In this issue of Occupational Medicine
Honorary Editor
The evidence-based review is an increasingly common phenomenon in our journal. In this issue we carry three evidence-based reviews concerned with upper limb disorder. In two papers, Palmer et al. consider the evidence for compensating carpal tunnel syndrome [1] and tenosynovitis and epicondylitis [2], and in a third paper Crawford and Laiou [3] consider the evidence for the effectiveness of the conservative treatment of these conditions and other upper limb disorders. All three papers comment on the relative dearth of good evidence which is now almost as familiar as the call for further research.
In terms of causation, Palmer et al. found reasonable evidence that certain tasks and postures were associated with twice the risk of carpal tunnel syndrome and specifically regular and prolonged use of hand-held vibratory tools. They did not find an important association with keyboard and computer work nor in a separate paper did they find sufficient evidence to support an association between work activity and epicondylitis or tenosynovitis at least not sufficiently to cause a doubling of risk. They conclude that there is a case for extending social security compensation for carpal tunnel syndrome but not for other work-related upper limb disorders at this time.
While there may be ongoing debate about causation, many occupational health practitioners are involved in the management of work-related upper limb disorder and sometimes this may extend to treatment. Where there are risk factors in the workplace, this can make sense, particularly where this means the worker obtains earlier treatment and this can be combined with supervised return-to-work rehabilitation programmes. Most treatment provided in the occupational health setting is likely to be conservative and Crawford and Laiou review the evidence for effectiveness of conservative treatment. They also find the evidence base to be weak but there was evidence of effectiveness for some conservative treatments for carpal tunnel syndrome and epicondylitis particularly and it is possible for treating occupational health practitioners to offer evidence-based treatment if not management at this time.
In another study McGuirk and Bogduk [4] investigated whether evidence-based guidelines actually made any difference in the management of low-back pain. Reassuringly, they found that injured workers who accepted evidence-based interventions had less time off work, spent less time on modified duties and had fewer recurrences and fewer developed chronic pain. Persisting with producing, finding and implementing the evidence may produce results.
This issue also contains the first in a new series designed to explore and explain commonly encountered questionnaires. Any dedicated follower of research will have by now become semi-familiar with all manners of strange-sounding research tools such as the Maslach Burnout Inventory or the SF-36. We thought that a nutshell description of some of these tools might be useful for practising occupational physicians, if not for actual use but to help understand some of the research findings. We begin in this issue with the General Health Questionnaire and will carry a different questionnaire in each issue from now on.
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 Top References |
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- Palmer KT, Harris EC, Coggon D. (2007) Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond) 57:57–66.[Medline]
- Palmer KT, Harris EC, Coggon D. (2007) Compensating occupationally related tenosynovitis and epicondylitis: a literature review. Occup Med (Lond) 57:67–74.[Medline]
- Crawford JO and Laiou E. (2007) Conservative treatment of work-related upper limb disorders—a review. Occup Med (Lond) 57:4–17.[Medline]
- McGuirk B and Bogduk N. (2007) Evidence-based care for low back pain in workers eligible for compensation. Occup Med (Lond) 57:36–42.[Medline]
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