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There is a very large body of published literature about workplace interventions for the primary and secondary prevention of back and upper extremity work-related disorders. Despite the large number of studies published, few meet the strictest criteria for scientific validity. At the same time, there is a another body of information derived from quality improvement studies and best practices that reflect the practical experience within industry. To the degree that there is agreement between the more scientific literature and best practices, this congruence is important in establishing a weight or pattern of evidence. In applying this information, there are several ethical and cost-benefit considerations, as well as practical barriers particularly in optimizing secondary prevention strategies.

The complexity of musculoskeletal disorders in the workplace requires a variety of strategies that may involve the worker, the workforce, and management. The literature shows that no single strategy is or will be effective for all types of industry; interventions are best tailored to the individual situation. Although we have no measure of their relative contributions, there are, however, some program elements that consistently recur within successful programs: management commitment, employee involvement, and directly addressing workplace physical and work organizational factors.

The weight and pattern of the evidence supports the conclusion that primary and secondary prevention interventions to reduce the incidence, severity, and consequences of musculoskeletal injuries in the workplace are effective when properly implemented. The evidence suggests that the most effective strategies involve a combined approach that takes into account the complex interplay between physical stressors and the policies and procedures of industries. When the scientific information is combined with the very practical quality improvement data, the panel is persuaded that continued focus on primary and secondary prevention can reduce the incidence and severity of these widespread musculoskeletal conditions affecting the worker in the workplace. Specifically, the panel concludes that:

    1. Interventions must mediate physical stressors, largely through the application of principles of ergonomics.

    2. Employee involvement is essential to successful implementation.

    3. Employer commitment, demonstrated by an integrated program and supported by best practices review, is important for success.

    4. Because of limitations in the scientific literature, a comprehensive and systematic research program, supported by an infrastructure linking industry, labor, government, and academic efforts, is needed to further



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