Lack of evidence on upper limb disorders hampers treatment

A severe lack of evidence is holding doctors back from providing the right treatment for people suffering from upper limb disorders, new research has suggested.

An evidence review by NHS Plus and funded by the Royal College of Physicians’ Occupational Health Clinical Effectiveness Unit, found just four papers of a high enough quality looking at how people with these conditions – such as shoulder, arm, wrist and hand conditions and carpal tunnel syndrome – could be helped in their workplace.

It is now calling for researchers to build an evidence base to inform future management, with priority areas needing to include the establishment of clear and consistent definitions for the various disorders studied and assessing outcomes such as job retention and sickness absence in relation to multi-­disciplinary rehabilitation.

There was also an urgent need for research into the effect of modern keyboard design on occupational outcomes in comparison with current standard workstation equipment. Nevertheless the unit’s guideline development group recommended, on the basis of the evidence available, that OH practitioners and employers ­allow people with carpal tunnel syndrome to try out alternative computer keyboards.

It also recommended offering or making available multi-discipline rehabilitation processes for staff with non-specific arm pain who have been absent from work for more than four weeks.

Dr Ira Madan, former director of clinical standards at NHS Plus, said: “For the first time, all the evidence on the effectiveness of occupational health interventions in the management of upper limb pain in the workplace has been collated into one document.

“NHS Plus is concerned by the lack of research in this important area and we would encourage academic departments to fill the gaps in the evidence base,” she added.

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