Background

The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates.

Objectives

We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence).

Data sources

We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts.

Study eligibility and criteria

We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of occupational exposure to ergonomic risk factors (any exposure to force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing ≥ 2 h/day) compared with no or low exposure to the theoretical minimum risk exposure level (<2 h/day) on the prevalence or incidence of MSD or OA.

Study appraisal and synthesis methods

At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using Navigation Guide tools adapted to this project.

Results

In total eight studies (4 cohort studies and 4 case control studies) met the inclusion criteria, comprising a total of 2,378,729 participants (1,157,943 females and 1,220,786 males) in 6 countries in 3 WHO regions (Europe, Eastern Mediterranean and Western Pacific). The exposure was measured using self-reports in most studies and with a job exposure matrix in one study and outcome was generally assessed with physician diagnostic records or administrative health data. Across included studies, risk of bias was generally moderate.

Compared with no or low exposure (<2 h per day), any occupational exposure to ergonomic risk factors increased the risk of acquiring MSD (odds ratio (OR) 1.76, 95% confidence interval [CI] 1.14 to 2.72, 4 studies, 2,376,592 participants, I² 70%); and increased the risk of acquiring OA of knee or hip (OR 2.20, 95% CI 1.42 to 3.40, 3 studies, 1,354 participants, I² 13%); Subgroup analysis for MSD found evidence for differences by sex, but indicated a difference in study type, where OR was higher among study participants in a case control study compared to study participants in cohort studies.

Conclusions

Overall, for both outcomes, the main body of evidence was assessed as being of low quality. Occupational exposure to ergonomic risk factors increased the risk of acquiring MSD and of acquiring OA of knee or hip. We judged the body of human evidence on the relationship between exposure to occupational ergonomic factors and MSD as “limited evidence of harmfulness” and the relationship between exposure to occupational ergonomic factors and OA also as “limited evidence of harmfulness”. These relative risks might perhaps be suitable as input data for WHO/ILO modelling of work-related burden of disease and injury.

Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053

PROSPERO registration number: CRD42018102631

中文翻译：

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职业暴露于人体工程学危险因素对髋部或膝部骨关节炎和某些其他骨骼肌肉疾病的影响：WHO / ILO与工作有关的疾病和伤害负担联合估算中的系统评价和荟萃分析

背景

世界卫生组织（WHO）和国际劳工组织（ILO）在大型专家网络的协助下，正在制定与工作有关的疾病和伤害负担的联合估算（WHO / ILO联合估算）。机械性数据的证据表明，职业性接触人体工程学危险因素可能会导致其他肌肉骨骼疾病，而不是背部或颈部疼痛（MSD）或髋部或膝盖骨关节炎（OA）。在本文中，我们对参数进行了系统的回顾和荟萃分析，以估计由MSD或OA导致的残疾调整生命年的数量，这些数字可归因于职业暴露于人体工学风险因素，以开发WHO / ILO联合估算。

目标

我们旨在系统地回顾和荟萃分析职业暴露于人机工程学风险因素（力的施加，严格的姿势，重复性，手臂振动，举重，跪姿和/或下蹲和攀爬）对MSD和OA的影响（两个结果：患病率和发病率）。

数据源

我们开发并发布了协议，并在可行的情况下将“导航指南”用作组织系统的审查框架。我们在电子学术数据库中搜索了已发表和未发表研究的潜在相关记录，包括国际试验注册，Ovid Medline，EMBASE和CISDOC。我们还搜索了电子灰色文献数据库，互联网搜索引擎和组织网站；手工搜索的先前系统评价的参考清单，包括研究记录；并咨询了其他专家。

研究资格和标准

我们将世卫组织和/或国际劳工组织任何成员国中正规和非正规经济中的工作年龄（≥15岁）工人包括在内，但不包括儿童（<15岁）和无薪家政工人。我们纳入了随机对照试验，队列研究，病例对照研究和其他非随机干预研究，以评估职业暴露于人机工程学危险因素（任何暴露于用力，要求姿势，重复性，手臂振动，举升，跪下和/或蹲下和爬山≥2小时/天），而没有或很少暴露于MSD或OA的患病率或发生率的理论最低风险暴露水平（<2小时/天）。

学习评估和综合方法

至少有两名评论作者在第一阶段根据资格标准独立筛选标题和摘要，在第二阶段根据潜在合格记录的全文进行筛选，然后从合格研究中提取数据。缺少主要研究作者的数据。我们使用随机效应荟萃分析合并了优势比。使用适合该项目的“导航指南”工具，两位或更多的评论作者评估了偏差的风险和证据的质量。

结果

总共有八项研究（4项队列研究和4项病例对照研究）符合纳入标准，包括3个世卫组织区域（欧洲，东地中海和西太平洋）的6个国家的2,378,729名参与者（1,157,943名女性和1,220,786名男性）。在大多数研究中，使用自我报告测量暴露，在一项研究中使用工作暴露矩阵进行测量，通常使用医生的诊断记录或行政健康数据评估结果。在所有纳入的研究中，偏见风险通常为中等。

与无暴露或低暴露（每天少于2小时）相比，任何人体工程学危险因素的职业暴露都会增加获得MSD的风险（优势比（OR）1.76，95％置信区间[CI] 1.14至2.72，4个研究，2,376,592参与者，我² 70％）；并增加了获得膝或髋骨关节炎的风险（OR 2.20，95％CI 1.42至3.40，3个研究，1,354名参与者，I ² 13％）；MSD的亚组分析发现了性别差异的证据，但表明了研究类型的差异，病例对照研究的参与者与同类研究的参与者相比，OR更高。

结论

总体而言，对于这两种结果，评估的主要证据都是低质量的。职业暴露于人机工程学风险因素会增加获得MSD以及获得膝盖或臀部OA的风险。我们认为，关于人体工学因素与MSD暴露之间的关系的人类证据是“危害的有限证据”，而人体工学因素与OA接触之间的关系也被认为是“危害的有限证据”。这些相对风险可能适合作为WHO / ILO对与工作有关的疾病和伤害负担建模的输入数据。

协议标识符：  https : //doi.org/10.1016/j.envint.2018.09.053

PROSPERO注册号：  CRD42018102631