BMJ Open is committed to open peer review. As part of this … · 37 Ludwig Grillich, 38 University for Continuing Education Krems (Danube University Krems), Department for Evidence-39

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

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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

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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

8 [email protected]

9 phone: 0043 2732 893 2918

10 ORCID-ID: https://orcid.org/0000-0002-3324-0639

11

12 Agnes Ebenberger,



15 [email protected]

16

17 Lisa Affengruber,




21

22 Christina Kien




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26

27 Irma Klerings,




31

32 Monika Szelag,




36

37 Ludwig Grillich,




41

42 Ursula Griebler,




46

47

48 Word count: 5002 (including Competing interests and Funding statements)

49

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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

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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

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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

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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?’


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

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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

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https://work.cochrane.org/cochrane-reviews-about-occupational-safety-and-health

https://www.ilo.org/global/lang--en/index.htm

https://www.osha.gov/pls/publications/publication.AthruZ?pType=Types

http://www.who.int/occupational_health/publications/en/

https://osha.europa.eu/en/tools-and-publications



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

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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.

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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

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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.

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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].

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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

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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

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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

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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].

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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

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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.

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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.

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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

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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

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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.

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637

638

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Figure 1: PRISMA Flowchart of the study selection process

271x255mm (96 x 96 DPI)

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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

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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

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#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

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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* ) )


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* ) ) )


3 OR 4

6 TITLE-ABS-KEY ( meta-analy* OR metaanaly* OR ( systematic* W/5 ( review OR overview OR literature OR synthesis ) ) )


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 ) ) ) )


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

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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 ) )


2008-2018

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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

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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

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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


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

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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.

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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.

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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

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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.

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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.

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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).

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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.

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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.

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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

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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


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

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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

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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

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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; MÃ¤kelÃ¤, 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

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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


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

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low unclear low low unclear

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high high high high high

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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


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)

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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


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


Individual studies

Musculoskeletal disorders


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)


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


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 modifications


Shoulder pain intensity Low Lowry et al. 2017 (17)

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Author and year

Safe and no strenuous lifting

Usual practice 1 RCT Office workers Individual study

Shoulder symptoms Low Hoe et al. 2012 (37)


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


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.

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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


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


A: Phalen-test results B: Decrease of symptoms C: Endonitis and carpal tunnel syndrome D: Pain intensity

A: B: C: D:


Forearm supports n. a.

1 RCT, 1 prospective parallel group design


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:


Alternative mouse Conventional mouse

2 RCTs Office workers MA Incidence of neck/shoulder and right upper limb disorders

Moderate Hoe et al. 2012 (37)


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)

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Population/ Setting



Author and year


Conventional mouse without arm support


Moderate Hoe et al. 2012 (37)




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)


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)

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Population/ Setting



Author and year




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)



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)

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Population/ Setting



Author and year

Supplementary work breaks

Conventional work breaks

3 RCTs


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


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


Population/ Setting



Author and year

Education/ergonomics training, workplace modification

No intervention 1 quasi-experimental design

Office workers Individual study

Work-related musculoskeletal disorders


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)

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Population/ Setting



Author and year


No intervention A: 2 RCTs B: 1 RCT


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)


No intervention A: 3 RCTs B: 1 RCT


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)


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)

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Population/ Setting



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


Frequency and intensity of neck, shoulder, or wrist/hand ache or pain

Very low Hoe et al. 2012 (37)


One‑time ergonomic education


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)



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.

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Table 9: Overview of behavioural interventions to prevent diseases of skin and lung diseases


Population/Setting Method of data synthesis


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


Trainings based on motivating interviews

Conventional lectures

1 CBA Production line workers

Narrative Use of respiratory protective equipment


Training for the correct use of respiratory masks or personal protective equipment

No training 1 CBA Hospital workers Narrative Proportion of correctly used respirators


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)

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Author and year

worker’s behavioural compliance (by affecting actions that workers take to comply with health and safety precautions)



Table 10: Overview of relational interventions to prevent diseases of skin and lung diseases


Population/ Setting



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



Moisturizers No intervention 3 RCTs, 1 Cluster-RCT

Varying professions



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:


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Population/ Setting



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:


Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials


Table 11: Overview of mixed interventions/programmes to prevent diseases of skin and lung diseases




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


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Table 12: Overview of behavioural interventions to prevent work-related hearing loss




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


Table 13: Overview of relational interventions to prevent work-related hearing loss




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


1Total result on hearing protection devices only mentioned in Abstract, no further information given in review

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Table 14: Overview of mixed interventions/programmes to prevent work-related hearing loss




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)


Non-exposed workers

3 CBA Varying professions MA Hearing loss average


Hearing loss prevention programme with exposure information

Hearing loss prevention programme without exposure information

1 CBA Various workers of an aluminium smelter



Abbreviations: CBA = controlled before-after studies; MA = meta-analyses; RCTs = randomised controlled trials; STS: standard threshold shift,


Table 15: Overview of general behavioural occupational health and safety interventions




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)

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Author and year

Inspections with consultative activity

n. a. 3 Studies1 Varying professions Narrative Injuries

Strong4 or limited3 – depending on context


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


Specific deterrence without sanctions

n. a. 9 Studies1 Varying professions Narrative Injuries and truck crashes

Moderate to limited3


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)


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.

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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)



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




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

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Author and year

after sickness absence

al. 2015 (27)


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



MA Functional status (Roland disability questionnaire)



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)


MA Depression Very low van Vilsteren et al. 2015 (27)



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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

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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


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.


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

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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

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For peer review onlyEvidence-based occupational health and safety

interventions: a comprehensive overview of reviews

Journal: BMJ Open

Manuscript ID bmjopen-2019-032528.R1


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



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1 Evidence-based occupational health and 2 safety interventions: a comprehensive 3 overview of reviews4 Authors:



7 based Medicine and Evaluation, Dr. Karl Dorrek Str. 30, 3500 Krems, Austria

8 [email protected]

9 phone: 0043 2732 893 2918


11





16





21

22 Christina Kien




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26

27 Irma Klerings,




31

32 Monika Szelag,




36

37 Ludwig Grillich,




41

42 Ursula Griebler,




46

47

48 Word count: 4661 (including Competing interests, Funding statements, Differences between protocol

49 and review, Data availability, Acknowledgments, and author contributions)

50

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51 Abstract


53 suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS)




57 overview of reviews is to provide a comprehensive basis to informevidence-based decision-making

58 about interventions in the field of OHS.






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



69 interventions.




73 in this field.



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77 ARTICLE SUMMARY





82 search.


84 review.


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

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93 BACKGROUND

94 Occupational injuries and diseases cause extensive suffering and loss of productivity. The










104 at work[6].















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128 METHODS





133 Study design


135 Handbook[12].









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Legislation



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Audits by the health and safety executive

Comparison Another intervention (active control) or no intervention







motivation



Interventions in: leisure time School Non-OECD countries

151





156 characteristics and findings of the included studies’[12]. In addition, to be included in this overview of










166 tasks).

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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



182 person from the reviewer team. We used the software Covidence (https://www.covidence.org/) for

183 the study selection process.








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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:



200 studies)











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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


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








217 It was not appropriate or possible to involve patients or the public in this work.

218 RESULTS


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

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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.



233


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).



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].

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254 25, 27]]. The QoE varied widely between outcomes. See online appendix 6 for further details.




258 range of occupational groups.



261 transfer).


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.



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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].


286 Overall, seven SRs investigated interventions for the prevention of occupational injuries. One review




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].










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302 all outcomes).








310 Four SRs investigated for safety products and practices in the health sector to prevent occupational















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334 is uncertainty about the estimates of the effects.


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











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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]





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

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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







391 musculoskeletal disorders are one of the main causes for work-related mortality and morbidity[47].



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.



398 pesticides, legislation on the use of safety-engineered devices in the healthcare sector etc.). In some

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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.







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

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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.



445 FUNDING




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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










467 REFERENCES

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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.

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PRISMA Flowchart of the study selection process

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TITLE



ABSTRACT


50-73

INTRODUCTION



120-122

METHODS


128-129



146-175


135-145


Appendix 1



176-182


192-214


196-203



183-191


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192-195; 211-214

Page 1 of 2






RESULTS


217-232









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DISCUSSION


385-411


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


445-448



Page 2 of 2

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# Searches Results







7 or/1-6 30483

8





12 *Work/ 15722

13 *Workplace/ 9376


15 or/8-14 279210












27 or/16-26 1360949

28 15 and 27 47978

29 7 or 28 64546


31 29 not 30 63888

32 review.pt. 2393987

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34 32 and 33 135062

35


36 34 or 35 296663

37 31 and 36 1349










#7 {or #1-#6} 1501

#8





#12 [mh ^work] 225



#15 {or #8-#14} 11318



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#27 {or #16-#26} 191090

#28 #15 and #27 4272

#29 #7 or #28 4857


#31 #29 not #30 4832






Scopus

12 June 2018




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3 OR 4





5 AND 6




7 NOT 8

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10



2008-2018

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Ineligible outcome







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Ineligible setting


















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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.

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Excluded due to unclear risk of bias

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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.

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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



criteria?

CONCERNS regarding


CONCERNS regarding


CONCERNS regarding


results







low low low low low



low low low low low



low low low low low



low low low low low



low low low low low

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low low low low low



low low low low low



low low low low low






low low low low low



low low low low low



low low low low low



low low low low low

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low low low low low



low low low low low



low low low low low



low low low low low



low low low low low



low low low low low



low low low low low

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low low low low low



low low low low low



low low low low low



low low low low low

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Table 4: Characteristics of included studies





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)


Chen et al. 2018 [23] Low Exercise interventions, ergonomic interventions, breaks, cognitive behaviour therapy, education, myofeedback

Neck pain intensity











Kelly et al. 2018 [27] Low Exercise therapy Pain and functionality in work-related diseases of the upper extremities


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







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










Low Training, professional education, video, use of a back belt, exercise, training plus lifting aids

Incidence, intensity of back pain

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Injuries, poisoning

van der Molen et al. 2018 [35]





















Lunt et al. 2011 [41] Low Training for behavioural change Exposure to occupational health hazards








Tikka et al. 2017 [44]







van Vilsteren et al. 2015 [46]



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Author and year



Neck pain High Chen et al. 2018 [23]


No intervention 7 RCTs Varying professions MA Back pain Moderate Verbeek et al. 2011 [33]

Exercise therapy No intervention 9 RCTs, 2 SR


Narrative


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]



Neck pain Moderate Chen et al. 2018 [23]

Myofeedback No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]



10 RCTs


MA Neck pain 1A: 1B: 2B:

Moderate Chen et al. 2018 [23]





3 cohort studies

Varying professions MA Back pain Moderate Verbeek et al. 2011 [33]

General fitness exercise No intervention 4 RCTs


MA Neck pain A: B:

Low to Moderate

Chen et al. 2018 [23]

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Author and year


n. a. 1 RCT


Narrative Muskel-Skelett-Symptome




n. a. 2 RCTs


Individual studies





Pain severity Low Aas et al. 2011 [22]




Back pain Low Verbeek et al. 2011 [33]



Varying professions MA Back pain Low Verbeek et al. 2011 [33]


No intervention 1 RCT Office workers MA Pain prevalence Low Aas et al. 2011 [22]



Neck pain Low Chen et al. 2018 [23]



5 RCTs Varying professions (symptomatic and asymptomatic)

MA Shoulder pain intensity Low Lowry et al. 2017 [25]




Shoulder pain intensity Low Lowry et al. 2017 [25]



Shoulder symptoms Low Hoe et al. 2012 [30]



1 cohort study

Varying professions MA Back pain Very low Verbeek et al. 2011 [33]

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Author and year

Ergonomic training No intervention 2 RCTs Office workers MA


Very low Hoe et al. 2012 [30]



Neck pain Very low Chen et al. 2018 [23]



Pain n. a. Richardson et al. 2018 [26]


n. a.


Nurses Individual studies


A: B:

n. a. Richardson et al. 2018 [26]




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Population/ Setting



Author and year

Ergonomic mouse Conventional mouse




High Goodman et al. 2012 [24]

Ergonomic keyboards n. a. 1 quasi-expe-rimental design, 1 RCT



A: B: C: D:


Forearm supports n. a.




A: B: C: D:




Moderate Hoe et al. 2012 [30]


2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]





A: B: C:


Hoe et al. 2012 [30]

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Population/ Setting



Author and year




Moderate Hoe et al. 2012 [30]





A: B: C:


Hoe et al. 2012 [30]



4 RCTs Varying professions

Narrativee


A: B:

Moderate Stock et al. 2018 [28]


No intervention 1 RCT Healthcare personnel

Individual study


Low Hegewald et a. 2018 [32]



5 RCTs


MA Shoulder pain intensity Low Lowry et al. 2017 [25]


3 RCTs Office workers Narrativee Neck pain Low Chen et al. 2018 [23]

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Population/ Setting



Author and year




Low Hoe et al. 2012 [30]


Work as usual 1 RCT Computer workers


Low Stock et al. 2018 [28]




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]



2 RCTs Office workers MA Upper-extremity symptoms or pain, discomfort, work ability

Low Hoe et al. 2012 [30]




MA Neck pain A: B:

Low to very low

Chen et al. 2018 [23]




Very low Hegewald et al. 2018 [32]



3 RCTs


MA Neck pain A: B:

Very low Chen et al. 2018 [23]



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Population/ Setting



Author and year


No intervention 1 quasi-experimental design





No intervention 5 RCTs Computer users Individual studies1


Low to Moderate

Aas et al. 2011 [22]


Work as usual 4 RCTs, 1 non-RCT

Varying professions

Narrative


A: B: C: D:






Individual study


A: B: C:

Very low to low


Small aids Mechanical aids 1 RCT Nurses, nursing aids, teachers

Individual study


Very low to low


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Population/ Setting



Author and year






One‑time

ergonomic education


Individual study


Very low Freiberg et al. 2016 [31]


No intervention A) 4 CBAs B) 1 CBA C) 2 CBAs

Gesundheits-personal



A: B: C:



n. a.



Individual study


A: B: C:

n. a. Richardson et al. 2018 [26]




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Table 9: Overview of behavioural interventions for the prevention of occupational injuries


Population/ Setting



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)




Individual study

Noncompliance with doffing guidance


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:


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:


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]



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Table 10: Overview of relational interventions for the prevention of occupational injuries

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Population/ Setting



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]


MA A: Inner glove perforations B: Blood stains on the skin

A: B:

A: Moderate B: Moderate


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


MA Inner glove perforations Moderate Mischke et al.

2014 [37]


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


Legislation - Gradual introduction

No legislation 1 ITS Healthcare personnel

Individual study


A: B:

A: Low B: Low


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


Double indicator gloves Standard gloves (single or double)



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]

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Regular systems 1 RCT Healthcare personnel

Individual study

Incidence of blood leakage Low Reddy et al.

2017 [39]

Safe passive intravenous systems




Double gloving method Single gloving method

1 cross-over simulation study


Individual study

A: Contamination B: Noncompliance with guidance

A: B:

A: Very low B. Very low


Centers for Disease Control and Prevention recommended doffing

Individual doffing 1 RCT Healthcare personnel

Individual study

Contamination


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:


Gowns Aprons

1 Randomised cross-over simulation study


Individual study

Contamination


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


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


Safe blood collection systems


Individual study

A: Needlestick injuries im-mediate follow up B: Blood splashes

A: B:

A: Very low B: Very low


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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


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


2017 [39]


Regular systems 2 ITS Healthcare personnel

Individual studies


A: B:

A, B: Very low


Sharps containers Not applicable 2 ITS Healthcare

personnel Individual studies

Number of reported sharps injuries


Sharps containers No containers 1 CBA Healthcare

personnel Individual study



Safety inspections and sanctions for violations


Individual study

A: Non-fatal injuries, change in level B: Non-fatal injuries, change in slope

A: B:


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


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


Individual study

A: Contamination

A:

A: Very low



MA Needlestick injuries n. a. Mischke et al. 2014 [37]

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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:


Legislation on rollover protective structures or Safety Cabins on all tractors



A: B:


Legislation banning Endosulfan pesticide


Individual study

Injuries: A: immediate effect B: progressive effect

A: B:




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


Population/ Setting



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


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Table 12: Overview of behavioural interventions to prevent skin and lung diseases




Author and year

Educational intervention No intervention 1 RCT, 4 CBA Farm and construction workers



Very low Luong Thanh et al. 2016 [42]


Very low Bauer et al. 2018 [43]





Narrative Correct use of respiratory protective equipment








No training 1 CBA Hospital workers Narrative Proportion of correctly used respirators


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]



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Table 13: Overview of relational interventions to prevent skin and lung diseases




Author and year


Varying professions MA Signs of occupational irritant hand dermatitis

Low Bauer et al. 2018 [43]














Author and year




Moderate Tikka et al. 2017 [44]







Author and year



Low Tikka et al. 2017 [44]


n. a. 1 RCT, 3 CBA

n. a. n. a. Noise exposure Low Tikka et al. 2017 [44]

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New stricter legislation Not applicable 1 ITS Coal mines Individual study


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]








Author and year


Audiometric testing 1 RCT Agricultural students involved in farm work




Less well-implemented HLPP for hearing loss

4 CBA Varying professions MA Hearing loss STS Very low Tikka et al. 2017 [44]


Non-exposed workers

3 CBA Varying professions MA Hearing loss average




1 CBA Various workers of an aluminium smelter




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Author and year


No inspections 1 RCT, 2 CBA, 1 ITS


Individual studies


A: B:

Low Mischke et al. 2013 [45]


No inspections 1 RCT Varying professions Individual study

Physical workload Low Mischke et al. 2013 [45]







Author and year


MA

Cumulative duration of sickness absence A: Total B: Persons with musculoskeletal disorders

A: B: C:

High


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Author and year

C: Persons with mental health problems


MA Pain High



MA Time until first return-to-work

Moderate


Workplace interventions Usual care 1 RCT Varying professions, after sickness absence

Individual study


Moderate




Moderate



MA


A: B: C: D:

Very low



MA Depression Very low van Vilsteren et

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Author and year

al. 2015 [46]



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For peer review onlyEvidence-based occupational health and safety

interventions: a comprehensive overview of reviews

Journal: BMJ Open

Manuscript ID bmjopen-2019-032528.R2


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



BMJ Open on A


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1 Evidence-based occupational health and 2 safety interventions: a comprehensive 3 overview of reviews4 Authors:




8 [email protected]

9 phone: 0043 2732 893 2918


11





16





21

22 Christina Kien




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26

27 Irma Klerings,




31

32 Monika Szelag,




36

37 Ludwig Grillich,




41

42 Ursula Griebler,




46

47

48 Word count: 4814 (including Competing interests, Funding statements, Differences between protocol

49 and review, Data availability, Acknowledgments, and author contributions)

50

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51 Abstract


53 suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS)




57 overview of reviews is to provide a comprehensive basis to inform evidence-based decision-making

58 about interventions in the field of OHS.






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



69 interventions.




73 in this field.



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77 ARTICLE SUMMARY





82 search.


84 review.


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

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93 BACKGROUND

94 Occupational injuries and diseases cause extensive suffering and loss of productivity. The










104 at work[6].















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128 METHODS





133 Study design


135 Handbook[12].









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Legislation



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Audits by the health and safety executive

Comparison Another intervention (active control) or no intervention







motivation



Interventions in: Leisure time School Non-OECD countries

151





156 characteristics and findings of the included studies’[12]. In addition, to be included in this overview of










166 tasks).

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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



182 person from the reviewer team. We used the software Covidence (https://www.covidence.org/) for

183 the study selection process.








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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:



200 studies)











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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


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








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


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

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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.



235


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).



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

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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].



256 25, 27]. The QoE varied widely between outcomes. See online appendix 6 for further details.




260 range of occupational groups.



263 transfer).


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.

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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].


288 Overall, seven SRs investigated interventions for the prevention of occupational injuries. One review




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].









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304 all outcomes).








312 Four SRs investigated for safety products and practices in the health sector to prevent occupational















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336 is uncertainty about the estimates of the effects.


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











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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]





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

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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







393 musculoskeletal disorders are one of the main causes for work-related mortality and morbidity[47].



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.



400 pesticides, legislation on the use of safety-engineered devices in the healthcare sector etc.). In some

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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.







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

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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

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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.



463 FUNDING







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.

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475 ACKNOWLEDGMENTS










485 REFERENCES

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PRISMA Flowchart of the study selection process

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TITLE



ABSTRACT


50-73

INTRODUCTION



120-122

METHODS


128-129



146-175


135-145


Appendix 1



176-182


192-214


196-203



183-191


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192-195; 211-214

Page 1 of 2






RESULTS


221-232









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DISCUSSION


387-413


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


464-466



Page 2 of 2

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# Searches Results







7 or/1-6 30483

8





12 *Work/ 15722

13 *Workplace/ 9376


15 or/8-14 279210












27 or/16-26 1360949

28 15 and 27 47978

29 7 or 28 64546


31 29 not 30 63888

32 review.pt. 2393987

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34 32 and 33 135062

35


36 34 or 35 296663

37 31 and 36 1349










#7 {or #1-#6} 1501

#8





#12 [mh ^work] 225



#15 {or #8-#14} 11318



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#27 {or #16-#26} 191090

#28 #15 and #27 4272

#29 #7 or #28 4857


#31 #29 not #30 4832






Scopus

12 June 2018




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3 OR 4





5 AND 6




7 NOT 8

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10



2008-2018

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Ineligible outcome







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Ineligible setting


















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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.

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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.

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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.

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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.

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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



criteria?

CONCERNS regarding


CONCERNS regarding


CONCERNS regarding


results







low low low low low



low low low low low



low low low low low



low low low low low



low low low low low

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low low low low low



low low low low low



low low low low low






low low low low low



low low low low low



low low low low low



low low low low low

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low low low low low



low low low low low



low low low low low



low low low low low



low low low low low



low low low low low



low low low low low

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low low low low low



low low low low low



low low low low low



low low low low low

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Table 1: Characteristics of included studies





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)


Chen et al. 2018 [23] Low Exercise interventions, ergonomic interventions, breaks, cognitive behaviour therapy, education, myofeedback

Neck pain intensity











Kelly et al. 2018 [27] Low Exercise therapy Pain and functionality in work-related diseases of the upper extremities


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







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










Low Training, professional education, video, use of a back belt, exercise, training plus lifting aids

Incidence, intensity of back pain

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Injuries, poisoning






















Lunt et al. 2011 [41] Low Training for behavioural change Exposure to occupational health hazards


















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Intervention

Comparison

Number of studies; study design

Population/ Setting


Outcome

Result

Quality of evidence

Author and year


No intervention

1 RCT


Neck pain

High Chen et al. 2018 [23]


No intervention 7 RCTs Varying professions MA Back pain Moderate Verbeek et al. 2011 [33]

Exercise therapy

No intervention

9 RCTs, 2 SR


Narrative


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]




Myofeedback No intervention 2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]



10 RCTs


MA

Neck pain 1A: 1B: 2B:

Moderate

Chen et al. 2018 [23]





3 cohort studies

Varying professions

MA

Back pain

Moderate


General fitness exercise

No intervention

4 RCTs


MA

Neck pain

A: B:

Low to Moderate

Chen et al. 2018 [23]

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Intervention

Comparison Number of studies; study design

Population/ Setting


Outcome

Result

Quality of evidence

Author and year


n. a.

1 RCT


Narrative





n. a.

2 RCTs


Individual studies





Pain severity Low Aas et al. 2011 [22]



1 RCT

Varying professions

Individual study

Back pain

Low




Varying professions MA Back pain Low Verbeek et al. 2011 [33]


No intervention 1 RCT Office workers MA Pain prevalence Low Aas et al. 2011 [22]






5 RCTs


MA

Shoulder pain intensity

Low





Shoulder pain intensity Low Lowry et al. 2017 [25]



Shoulder symptoms Low Hoe et al. 2012 [30]



1 cohort study

Varying professions MA Back pain Very low Verbeek et al. 2011 [33]

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Intervention

Comparison Number of studies; study design

Population/ Setting


Outcome

Result

Quality of evidence

Author and year

Ergonomic training

No intervention

2 RCTs

Office workers

MA


Very low

Hoe et al. 2012 [30]



Neck pain Very low Chen et al. 2018 [23]



Pain n. a. Richardson et al. 2018 [26]


n. a.


Nurses

Individual studies


A: B:

n. a.





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Intervention

Comparison

Number and study design

Population/ Setting


Outcome

Result

Quality of evidence

Author and year

Ergonomic mouse

Conventional mouse


Office workers

Individual studies


High


Ergonomic keyboards

n. a.

1 quasi-experimental design, 1 RCT

Office workers

Individual studies


A: B:

C:

D:

High


Forearm supports

n. a.


Office workers

Individual studies


A:

B:

C: D:

High


Alternative mouse

Conventional mouse

2 RCTs

Office workers

MA

Incidence of neck/shoulder and right upper limb disorders

Moderate

Hoe et al. 2012 [30]


2 RCTs Office workers MA Neck pain Moderate Chen et al. 2018 [23]



2 RCTs

Office workers

MA


A: B: C:


Hoe et al. 2012 [30]

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Intervention

Comparison Number and study design

Population/ Setting


Outcome

Result

Quality of evidence

Author and year



2 RCTs

Office workers

MA


Moderate

Hoe et al. 2012 [30]



2 RCTs

Office workers

MA


A:

B: C:


Hoe et al. 2012 [30]



4 RCTs

Varying professions

Narrativee


A: B:

Moderate



No intervention

1 RCT


Individual study


Low

Hegewald et a. 2018 [32]



5 RCTs


MA

Shoulder pain intensity

Low



3 RCTs Office workers Narrativee Neck pain Low Chen et al. 2018 [23]

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Intervention


Population/ Setting


Outcome

Result

Quality of evidence

Author and year



2 RCTs

Office workers

MA


Low

Hoe et al. 2012 [30]


Work as usual

1 RCT

Computer workers


Low





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




2 RCTs

Office workers

MA

Upper-extremity symptoms or pain, discomfort, work ability

Low

Hoe et al. 2012 [30]


No intervention

4 RCTs


MA

Neck pain

A: B:

Low to very low

Chen et al. 2018 [23]







3 RCTs


MA

Neck pain

A: B:

Very low

Chen et al. 2018 [23]



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Intervention

Comparison


Population/ Setting


Outcome

Result

Quality of evidence

Author and year


No intervention 1 quasi- experimental design





No intervention

5 RCTs

Computer users

Individual studies1


Low to Moderate

Aas et al. 2011 [22]


Work as usual

4 RCTs, 1 non-RCT

Varying professions

Narrative


A:

B:

C:

D:





1 non-RCT

Nurses, nursing aids, teachers

Individual study


A: B: C:

Very low to low


Small aids

Mechanical aids

1 RCT


Individual study


Very low to low


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Intervention


Population/ Setting


Outcome

Result

Quality of evidence

Author and year


No intervention

1 RCT





One‑time ergonomic education

1 non-RCT


Individual study


Very low



No intervention

A) 4 CBAs B) 1 CBA C) 2 CBAs

Gesundheits- personal



A: B: C:

Very low



n. a.



Individual study


A:

B:

C:

n. a.





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Table 4: Overview of behavioural interventions for the prevention of occupational injuries

Intervention

Comparison


Population/ Setting


Outcome

Result

Quality of evidence

Author and year

Active training (face-to- face instruction)




Individual study

Noncompliance with PPE use

Very low


Active training (face-to- face instruction)




Individual study

Noncompliance with doffing guidance


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


Safety campaign

No intervention

1 ITS


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


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:


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:




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Table 5: Overview of relational interventions for the prevention of occupational injuries

Intervention

Comparison


Population/ Setting


Outcome

Result

Quality of evidence

Author and year


10 RCTs Surgical staff MA Glove perforations per surgeon per operation

High Parantainen et al. 2011 [38]

Double gloves

Single gloves

8 RCTs


MA

Dexterity: outer glove perforations – number of perforations

Moderate Mischke et al. 2014 [37]


MA A: Inner glove perforations B: Blood stains on the skin

A: B:

A: Moderate B: Moderate


Double indicator gloves Double standard gloves


MA Inner glove perforations Moderate Mischke et al. 2014 [37]

Triple special gloves Double standard gloves


MA Inner glove perforations Moderate Mischke et al.

2014 [37]


4 RCTs Surgical staff MA Self-reported needle stick injuries

Moderate Parantainen et al. 2011 [38]

Legislation - Interruption

No legislation

2 ITS


MA


A: B:

A: Moderate B: Very low


Legislation - Gradual introduction

No legislation

1 ITS


Individual study


A: B:

A: Low B: Low


Thicker gloves Thinner gloves 2 RCTs Healthcare personnel


One fabric glove over one normal glove

Two normal gloves 3 RCTs Healthcare personnel


Double indicator gloves Standard gloves (single or double)



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]





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Individual study

Incidence of blood leakage Low Reddy et al.

2017 [39]

Safe passive intravenous systems




Double gloving method

Single gloving method

1 cross-over simulation study


Individual study

A: Contamination B: Noncompliance with guidance

A: B:

A: Very low B. Very low


Centers for Disease Control and Prevention recommended doffing

Individual doffing

1 RCT


Individual study

Contamination


European and national safety and health regulations and standards for construction sites

Not applicable

5 ITS


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:


Gowns

Aprons

1 Randomised cross-over simulation study


Individual study

Contamination


Multiple safe devices Not applicable 2 ITS Healthcare personnel

MA Percutaneous exposure injuries caused by needles


Multiple safe devices Regular devices 1 CBA Healthcare personnel

Individual study

Percutaneous exposure injuries caused by needles


PPE with Powered Air Purifying Respirator Attire

Enhanced respiratory and contact precautions attire

1 RCT


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



Regular systems

1 RCT


Individual study

A: Needlestick injuries immediate follow up B: Blood splashes

A: B:

A: Very low B: Very low


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Not applicable

2 ITS


Individual studies


A: B:

A, B: Very low


Safe injection systems Regular systems 1 RCT, 1 CBA Healthcare personnel

Individual studies


2017 [39]


Regular systems 1 RCT, 1 CBA Healthcare personnel

Individual studies


2017 [39]


Regular systems

2 ITS


Individual studies


A: B:

A, B: Very low


Sharps containers Not applicable 2 ITS Healthcare

personnel Individual studies



Sharps containers No containers 1 CBA Healthcare

personnel Individual study



Safety inspections and sanctions for violations


Individual study

A: Non-fatal injuries, change in level B: Non-fatal injuries, change in slope

A: B:


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


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


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


Individual study

A: Contamination A: A: Very low Verbeek et al. 2016 [40]


MA Needlestick injuries n. a. Mischke et al. 2014 [37]

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Legislation on rollover protective structures or Safety Cabins on new tractors



A: B:


Legislation on rollover protective structures or Safety Cabins on all tractors



A: B:


Legislation banning Endosulfan pesticide


Individual study

Injuries: A: immediate effect B: progressive effect

A: B:




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


Population/ Setting


Outcome

Result Quality of evidence

Author and year

Occupational health and safety services

n. a.

1 CBA


Individual study

Injuries

n. a.


Abbreviations: CBA = controlled before-after studies; n. a. = not available


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Table 7: Overview of behavioural interventions to prevent skin and lung diseases

Intervention

Comparison


Population/Setting


Outcome

Result

Quality of evidence

Author and year

Educational intervention

No intervention

1 RCT, 4 CBA

Farm and construction workers



Very low



Very low Bauer et al. 2018 [43]





Narrative

Correct use of respiratory protective equipment

Very low








No training

1 CBA

Hospital workers

Narrative

Proportion of correctly used respirators

Very low


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]



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Table 8: Overview of relational interventions to prevent skin and lung diseases

Intervention

Comparison


Population/ Setting


Outcome

Result

Quality of evidence

Author and year

















Author and year











Author and year



Low Tikka et al. 2017 [44]


n. a. 1 RCT, 3 CBA

n. a. n. a. Noise exposure Low Tikka et al. 2017 [44]

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New stricter legislation

Not applicable

1 ITS

Coal mines

Individual study


A: B:

Very low


Earmuffs

Earplug

2 CBA Workers with noise exposition above 88–94 dB(A)

MA

Hearing loss









Author and year


Audiometric testing

1 RCT

Agricultural students involved in farm work

Individual study

Hearing loss average

Moderate



Less well- implemented HLPP for hearing loss

4 CBA

Varying professions

MA

Hearing loss STS

Very low



Non-exposed workers

3 CBA

Varying professions

MA Hearing loss average




1 CBA

Various workers of an aluminium smelter

Individual study

Hearing loss average

Very low



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Intervention

Comparison


Population/Setting


Outcome

Result

Quality of evidence

Author and year


No inspections

1 RCT, 2 CBA, 1 ITS


Individual studies


A: B:

Low



No inspections

1 RCT

Varying professions

Individual study

Physical workload

Low





Intervention

Comparison


Population/Setting


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


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Intervention


Population/Setting


Outcome

Result

Quality of evidence

Author and year

C: Persons with mental health problems


Usual care

5 RCTs Varying professions, after sickness absence

MA

Pain

High



Usual care


MA

Time until first return-to-work

Moderate



Usual care

1 RCT Varying professions, after sickness absence

Individual study


Moderate



Usual care



Moderate



Usual care

6 RCTs


MA


A: B: C: D:

Very low



Usual care

4 RCTs


MA

Depression

Very low

van Vilsteren et

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Intervention


Population/Setting


Outcome

Result

Quality of evidence

Author and year

al. 2015 [46]



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Documents

BMJ Open is committed to open peer review. As part of this … · 37 Ludwig Grillich, 38 University for Continuing Education Krems (Danube University Krems), Department for Evidence-39