Applying epidemiological principles to ergonomics: a checklist for incorporating sound design and interpretation of studies

A unified framework for bias assessment in clinical research

Methodological flaws, limitations, and inadequate practices in research are well known and pose threats to the internal validity of any research study. However, there are ways of safeguarding research conduct to reduce the chance of research producing distorted results. Numerous tools now exist to assess the incorporation of such safeguards into primary research studies (also known as quality and/or risk-of-bias assessment). These tools typically include a variety of items that are then checked against those implemented in the study. Despite a lot of research in this area, no comprehensive generic classification of safeguards across study designs exist, although attempts have been made to clarify aspects of this. We review the developments in this area as well as use preliminary data from 100 methodological studies to illustrate our proposed approach. We conclude by proposing a new framework for identifying research studies at risk of being biased and the information in this article will promote a unification of the diverse approaches to facilitating bias assessment in clinical research.

Do Workplace Ergonomic Interventions to Control Musculoskeletal Disorders Really Work?

The purpose of this study was to examine the effectiveness of ergonomic field interventions to control work-related musculoskeletal disorders. This paper is an extension of the one written for the 1998 National Academy of Sciences/National Research Council steering committee to examine the scientific literature relevant to work-related musculoskeletal disorders. Over 600 papers were read, and 98 were found that met the selection criteria. Eighty-four percent of all of the studies found some positive results, although the majority had mixed results. The most effective interventions were those that utilized multiple components. Only 31% of the studies used experimental or quasi-experimental designs. The implications for the conduct of ergonomic interventions and federal regulations are discussed.

From Structured Abstracts to Structured Articles: A Modest Proposal

Work with structured abstracts—which contain sub-headings in a standard order—has suggested that such abstracts contain more information, are of a higher quality, and are easier to search and to read than are traditional abstracts. The aim of this article is to suggest that this work with structured abstracts can be extended to cover scientific articles as a whole. The article outlines a set of sub-headings—drawn from research on academic writing—that can be used to make the presentation of scientific papers easier to read and to write. Twenty published research papers are then analyzed in terms of these sub-headings. The analysis, with some reservations, supports the viability of this approach.

Decision-making capacity evaluation in adult guardianship: a systematic review

BACKGROUND

Evidence of impaired decision-making capacity is a legal requirement for adult guardianship. To understand the quality of the evidence health professionals commonly provide in reports submitted to guardianship courts, a systematic review was undertaken to appraise the design and methodological quality of the published literature on health professionals' written reports of decision-making capacity and to describe the content of these reports.

METHODS

Electronic searches from 1980 to 2015 identified 1183 articles of which 11 met the inclusion criteria where each evaluated quantitatively the content of health professionals' written reports submitted to adult guardianship proceedings. Methodological quality of the selected studies was rated using a critical appraisal tool.

RESULTS

Nine studies sourced files from courts in the U.S. and one from Sweden; another reported on guardianship decisions from Australia. Four studies were rated as moderately strong or strong. Strengths included the use of comparison groups and a reliable and valid instrument to code reports. The review showed a person's medical condition was often cited as evidence of impaired decision-making capacity. Cognitive, psychiatric and functional abilities were less often described, and a person's values and preferences were rarely recorded.

CONCLUSIONS

It is recommended health professionals describe the process by which a person makes a particular decision (their ability to understand, appreciate, reason and communicate) in addition to providing medical information, including cognitive, psychiatric and functional abilities. This approach provides support for a professional's opinion and evidence for a court. International studies of health professionals' approach to decision-making capacity evaluation are needed.

A review of critical appraisal tools show they lack rigor: Alternative tool structure is proposed

OBJECTIVES

To evaluate critical appraisal tools (CATs) that have been through a peer-reviewed development process with the aim of analyzing well-designed, documented, and researched CATs that could be used to develop a comprehensive CAT.

STUDY DESIGN AND SETTING

A critical review of the development of CATs was undertaken.

RESULTS

Of the 44 CATs reviewed, 25 (57%) were applicable to more than one research design, 11 (25%) to true experimental studies, and the remaining 8 (18%) to individual research designs. Comprehensive explanation of how a CAT was developed and guidelines to use the CAT were available in five (11%) instances. There was no validation process reported in 11 CATs (25%) and 33 CATs (77%) had not been reliability tested. The questions and statements that made up each CAT were coded into 8 categories and 22 items such that each item was distinct from every other.

CONCLUSIONS

CATs are being developed while ignoring basic research techniques, the evidence available for design, and comprehensive validation and reliability testing. The basic structure for a comprehensive CAT is suggested that requires further study to verify its overall usefulness. Meanwhile, users of CATs should be careful about which CAT they use and how they use it.

Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: a 3 year cross-over trial

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover.

OUTCOMES

Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.

Evaluation of two preventive interventions for reducing musculoskeletal complaints in operators of video display terminals

BACKGROUND AND PURPOSE

The purpose of this study was to evaluate the efficacy of a preventive ergonomic intervention, which was provided by physical therapists, on spinal and upper-extremity work-related posture and symptom complaints of workers who use video display terminals (VDT).

SUBJECTS

Two hundred employees who spent at least 20 hours per week at a VDT were randomly divided into 2 groups. Group E received the ergonomic intervention and an informative brochure, and group I received only the brochure.

METHODS

Both groups were evaluated at the beginning of the study and at a follow-up 5 months later. The following tools were used: a pain drawing and the Rapid Entire Body Assessment (REBA) method to assess spinal and upper-extremity work-related posture.

RESULTS

Group E had a lower REBA score and reduced lower back, neck, and shoulder symptoms compared with group I.

DISCUSSION AND CONCLUSION

The results suggest that a personalized preventive ergonomic intervention can improve spinal and upper-extremity work-related posture and musculoskeletal symptoms for workers who use VDTs.

Psychometric and Administrative Properties of Measures Used in Assistive Technology Device Outcomes Research

Although there have been numerous calls for increasing the quantity and quality of assistive technology outcomes research, no one has analyzed the nature of data that the field has been accumulating. This article summarizes our evaluation of 82 outcome studies, published between 1980 and 2001, addressing assistive technology devices (ATDs). Our data indicate that the "typical" ATD outcomes study published in the past 20 years is one that (a) used a sample population that was diverse in terms of age, disability population, and type of ATD being used; (b) measured user-reported dependent variables with instruments designed specifically for the study; (c) did not report adequate information on the reliability and validity for the measurement instruments that were used; (d) did not discuss the staff workload associated with learning, administering, and scoring its data collection tools; and (e) did not differentiate its findings in terms of distinguishable participant subgroups. Several suggestions are provided to guide future development of assistive technology outcome measures in the domains of usability, quality of life, and social role performance. In addition, seven recommendations are offered to outcomes researchers, policy makers, journal editors, and reviewers in order to improve the reporting of assistive technology outcomes research.

New roads and human health: a systematic review

We sought to synthesize evidence of the health effects of construction of new roads by systematically reviewing observational studies of such effects. We included and critically appraised 32 studies. The review suggested that out-of-town bypasses decrease injuries on main roads through or around towns, although more robust evidence is needed on effects on secondary roads. New major urban roads have statistically insignificant effects on injury incidence. New major roads between towns decrease injuries. Out-of-town bypasses reduce disturbance and community severance in towns but increase them elsewhere. Major urban roads increase disturbance and severance. More robust research is needed in this area, particularly regarding effects of new roads on respiratory health, mental health, access to health services, and physical activity.