratings
Low
Hegewald et a. 2018 [32]
Workplace modifications
Advice, brochure or no intervention
5 RCTs
Varying professions (symptomatic and asymptomatic)
MA
Shoulder pain intensity
Low
Lowry et al. 2017 [25]
Arm support Conventional mouse
3 RCTs Office workers Narrativee Neck pain Low Chen et al. 2018 [23]
Page 62 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Alternative mouse with arm support
Conventional mouse without arm support
2 RCTs
Office workers
MA
Incidence of neck/shoulder and right upper limb disorders
Low
Hoe et al. 2012 [30]
Feedback about computer workstation set-up & psychosocial aspects of work
Work as usual
1 RCT
Computer workers
Narrativee one-month prevalence of any musculoskeletal pain
Low
Stock et al. 2018 [28]
Lower monitor angle High monitor angle 1 RCT Office workers Individual study
Neck pain Low Chen et al. 2018 [23]
Interventions to reduce patient lifting in a hospital setting through safe lifting programs and equipment
Usual practice
1 RCT
Healthcare workers
Narrativee
A: Frequency of work- related shoulder pain and of work-related low back pain B: Compensated musculoskeletal work injury rates and time loss injury rates
A: B:
Low
Stock et al. 2018 [28]
Supplementary breaks or reduced work hours
Conventional breaks and normal work hours
2 RCTs
Office workers
MA
Upper-extremity symptoms or pain, discomfort, work ability
Low
Hoe et al. 2012 [30]
Ergonomic adjustments (eg, keyboard, monitor, mouse)
No intervention
4 RCTs
A: Office workers in general B: Office workers symptomatic
MA
Neck pain
A: B:
Low to very low
Chen et al. 2018 [23]
Technical patient handling equipment
No intervention 2 CBAs Healthcare personnel
MA Back pain at 1-year follow-up
Very low Hegewald et al. 2018 [32]
Supplementary work breaks
Conventional work breaks
3 RCTs
A: Office workers in general B: Office workers symptomatic
MA
Neck pain
A: B:
Very low
Chen et al. 2018 [23]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 63 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 3: Overview of mixed interventions/programmes to prevent diseases of the musculoskeletal system
Intervention
Comparison
Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Education/ergonomics training, workplace modification
No intervention 1 quasi- experimental design
Office workers Individual study
Work-related musculoskeletal disorders
High Goodman et al. 2012 [24]
Workplace interventions with several components (including exercise, workplace modifications, breaks)
No intervention
5 RCTs
Computer users
Individual studies1
Pain prevalence or pain severity, sick leave
Low to Moderate
Aas et al. 2011 [22]
Participatory ergonomic interventions based on training groups of workers to analyze work, identify problems and propose solutions
Work as usual
4 RCTs, 1 non-RCT
Varying professions
Narrative
A: Three-month prevalence of neck pain and low-back pain B: Back pain intensity C: Number of days with any musculoskeletal pain D: Three-month prevalence of musculoskeletal sick leave
A:
B:
C:
D:
A: Very low B: Low C: Low D: Low
Stock et al. 2018 [28]
Provision of and education in patient handling with small aids
No intervention or usual practice
1 non-RCT
Nurses, nursing aids, teachers
Individual study
A: 1-month prevalence of low back pain B: 1-month prevalence of upper arm pain C: 1-year follow-up: 7-day prevalence of low back pain and shoulder pain
A: B: C:
Very low to low
Freiberg et al. 2016 [31]
Small aids
Mechanical aids
1 RCT
Nurses, nursing aids, teachers
Individual study
1-year follow-up: 7-day prevalence of low back pain and shoulder pain
Very low to low
Freiberg et al. 2016 [31]
Page 64 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Ergonomic training and equipment
No intervention
1 RCT
Office workers Individual study
Frequency and intensity of neck, shoulder, or wrist/hand ache or pain
Very low Hoe et al. 2012 [30]
Provision of and education in patient handling with small aids
One‑time ergonomic education
1 non-RCT
Nurses, nursing aids, teachers
Individual study
12-month prevalence of low back pain
Very low
Freiberg et al. 2016 [31]
Technical patient handling equipment (i.e., nursing beds, low nursing home beds, bed movers, mobile lifts, wall lifts, overhead lifts, ceiling lifts, day care chairs, or mechanical position change aids); as a solitary measure or as part of a multimodal intervention
No intervention
A) 4 CBAs B) 1 CBA C) 2 CBAs
Gesundheits- personal
A: MA B: Individual study C: Individual studies
A: Musculoskeletal injury claims B: Repeated musculoskeletal injuries (follow-up: 2 years) C: Cervical spine (neck) injuries
A: B: C:
Very low
Hegewald et al. 2018 [32]
Multi-component interventions (e.g. training, guidelines for patient transfer, physical exercise, ergonomic interventions)
n. a.
2 cohort studies with control group, 1 RCT
Healthcare personnel
Individual study
A: Pain B: Sickness absence C: Accidents
A:
B:
C:
n. a.
Richardson et al. 2018 [26]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Results of all five RCTs were described separately; one RCT had positive effects, all others showed no significant effects. Pooled results of two studies also show no effect.
Page 65 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 4: Overview of behavioural interventions for the prevention of occupational injuries
Intervention
Comparison
Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Active training (face-to- face instruction)
Passive training (folders or videos)
1 retrospective cohort study
Health or hospital staff
Individual study
Noncompliance with PPE use
Very low
Verbeek et al. 2016 [40]
Active training (face-to- face instruction)
Passive training (folders or videos)
1 retrospective cohort study
Health or hospital staff
Individual study
Noncompliance with doffing guidance
Very low Verbeek et al. 2016 [40]
Drug-free workplace programme
No intervention
1 ITS
Construction workers
Individual study
A: non-fatal injuries in the year following implementation B: non-fatal injuries in the years thereafter
A: B:
Very low
van der Molen et al. 2018 [35]
Safety campaign
No intervention
1 ITS
Construction workers
Individual study
A: initial decrease in injuries at the company level B: sustained decrease in injuries at the company level C: initial decrease in injuries at the regional level D: sustained decrease in injuries at the regional level
A: B:
C:
D:
Very low
van der Molen et al. 2018 [35]
Safety training interventions
No intervention
1 ITS, 1 CBA Construction workers
Individual studies
A: non-fatal injuries, immediate effect B: non-fatal injuries, trend
A: B:
Very low van der Molen et al. 2018 [35]
Educational interventions
No intervention 3 RCTs Agricultural workers
MA Injuries n. a. Rautiainen et al. 2008 [34]
Insurance premium discount program
No intervention
1 ITS Agricultural workers
Individual study
A: Injuries, immediate effect B: Injuries, progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 66 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 5: Overview of relational interventions for the prevention of occupational injuries
Intervention
Comparison
Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Blunt suture needles Sharp suture needles
10 RCTs Surgical staff MA Glove perforations per surgeon per operation
High Parantainen et al. 2011 [38]
Double gloves
Single gloves
8 RCTs
Healthcare personnel
MA
Dexterity: outer glove perforations – number of perforations
Moderate Mischke et al. 2014 [37]
Double gloves Single gloves 12 RCTs Healthcare personnel
MA A: Inner glove perforations B: Blood stains on the skin
A: B:
A: Moderate B: Moderate
Mischke et al. 2014 [37]
Double indicator gloves Double standard gloves
2 RCTs Healthcare personnel
MA Inner glove perforations Moderate Mischke et al. 2014 [37]
Triple special gloves Double standard gloves
2 RCTs Healthcare personnel
MA Inner glove perforations Moderate Mischke et al.
2014 [37]
Blunt suture needles Sharp suture needles
4 RCTs Surgical staff MA Self-reported needle stick injuries
Moderate Parantainen et al. 2011 [38]
Legislation - Interruption
No legislation
2 ITS
Healthcare personnel
MA
Percutaneous exposure injuries caused by needles: A: Change in level B: Change in slope
A: B:
A: Moderate B: Very low
Reddy et al. 2017 [39]
Legislation - Gradual introduction
No legislation
1 ITS
Healthcare personnel
Individual study
Percutaneous exposure injuries caused by needles: A: Change in level B: Change in slope
A: B:
A: Low B: Low
Reddy et al. 2017 [39]
Thicker gloves Thinner gloves 2 RCTs Healthcare personnel
MA Inner glove perforations Low Mischke et al. 2014 [37]
One fabric glove over one normal glove
Two normal gloves 3 RCTs Healthcare personnel
MA Inner glove perforations Low Mischke et al. 2014 [37]
Double indicator gloves Standard gloves (single or double)
2 RCTs Healthcare personnel
MA Inner glove perforations Low Mischke et al. 2014 [37]
Triple gloves Double gloves 1 RCT Healthcare personnel
Individual study
Inner glove perforations Low Mischke et al. 2014 [37]
Safe passive injection systems
Safe active injection systems
1 ITS Healthcare personnel
Individual study
Needlestick injuries Low Reddy et al.
2017 [39]
Safe active intravenous systems
Regular systems 4 RCTs Healthcare personnel
MA Incidences of blood contamination
Low Reddy et al. 2017 [39]
Page 67 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Safe active intravenous systems
Regular systems 1 RCT Healthcare personnel
Individual study
Incidence of blood leakage Low Reddy et al.
2017 [39]
Safe passive intravenous systems
Regular systems 2 RCTs Healthcare personnel
MA Incidences of blood contamination
Low Reddy et al. 2017 [39]
Double gloving method
Single gloving method
1 cross-over simulation study
Healthcare personnel
Individual study
A: Contamination B: Noncompliance with guidance
A: B:
A: Very low B. Very low
Verbeek et al. 2016 [40]
Centers for Disease Control and Prevention recommended doffing
Individual doffing
1 RCT
Healthcare personnel
Individual study
Contamination
Very low Verbeek et al. 2016 [40]
European and national safety and health regulations and standards for construction sites
Not applicable
5 ITS
Construction workers
MA
A: Fatal injuries, change in level B: Fatal injuries, change in slope C: Non-fatal injuries, change in level D: Non-fatal injuries, change in slope
A:
B:
C:
D:
Very low van der Molen et al. 2018 [35]
Gowns
Aprons
1 Randomised cross-over simulation study
Healthcare personnel
Individual study
Contamination
Very low Verbeek et al. 2016 [40]
Multiple safe devices Not applicable 2 ITS Healthcare personnel
MA Percutaneous exposure injuries caused by needles
Very low Reddy et al. 2017 [39]
Multiple safe devices Regular devices 1 CBA Healthcare personnel
Individual study
Percutaneous exposure injuries caused by needles
Very low Reddy et al. 2017 [39]
PPE with Powered Air Purifying Respirator Attire
Enhanced respiratory and contact precautions attire
1 RCT
Healthcare personnel
Individual study
A: Any contamination B: Noncompliance with donning guidance C: Noncompliance with doffing guidance
A: B: C:
A: Very low B: Very low C: Very low
Verbeek et al. 2016 [40]
Safe blood collection systems
Regular systems
1 RCT
Healthcare personnel
Individual study
A: Needlestick injuries im- mediate follow up B: Blood splashes
A: B:
A: Very low B: Very low
Reddy et al. 2017 [39]
Page 68 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Safe blood collection systems
Not applicable
2 ITS
Healthcare personnel
Individual studies
Number of reported sharps injuries: A: Change in level B: Change in slope
A: B:
A, B: Very low
Reddy et al. 2017 [39]
Safe injection systems Regular systems 1 RCT, 1 CBA Healthcare personnel
Individual studies
Needlestick injuries Very low Reddy et al.
2017 [39]
Safe intravenous systems
Regular systems 1 RCT, 1 CBA Healthcare personnel
Individual studies
Needlestick injuries Very low Reddy et al.
2017 [39]
Safe intravenous systems
Regular systems
2 ITS
Healthcare personnel
Individual studies
Number of reported sharps injuries: A: Change in level B: Change in slope
A: B:
A, B: Very low
Reddy et al. 2017 [39]
Sharps containers Not applicable 2 ITS Healthcare
personnel Individual studies
Number of reported sharps injuries
Very low Reddy et al. 2017 [39]
Sharps containers No containers 1 CBA Healthcare
personnel Individual study
Number of reported sharps injuries
Very low Reddy et al. 2017 [39]
Safety inspections and sanctions for violations
No intervention 1 ITS Construction workers
Individual study
A: Non-fatal injuries, change in level B: Non-fatal injuries, change in slope
A: B:
Very low van der Molen et al. 2018 [35]
Subsidy for scaffolding
No intervention 1 CBA Construction workers
Individual study
Injuries A: Very low van der Molen et al. 2018 [35]
Mandatory random and for-cause alcohol testing programme
Not applicable 2 ITS Occupational drivers
Narrative A: Level of injuries, immediate effect B: Level of injuries, long- term trend
A: B:
Limited1 Cashman et al.
2009 [36]
Mandatory random drug testing programme
Not applicable 2 ITS Occupational drivers
Narrative A: Level of injuries, immediate effect B: Level of injuries, long- term trend
A: B:
Limited1 Cashman et al.
2009 [36]
PPE made of more breathable material
Regular PPE 1 exposure simulation studiy
Healthcare personnel
Individual study
A: Contamination A: A: Very low Verbeek et al. 2016 [40]
Double gloves Single gloves 2 RCTs Healthcare personnel
MA Needlestick injuries n. a. Mischke et al. 2014 [37]
Page 69 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Legislation on rollover protective structures or Safety Cabins on new tractors
Not applicable 1 ITS Agricultural workers
MA Fatal injuries: A: immediate effect B: progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Legislation on rollover protective structures or Safety Cabins on all tractors
Not applicable 1 ITS Agricultural workers
MA Fatal injuries: A: immediate effect B: progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Legislation banning Endosulfan pesticide
Not applicable 1 ITS Agricultural workers
Individual study
Injuries: A: immediate effect B: progressive effect
A: B:
n. a. Rautiainen et al. 2008 [34]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1 Defined as: Limited evidence - one low quality RCT or one CBA study or one ITS
Table 6: Overview of mixed interventions/programmes for the prevention of occupational injuries
Intervention
Comparison Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result Quality of evidence
Author and year
Occupational health and safety services
n. a.
1 CBA
Construction workers
Individual study
Injuries
n. a.
van der Molen et al. 2018 [35]
Abbreviations: CBA = controlled before-after studies; n. a. = not available
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 70 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 7: Overview of behavioural interventions to prevent skin and lung diseases
Intervention
Comparison
Number and study design
Population/Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Educational intervention
No intervention
1 RCT, 4 CBA
Farm and construction workers
Partially narrative, partially MA
Self-reported respiratory protective equipment use
Very low
Luong Thanh et al. 2016 [42]
Skin protection education No intervention 3 Cluster-RCTs Varying professions MA Signs of occupational irritant hand dermatitis
Very low Bauer et al. 2018 [43]
Conventional training with additions (biosimulated vision training, program active or passive teaching, computer-simulated training)
Conventional training (lectures, books)
1 Cluster-RCT 2 RCTs
Health workers, adults (not specified)
Narrative
Correct use of respiratory protective equipment
Very low
Luong Thanh et al. 2016 [42]
Trainings based on motivating interviews
Conventional lectures
1 CBA Production line workers
Narrative Use of respiratory protective equipment
Very low Luong Thanh et al. 2016 [42]
Training for the correct use of respiratory masks or personal protective equipment
No training
1 CBA
Hospital workers
Narrative
Proportion of correctly used respirators
Very low
Luong Thanh et al. 2016 [42]
Training for behavioural change: interventions intended to affect worker’s behavioural compliance (by affecting actions that workers take to comply with health and safety precautions)
n. a.
5 RCTs, 3 CBA, 1 multiple baseline study
Varying professions
Narrative
Exposure to occupational health hazards
n. a.
Lunt et al. 2011 [41]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 71 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Table 8: Overview of relational interventions to prevent skin and lung diseases
Intervention
Comparison
Number and study design
Population/ Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Barrier creams No intervention 4 RCTs, 1 Cluster-RCT
Varying professions MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 [43]
Barrier cream plus moisturizers
No intervention 3 RCTs, 1 Cluster-RCT
Varying professions MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 [43]
Moisturizers No intervention 3 RCTs, 1 Cluster-RCT
Varying professions MA Signs of occupational irritant hand dermatitis
Low Bauer et al. 2018 [43]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 9: Overview of behavioural interventions to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/ Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Earplugs with instruction
Earplugs without instruction
2 RCTs Varying professions MA Attenuation of noise
Moderate Tikka et al. 2017 [44]
Abbreviations: MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 10: Overview of relational interventions to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Exposure information Training as usual 1 RCT Construction workers
Individual study Mean noise level
Low Tikka et al. 2017 [44]
Use of hearing protection 1
n. a. 1 RCT, 3 CBA
n. a. n. a. Noise exposure Low Tikka et al. 2017 [44]
Page 72 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
New stricter legislation
Not applicable
1 ITS
Coal mines
Individual study
Median personal noise exposure A: Immediate effect B: Long-term trend
A: B:
Very low
Tikka et al. 2017 [44]
Earmuffs
Earplug
2 CBA Workers with noise exposition above 88–94 dB(A)
MA
Hearing loss
Very low Tikka et al. 2017 [44]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
1Total result on hearing protection devices only mentioned in Abstract, no further information given in review
Table 11: Overview of mixed interventions/programmes to prevent work-related hearing loss
Intervention Comparison Number and study design
Population/Setting Method of data synthesis
Outcome Result Quality of evidence
Author and year
Hearing loss prevention programme
Audiometric testing
1 RCT
Agricultural students involved in farm work
Individual study
Hearing loss average
Moderate
Tikka et al. 2017 [44]
Well-implemented hearing loss prevention programme
Less well- implemented HLPP for hearing loss
4 CBA
Varying professions
MA
Hearing loss STS
Very low
Tikka et al. 2017 [44]
Hearing loss prevention programme
Non-exposed workers
3 CBA
Varying professions
MA Hearing loss average
Very low Tikka et al. 2017 [44]
Hearing loss prevention programme with exposure information
Hearing loss prevention programme without exposure information
1 CBA
Various workers of an aluminium smelter
Individual study
Hearing loss average
Very low
Tikka et al. 2017 [44]
Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials; STS: standard threshold shift,
Page 73 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 12: Overview of general behavioural occupational health and safety interventions
Intervention
Comparison
Number and study design
Population/Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Occupational safety and health inspections
No inspections
1 RCT, 2 CBA, 1 ITS
Motor carrier drivers in ITS; various industries in other studies
Individual studies
Fatal and non-fatal injuries A: Short- and medium-term (Ø 21 and 24 months) B: Long-term (Ø 36 and 48 months)
A: B:
Low
Mischke et al. 2013 [45]
Occupational safety and health inspections
No inspections
1 RCT
Varying professions
Individual study
Physical workload
Low
Mischke et al. 2013 [45]
Abbreviations: CBA = controlled before-after studies; ITS = interrupted time series; MA = meta-analyses; n. a. = not available; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Table 13: Overview of general mixed occupational health and safety interventions/programmes
Intervention
Comparison
Number and study design
Population/Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
Workplace interventions
Usual care
8 RCTs
Varying professions, after sickness absence
MA
Cumulative duration of sickness absence A: Total B: Persons with musculoskeletal disorders
A:
B: C:
High
van Vilsteren et al. 2015 [46]
Page 74 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number and study design
Population/Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
C: Persons with mental health problems
Workplace interventions
Usual care
5 RCTs Varying professions, after sickness absence
MA
Pain
High
van Vilsteren et al. 2015 [46]
Workplace interventions
Usual care
5 RCTs Varying professions, after sickness absence
MA
Time until first return-to-work
Moderate
van Vilsteren et al. 2015 [46]
Workplace interventions
Usual care
1 RCT Varying professions, after sickness absence
Individual study
Risk of recurrences of sick leave
Moderate
van Vilsteren et al. 2015 [46]
Workplace interventions
Usual care
6 RCTs Varying professions, after sickness absence
MA Functional status (Roland disability questionnaire)
Moderate
van Vilsteren et al. 2015 [46]
Workplace interventions
Usual care
6 RCTs
Varying professions, after sickness absence
MA
Time until lasting return-to-work A: Total B: Persons with musculoskeletal disorders C: Persons with mental health problems D: Persons with cancer
A: B: C: D:
Very low
van Vilsteren et al. 2015 [46]
Workplace interventions
Usual care
4 RCTs
Varying professions, after sickness absence
MA
Depression
Very low
van Vilsteren et
Page 75 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
For peer review only
Intervention
Comparison Number and study design
Population/Setting
Method of data synthesis
Outcome
Result
Quality of evidence
Author and year
al. 2015 [46]
Abbreviations: MA = meta-analyses; RCTs = randomised controlled trials
Explanations for column Result: Effect direction: up arrow = positive health effects, down arrow = negative health effects, sideways arrows = mixed effects / contradictory results; statistical significance: black arrow: p < 0.05; grey arrow: p > 0.05; empty arrow: no statistical data reported
Page 76 of 76
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on August 10, 2021 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2019-032528 on 11 D
ecember 2019. D
ownloaded from
Top Related