243 - Effectiveness and characteristics of work participation interventions for adults with musculoskeletal upper limb conditions: a systematic review...Chartered Society of Physiotherapy (CSP) Annual Conference, November 21-22, 2024, Newport, Wales

Abstract

Purpose: The aims of the review were to (i) identify interventions that enhance work participation for individuals with upper limb musculoskeletal conditions, and (ii) explore contextual factors and mechanisms that suggest how the intervention is effective, for whom and in what setting. Methods: The review protocol was pre-registered with PROSPERO (CRD42023433216). We used a pre-defined strategy to search six healthcare databases (Medline, PsychInfo, EMCARE, AMED, CINAHL, PEDro), three trials databases, two naïve Google searches, and the reference lists of existing systematic reviews and included papers. Eligibility criteria were: Population – adults (aged = 18 years), with musculoskeletal upper limb conditions including traumatic and non-traumatic presentations. Intervention – strategies aimed at enhancing work participation. Outcomes – measures including return to work, increased work duties or hours, and work functioning. Study designs – randomised and non-randomised experimental studies, mixed methods and qualitative studies, and case series. Two reviewers independently screened, extracted data, and completed quality appraisal using the relevant Joanna Briggs Institute tool for the study design. Interventions were described using TIDieR (Template for Interventions Description and Replication). Results: Initial searches yielded 3,153 articles after removal of duplicates. We excluded 3,069 during title and abstract screening, and 61 were excluded during full text screening. Twenty-two studies (23 articles) were included in the review. Interventions were classified into three categories (i) multimodal or multidisciplinary (n=13), (ii) ergonomic (n=4), and (iii) exercise or activity-based (n=5), and were delivered in two settings, workplace (n=8) and healthcare (n=14). Reported outcome domains were: return to work, self-reported work functioning, work productivity, and work-related costs. Heterogeneity in interventions and outcomes prevented formal meta-analysis. Contextual occupational factors were poorly reported. Conclusion(s): This review collates the existing literature evaluating the effectiveness of work participation interventions for adults with upper limb conditions. Variation in outcome measures prevented meta-analysis. Many of the described interventions were resource-intensive and therefore full cost-effective analysis would be beneficial for healthcare providers and decision-makers. Impact: We recommend development and use of a core outcome set for work-related studies to facilitate comparative analyses. We also recommend that researchers report contextual occupational factors, for example work status, including employed/self-employed; work type, including manual/non-manual; and brief descriptions of local/national sickness benefits. Our review found no clear benefit of any one type of work participation intervention.