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A Scoping Review BMJ Open: first published as 10.1136/bmjopen-2019-032668 on 12 February 2020. Downloaded from Open access Original research Education as a strategy for managing occupational- related musculoskeletal pain: a scoping review Thorvaldur Skuli Palsson ,1 Shellie Boudreau,2 Morten Høgh,1 Pablo Herrero ,3 Pablo Bellosta- Lopez,4 Victor Domenech- Garcia,4 Francesco Langella,5 Nicolo Gagni,5 Steffan Wittrup Christensen,1,6 Morten Villumsen1,7 To cite: Palsson TS, ABSTRACT Strengths and limitations of this study Boudreau S, Høgh M, et al. Background Musculoskeletal (MSK) pain is the primary Education as a strategy for contributor to disability worldwide. There is a growing ► The study design allowed for including literature managing occupational- consensus that MSK pain is a recurrent multifactorial related musculoskeletal pain: from non- randomised studies to investigate the role condition underpinned by health and lifestyle factors. a scoping review. BMJ Open of education for managing work- related musculo- Studies suggest that education on work- related pain and 2020;10:e032668. doi:10.1136/ skeletal pain. individualised advice could be essential and effective for bmjopen-2019-032668 ► The study presents a broad overview of resources managing persistent MSK pain. available for healthcare professionals and the gen- ► Prepublication history and Objective The objective of this scoping review was to eral public regarding work- related musculoskeletal additional material for this map the existing educational resources for work- related paper are available online. To pain. MSK (WRMSK) pain, and the effects of implementing view these files, please visit ► Relevant studies conducted in working populations educational strategies in the workplace on managing the journal online (http:// dx. doi. may have been excluded if the article did not state WRMSK pain. org/ 10. 1136/ bmjopen- 2019- that the focus was on work- related pain. copyright. 032668). Methods This scoping review assessed original studies ► The scoping review search strategy was not peer that implemented and assessed education as a strategy reviewed. Received 02 July 2019 to manage WMSK pain. Literature search strategies Revised 11 December 2019 were developed using thesaurus headings (ie, MeSH and Accepted 10 January 2020 CINAHL headings) and free- text search including words http://bmjopen.bmj.com/ related to MSK in an occupational setting. The search was MSK (WMSK) pain by modifying the phys- carried out in PubMed, CINAHL, Cochrane Library and Web ical load seem inadequate5 6 and the lack of of Science in the period 12–14 February 2019. effects may pertain to the nature of MSK pain Results A total of 19 peer- reviewed articles were where, for example, psychological health included and the study design, aim and outcomes and lifestyle- related factors play a significant were summarised. Of the 19 peer- reviewed articles, 10 role.2 7 8 Therefore, strategies for addressing randomised controlled trial (RCT) studies assessed the 7 9 10 influence of education on work- related MSK pain. Many WMSK pain require re- conceptualisation studies provided a limited description of the education and inclusion of multifactorial approaches. on February 12, 2020 at Universidad San Jorge. Protected by material and assessed/used different methods of delivery. Ultimately, re- conceptualising the under- A majority of studies concluded education positively standing of WMSK pain would imply an aban- influences work- related MSK pain. Further, some studies donment of a direct (causal) relation between reported additive effects of physical activity or ergonomic work- related activities (eg, sitting, lifting and adjustments. load) and WMSK pain. Instead, work- related Conclusions There is a gap in knowledge regarding the activities should be considered one of many best content and delivery of education of material in the contributors to WMSK pain.4 workplace. Although beneficial outcomes were reported, By accounting for the multidimensional more RCT studies are required to determine the effects of © Author(s) (or their nature of WMSK pain and individual vari- education material as compared with other interventions, employer(s)) 2020. Re- use ability, a previous interventional study11 permitted under CC BY-NC. No such as exercise or behavioural therapy. commercial re- use. See rights demonstrated a small but significant pain and permissions. Published by reduction where the level of pain relief was BMJ. INTRODUCTION significantly associated with the number For numbered affiliations see The socioeconomic impact of musculoskel- of clinician–worker interactions. A similar end of article. etal (MSK) pain–related disability and associ- effect was observed on return to work when Correspondence to ated work absenteeism affects the individual adopting a multidisciplinary approach Dr Thorvaldur Skuli Palsson; worker, the family, the worker’s organisation including a brief two- session intervention tsp@ hst. aau. dk and society.1–4 Efforts to prevent work- related with a healthcare professional.12 Palsson TS, et al. BMJ Open 2020;10:e032668. doi:10.1136/bmjopen-2019-032668 1 BMJ Open: first published as 10.1136/bmjopen-2019-032668 on 12 February 2020. Downloaded from Open access The literature search strategy was developed to consider population, concept and context, and educational strat- egies to manage WMSK pain in a working population. For the purpose of this scoping review, educational strat- egies were defined as an initiative designed to educate the employees with the aim of promoting occupational health in the workplace. In addition, management strategy was defined as a method aimed at preventing or reducing the burden of MSK pain in an occupational setting. Studies were included if the effect of education was assessed in any way (ie, as the primary intervention or control) and if they were (1) based on peer- reviewed research articles performed on adult humans (above 18 years), (2) had full text available in English, (3) were focused on occupational- related pain in a working popu- lation, and (4) described management strategies aimed at promoting retention or well-being in the workplace. A PRISMA diagram, divided into the categories identifi- cation, screening, eligibility and inclusion, was used to document and guide the screening process as recom- Figure 1 PRISMA flowchart demonstrating the findings in mended22 (figure 1). After identification and removal of each step of the screening process. duplicates, studies were excluded in the screening process (title and abstract) if (1) no abstract was available, (2) From a socioeconomic perspective, enabling individ- they were not in English, or (3) if title and abstract indi- uals return or continue to work despite having episodes cated that the focus of the article was outside the scope of recurrent pain may be beneficial for the individual of the review. When screening for eligibility (full text), worker and the organisation.13 In this regard, organisa- articles were excluded if (1) the intervention was wrong tions should adopt a broad approach, appreciating the (ie, non- educational), (2) the study design was wrong copyright. multidimensional nature of pain for ensuring workability (eg, opinion papers or prevalence studies) or (3) if the instead of solely focusing on prevention and manage- study was conducted in a non- occupational context (eg, ment of WMSK pain.14 Successful rehabilitation of WMSK the educational intervention was not specifically aimed at may depend on better collaboration and communication a working population). http://bmjopen.bmj.com/ between the organisation, managers and the individual Literature search strategies were developed using worker.10 15 Furthermore, communicating education thesaurus headings (ie, MeSH and CINAHL headings) and about work- related pain and individualised advice could be free- text search including words related to MSK in an occu- essential for the management of persistent MSK pain.16–18 pational setting. The search was carried out in PubMed, In fact, communication of non-threatening information CINAHL, Cochrane Library and Web of Science in the about MSK pain may reduce absenteeism.19 20 However, period 12–14 February 2019. According to the indexing in an overview of educational material for employees for PubMed, the MeSH term “musculoskeletal pain” only covers the self- management of WMSK pain and implementation the terms myalgia and pelvic girdle pain. Therefore, the MeSH on February 12, 2020 at Universidad San Jorge. Protected by strategies for pain management within the workplace is terms “Neck pain”, “Back pain” and “Shoulder pain” were added lacking. in the PubMed search, as these were the areas considered The objective of this scoping review was to map the to be most frequently investigated and reported in relation 23 existing educational resources focusing on WMSK pain. to occupational- related MSK pain. For a detailed descrip- Moreover, the objective was to provide an overview of tion of the search strategy in each database, see table 1. No the available evidence on implementation of educational restrictions on publication year were applied in order to resources in occupational settings to help manage WMSK enable full mapping of the area. When all records had been pain. identified using the selection criteria, the reference lists of the included studies were screened to identify additional relevant studies. All studies identified using the literature METHODS search strategies were uploaded to Mendeley
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