Abstract
BackgroundBack pain is a widespread health problem that accounts for substantial disability and high costs. The workplace is considered to critically affect the occurrence and persistence of back pain and therefore offers an important opportunity for preventive interventions. Various work-related intervention strategies including both single- and multicomponent interventions have been developed and evaluated so far. To determine their effectiveness, a method of analysis is needed that particularly meets the challenges of the multidimensionality and diversity of these interventions. This planned systematic review and network meta-analysis aims to compare the effects of different work-related interventions for preventing non-specific back pain in people within a formal employment-related context.MethodsWe will search the following databases: CENTRAL, MEDLINE, Web of Science, CINAHL, PsycINFO, PEDro, SPORTDiscus, and Academic Search Premier from their inception onwards, as well as additional sources. Randomized controlled trials (RCTs) and cluster-RCTs will be considered if they (1) include people within a formal employment-related context, (2) include people without back pain or mixed samples (i.e., people with and without back pain), (3) compare one or more work-related preventive intervention(s) to a control condition, and (4) assess non-specific back pain (incidence or/and pain intensity), ability to work (numbers of participants or/and numbers of days absent from work), intervention-related adverse events or/and self-reported satisfaction with the intervention. Random-effects pairwise meta-analyses and frequentist network meta-analyses will be conducted where appropriate. We will calculate summary effect sizes for each comparison of interventions and rank interventions according to their P scores. If feasible, we will conduct additional component network meta-analyses. We plan to conduct subgroup analyses for job exposure, intervention duration, baseline back pain, different localizations of back pain, and gender. Risk of bias will be assessed using RoB 2 and the certainty of the evidence will be rated using the GRADE approach.DiscussionThis systematic review aims to identify work-related intervention strategies as well as components within work-related interventions that are effective for preventing back pain. We expect the results to provide guidance for selecting the most promising interventions and foster the purposeful use of resources. Additionally, they may inform the development and implementation of work-related interventions as well as the design of future research in this field.Trial registrationPROSPERO CRD42021232469
Highlights
Back pain is a widespread health problem that accounts for substantial disability and high costs
This showed that these reviews largely either focus on specific interventions or populations, do not focus on interventions delivered within workplace settings [11, 18, 19], or do not include meta-analyses or Network meta-analysis (NMA) [9]
By using NMA and component network meta-analysis (CNMA), we expect to gain novel and important insights that go beyond the available systematic reviews [9, 11, 19]
Summary
This planned systematic review has a priori been registered with PROSPERO (CRD42021232469). Depending on the available measurement points in the original studies, we may decide to choose a different follow-up category for our main analysis in order to include more data This decision will be made before any metaanalyses are conducted. Following the approach for rating NMA results described by the GRADE working group [51], the certainty of direct effect estimates will be rated in a first step, considering RoB, inconsistency, indirectness, and publication bias. These ratings will inform the rating of the indirect estimates; intransitivity will be considered for indirect evidence [52]. If no NMA can be performed, we will only rate the certainty of the evidence of our pairwise meta-analyses
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