Friday, September 19, 2008

A DISCUSSION ON RSI

1.1 Work related or occupation related pain is called repetitive stress injuries (RSI) or cumulative trauma disorders (CTD). They are usually caused by poor posture while working, poor work place accessories such as inadequate chair and table height, tension related due to work, working more than scheduled hours etc.
1.2 According to a Cochrane review
1. Incidence: In the USA, cumulative trauma disorders account for between 56 and 65% of all occupational injuries.
2. Prevalence: Overall, the estimated prevalence of these injuries is approximately 30% and the incidence is rapidly increasing.
1.3 Interventions: Conservative interventions such as physiotherapy and ergonomic work-place adjustments play a major role in the treatment. Research input suggests:
1. That there is positive effect of exercise when compared to massage
2. Adding breaks during computer work helps
3. Massage adds to the treatment out come of manual therapy, manual therapy as add-on to treatment by exercises
4. Changing work place accessories such as some keyboards in people with carpal tunnel syndrome when compared to placebo helps.
5. In addition to endurance exercises light strength training can be added in office attached gym hours of the corporate protocols.
6. Ergonomic consultancy is an invaluable asset for reducing work hour loss due to occupation related hazards.
1.4 However the Cochrane review mentioned in 1.2 mentioned following things:
1. There is conflicting evidence concerning the efficacy of exercises over no treatment (eight studies) or as add-on treatment (three studies), and no differences between strength and endurance exercises can be found yet (four studies).
2. Conflicting evidence about the effectiveness of ergonomic programs over no treatment (two studies). No adverse effects were mentioned in the studies.
3. The most important limitations of the included studies are the heterogeneity of the participants, interventions and outcome measures used.
4. No clear definition of 'work-relatedness' could be found in the majority of the studies. Methodological flaws and low power in many of the studies may have influenced the results.
NB: readers and clinicians in physiotherapy especially in work related diseases are cautioned that research conclusions are based on the data discussed in that study. Hence clinical effectiveness is an entirely issue. The clinician is advised to with clinical effectiveness rather than research inputs at times.

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