Strategies for the prevention of carpal tunnel syndrome in the workplace: A systematic review.

Carpal Tunnel Syndrome (CTS) is one of the most frequently occurring musculoskeletal disorders of the upper limbs. Strategies for preventing CTS in the workplace include interventions such as ergonomics, education, exercise, physical therapy, and occupational health. The purpose of this study was to provide a general overview based on the review of scientific literature regarding strategies used for preventing CTS in working populations. From September to October 2018, the MEDLINE, PUBMED, EMBASE and SCOPUS (1990 to December 2017) databases were searched for evidence. The risk of bias assessment in the selected papers was evaluated using the criteria recommended by The Cochrane Handbook and the methodological quality of the included studies was evaluated using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. A total of 11 studies were included in the present review. A total of 1,061 subjects participated in the studies. The quality of the included studies was limited in three studies, appropriate in three studies, good in three studies, and strong in two studies. The overall results suggest a mixed level of evidence of the effect of applying strategies for preventing CTS in the workplace. The bias assessment was primarily due to incomplete result data, selective reporting of results, and blinding. In this review, interventions focused on the modification or change of accessories (keyboard, mouse, wrist rest, and the overall workstation), education in ergonomics, exercise, and physical therapies, among others, were analyzed. The findings of this review show different possibilities when choosing an intervention strategy for the workplace. However, it was challenging to analyze each of the papers owing to the heterogeneity of the studies included.

Práctica clínica cotidiana frente a la evidencia científica en el manejo fisioterapéutico del dolor lumbar crónico inespecífico / Daily Clinical Practice of Scientific Evidence in the Physiotherapeutic Management of Chronic Nonspecific Low Back Pain / Prática clínica cotidiana versus a evidência científica no manejo fisioterapêutico da dor lombar crónica inespecífica

Introducción: El 80% de los adultos experimenta dolor lumbar por lo menos una vez en su vida. El dolor lumbar es la tercera causa de consulta en urgencias, la cuarta en medicina general, la segunda de pensión por invalidez y la primera de reubicación laboral. Objetivo: Comparar los criterios que orientan la toma de decisiones de un grupo de fisioterapeutas en Bogotá, Colombia para el manejo del dolor lumbar crónico inespecífico con los criterios de manejo contenidos en la guía COST B13 (European Guidelines for the Management of Chronic Non-Specific Low Back Pain, 2004). Materiales y método: Se trató de un estudio descriptivo, en el cual se seleccionó la guía de práctica clínica COST B13 para el manejo de dolor lumbar crónico inespecífico mediante la herramienta AGREE y se aplicó una encuesta a 50 fisioterapeutas por medio de un muestreo por conveniencia con el fin de comparar las prácticas clínicas que se realizan frente a las recomendaciones dadas en la guía. Resultados: El 56% de los encuestados contaba con algún tipo de entrenamiento para el manejo del dolor lumbar crónico inespecífico (DLCI). El 94% de los pacientes con DLCI atendidos oscilan en edades de 40 a 59 años, con predominio del sexo femenino. El 80% de los fisioterapeutas encuestados manifestó que la ayuda diagnóstica con la que cuentan para el manejo de los pacientes es la imagen radiológica. El 80% de los fisioterapeutas evalúa la variable de dolor lumbar experimentado por el paciente y el 54% la postura. Otros aspectos fueron reportados en menor porcentaje como test neurales, rangos de movimiento y pruebas de flexibilidad muscular. En el tratamiento del DLCI, los fisioterapeutas reportan hacer uso de los estiramientos en el 80% de los casos, la termoterapia superficial, en el 70% y el fortalecimiento muscular isométrico, en el 70%, todos con resultados favorables. Conclusión: Existen diferencias entre la práctica clínica y los lineamientos contenidos en las recomendaciones dadas por la guía COST B13 para DLCI, principalmente en los procesos de evaluación clínica, ya que suelen estar centrados en la observación y no siempre en la medición rigurosa, lo que dificulta la posibilidad de establecer indicadores de proceso y desenlace en el diagnóstico y tratamiento de los pacientes con DLCI.

Introduction: 80% of adults experience back pain at least once in their life.Back pain is the third leading cause of consultation in the emergency room, the fourth in general practice, the second of disability pension and the first job relocation. Objective: To compare criteria that guide decision making of a group of physiotherapists in Bogota, Colombia, for managing chronic nonspecific low back pain management criteria contained in the guide COST B13 (European Guidelines for the Management of Chronic Non-Specific Low Back Pain, 2004). Material and methods: This was a descriptive study, for which the clinical practice guideline COST B13 for the management of chronic nonspecific low back pain through the AGREE tool is selected. A survey was applied to 50 physiotherapists through a convenience sample to compare the clinical practices performed with the recommendations given guidance. Results: 56% of respondents had some type of training for the management of chronic nonspecific low back pain (cnlbp). 94% of attended patients with cnlbp ranged ages from 40 to 59, with female predominance. 80% of respondents stated that physiotherapists' diagnostic help with counting for the management of patients is the radiological image. 80 % of physiotherapists evaluate the variable of experienced lumbar pain based on what the patient says and 54% based on the posture. Other aspects reported rated lower percentages. In the treatment of cnlbp, physiotherapists reported the use of stretching in 80% of cases; superficial thermotherapy in 70% and isometric muscle strength in 70% of cases, all with favorable results. Conclusion: There are differences between the physiotherapists' clinical practice of and the guidelines contained in the recommendations of the in the cnlbp cost B13 guide. Mainly in the processes of physiotherapeutic assessment, as they are often focused on observation and not always in the rigorous measurement, which makes it difficult to establish process indicators and results in the diagnosis and treatment of patients with cnlbp.

Introdução: o 80% dos adultos experimenta dor lombar pelo menos uma vez em sua vida; a dor lombar é a terceira causa de consulta em emergências, a quarta em medicina geral, a segunda de pensão por invalidez e a primeira de deslocalização laboral. Objetivo: Comparar os critérios que orientam a tomada de decisões de um grupo de fisioterapeutas em Bogotá, Colômbia, para o manejo da dor lombar crónica inespecífico com os critérios de manejo conteúdos na guia COST B13 (European Guidelines for the Management of Chronic Non-Specific Low Back Pain, 2004). Materiais e métodos: tratou-se de um estudo descritivo, no qual se selecionou a guia de prática clínica COSTB 13 para o manejo de dor lombar crónico inespecífico através da ferramenta AGREE e se aplicou uma enquete a 50 fisioterapeutas através de uma amostragem por conveniência com o fim de comparar as práticas clínicas que se realizam frente às recomendações dadas na guia. Resultados: o 56% dos questionados contavam com algum tipo de treinamento para o manejo da dor lombar crónico inespecífico (DLCI). O 94% dos pacientes com DLCI atendidos oscilam em idades de 40 a 59 anos, com predomínio do sexo feminino. O 80% dos fisioterapeutas avalia a variável de dor lombar experimentado pelo paciente e o 54% a postura. Outros aspectos foram reportados em menor porcentagem como teste neurais, rasgos de movimentos, e provas de flexibilidade muscular. No tratamento da DLCI, os fisioterapeutas reportam fazer uso dos estiramentos no 80% dos casos, a termoterapia superficial no 70% e o fortalecimento muscular isométrico no 70%, todos com resultados favoráveis. Conclusões: Existem diferenças entre a prática clínica e os lineamentos conteúdos nas recomendações dadas pela guia COST B12 para DLCI principalmente nos processos de avaliação clínica devido a que costumam estar centrados na observação e não sempre na medição rigorosa o que dificulta a possibilidade de estabelecer indicadores de processo e desenlace no diagnóstico e tratamento dos pacientes com DLCI.