Interventions to prevent injuries in construction workers.

BACKGROUND: Construction workers are frequently exposed to various types of injury-inducing hazards. There are a number of injury prevention interventions, yet their effectiveness is uncertain. OBJECTIVES: To assess the effects of interventions for preventing injuries in construction workers. SEARCH METHODS: We searched the Cochrane Injuries Group's specialised register, CENTRAL (issue 3), MEDLINE, Embase and PsycINFO up to April 2017. The searches were not restricted by language or publication status. We also handsearched the reference lists of relevant papers and reviews. SELECTION CRITERIA: Randomised controlled trials, controlled before-after (CBA) studies and interrupted time-series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed their risk of bias. For ITS studies, we re-analysed the studies and used an initial effect, measured as the change in injury rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS: Seventeen studies (14 ITS and 3 CBA studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of: introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, we rated the quality of the evidence as very low for all comparisons.Compulsory interventionsRegulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of -0.33; 95% confidence interval (CI) -2.08 to 1.41) and may or may not have a sustained effect (ES -0.03; 95% CI -0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI -2.83 to 2.97; 1 ITS study).Educational interventionsSafety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).Informational interventionsWe found no studies that had evaluated informational interventions alone such as campaigns for risk communication.Persuasive interventionsWe found no studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods.Facilitative interventionsMonetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).Multifaceted interventionsA safety campaign intervention may result in an initial (ES -1.82; 95% CI -2.90 to -0.74) and sustained (ES -1.30; 95% CI -1.79 to -0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multifaceted drug-free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years (95% CI -3.5 to -0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study). AUTHORS' CONCLUSIONS: The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. More studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers' and workers' adherence to the safety measures prescribed by regulation.

Interventions to prevent injuries in construction workers.

BACKGROUND: Construction workers are frequently exposed to various types of injury-inducing hazards. A number of injury prevention interventions have been proposed, yet their effectiveness is uncertain. OBJECTIVES: To assess the effects of interventions to prevent injuries in construction workers. SEARCH METHODS: We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, PsycINFO, OSH-ROM (including NIOSHTIC and HSELINE), Scopus, Web of Science and EI Compendex to September 2011. The searches were not restricted by language or publication status. The reference lists of relevant papers and reviews were also searched. SELECTION CRITERIA: Randomised controlled trials, controlled before-after (CBA) studies and interrupted time series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed study quality. For ITS, we re-analysed the studies and used an initial effect, measured as the change in injury-rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS: Thirteen studies, 12 ITS and one CBA study met the inclusion criteria. The ITS evaluated the effects of the introduction or change of regulations (N = 7), a safety campaign (N = 2), a drug-free workplace programme (N = 1), a training programme (N = 1), and safety inspections (N = 1) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance.The overall risk of bias among the included studies was high as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome.The regulatory interventions at national or branch level showed a small but significant initial and sustained increase in fatal (effect sizes of 0.79; 95% confidence interval (CI) 0.00 to 1.58) and non-fatal injuries (effect size 0.23; 95% CI 0.03 to 0.43).The safety campaign intervention resulted in a decrease in injuries at the company level but an increase at the regional level. Training interventions, inspections or the introduction of occupational health services did not result in a significant reduction of non-fatal injuries in single studies.A multifaceted drug-free workplace programme at the company level reduced non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years per year (95% CI -3.5 to -0.5). AUTHORS' CONCLUSIONS: The vast majority of technical, human and organisational interventions that are recommended by standard texts of safety, consultants and safety courses have not been adequately evaluated. There is no evidence that introducing regulations for reducing fatal and non-fatal injuries are effective as such. There is neither evidence that regionally oriented safety campaigns, training, inspections nor the introduction of occupational health services are effective at reducing non-fatal injuries in construction companies. There is low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign and a multifaceted drug workplace programme can reduce non-fatal injuries among construction workers. Additional strategies are needed to increase the compliance of employers and workers to the safety measures that are prescribed by regulation. Continuing company-oriented interventions among management and construction workers, such as a targeted safety campaign or a drug-free workplace programme, seem to have an effect in reducing injuries in the longer term.

Pre-employment examinations for preventing occupational injury and disease in workers.

BACKGROUND: Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence. OBJECTIVES: To evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sickness absence compared to no intervention or alternative interventions. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO and PEDro (to December 2009) not restricted by date, language or publication type. SELECTION CRITERIA: We included randomised controlled trials (RCTs), controlled before-after studies (CBA), and interrupted time-series (ITS) of health examinations to prevent occupational diseases and injuries in job applicants. DATA COLLECTION AND ANALYSIS: Four review authors (NM, ML, JV, ES) independently selected studies, extracted data, and determined study quality. The studies were too heterogeneous for statistical pooling of results. MAIN RESULTS: We included two RCTs, five CBA studies and two ITS. Seven studies with 5872 participants evaluated the screening process of pre-employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process.Of those studies that evaluated the screening process, one study found that a general examination did not reduce sick leave (Mean Difference -0.1 95% CI -0.5 to 0.3) but another study found that a more task focused examination did (MD -36 95% CI -68.3 to -3.8). One study found that incorporation of a bronchial challenge test decreased occupational asthma (trend change -2.6 95% CI -3.6 to -1.5). Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits. The rates of rejecting job applicants varied from 2% to 35%.Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented.We rated the evidence for all outcomes as very low quality. AUTHORS' CONCLUSIONS: There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease, injury, or sickness absence. This supports the current policy to restrict pre-employment examinations to job-specific examinations. More studies are needed that take into account the harms of rejecting job applicants.

Functional capacity evaluations for the prevention of occupational re-injuries in injured workers.

BACKGROUND: Functional capacity evaluation (FCE) has been widely used to assess workers' physical state of readiness to return to work (RTW) after an injury and to make recommendations for the time and capacity in which they might return. FCEs are also used to prevent re-injury after RTW. Despite being a commonly used tool, little is known about how effective FCE is in preventing occupational injuries. OBJECTIVES: To assess the effectiveness of FCE-based return to work recommendations in preventing occupational re-injuries of injured workers compared with no intervention or alternative interventions. SEARCH STRATEGY: We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1980 to December 2009), PsycINFO (1983 to December 2009) and PEDro (1929 to December 2009). The searches were not restricted by date, language or type of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of FCE-based return to work recommendations for preventing occupational re-injuries in injured workers. DATA COLLECTION AND ANALYSIS: Four authors (NM, ES, JV, ML), in pairs, independently selected studies for inclusion, extracted data and assessed risk of bias. MAIN RESULTS: We found no studies that compared FCE to no intervention. We found one RCT with 372 participants in which a short-form of one FCE was compared to the standard long-form FCE (Isernhagen Work Systems). Outcomes were recurrence rates of re-injuries. There was no significant difference between the two forms of FCE.We rated the overall quality of the evidence as low. AUTHORS' CONCLUSIONS: There is no evidence for or against the effectiveness of FCE compared to no intervention. A short version of FCE showed similar effectiveness to a long version in preventing re-injury. More RCTs are needed.

Writing a Cochrane systematic review on preventive interventions to improve safety: the case of the construction industry.

OBJECTIVES: The objective of this paper is to describe the main steps and to conduct a systematic literature review on preventive interventions concerning work-related injuries and to illustrate the process. METHODS: Based on the Cochrane handbook, a structured framework of six steps was outlined for the development of a systematic review. This framework was used to describe a Cochrane systematic review (CSR) on the effectiveness of interventions to prevent work related injuries in the construction industry. RESULTS: The 6 main steps to write a CSR were: formulating the problem and objectives; locating and selecting studies; assessing study quality; collecting data; analysing data and presenting results; and interpreting results. The CSR on preventing injuries in the construction industry yielded five eligible intervention studies. Re-analysis of original injury data of the studies on regulatory interventions, through correcting for pre-intervention injury trends led to different conclusions about the effectiveness of interventions than those reported in the original studies. CONCLUSIONS: The Cochrane handbook for systematic reviews of interventions provides a practical and feasible six-step framework for developing and reporting a systematic review for preventive interventions.

Effectiveness of interventions in preventing injuries in agriculture--a systematic review and meta-analysis.

OBJECTIVES: This study reviewed the effectiveness of interventions in preventing occupational injuries among workers in agriculture. METHODS: Randomized controlled trials, controlled before-after studies, and interrupted time-series studies assessing interventions aimed at preventing injuries among workers in agriculture were considered. MEDLINE and five other databases were searched up to June 2006. Two authors independently assessed the eligibility of studies and the methodological quality of the ones included. Randomized controlled trials were combined in a meta-analysis. Interrupted time-series studies were reanalyzed to assess the immediate and progressive effect on injuries. RESULTS: Five randomized controlled trials and three interrupted time-series studies met the inclusion criteria. Six studies evaluated educational interventions and financial incentives, and two studies evaluated the effect of legislation. Three randomized controlled trials on educational interventions with 4670 adult participants did not indicate any injury-reducing effect, with a rate ratio of 1.02 (95% confidence interval 0.87-1.20), nor did two randomized controlled trials among children (6895 participants). Financial incentives decreased the injury level immediately after the intervention in one interrupted time-series study. Banning endosulfan pesticide in Sri Lanka led to a significant decrease in the trend of poisonings over time. Legislation requiring rollover protective structures on all tractors in Sweden did not produce a reduction in injuries, but the same requirement for new tractors was associated with a decrease in fatal injuries. CONCLUSIONS: The reviewed studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives may be a better means of reducing injury rates. Banning highly toxic pesticides may be effective. Legislation on safety devices on tractors yielded contradictory results.

The effectiveness of interventions for preventing injuries in the construction industry: a systematic review.

BACKGROUND: Occupational injury rates among construction workers are the highest among the major industries. A number of injury-prevention interventions have been proposed, yet the effectiveness of these is uncertain. Thus a systematic review evaluating the effectiveness of interventions for preventing occupational injuries among construction workers was conducted. METHODS: Seven databases were searched, from the earliest available dates through June 2006, for published findings of injury prevention in construction studies. Acceptable study designs included RCTs; controlled before-after studies; and interrupted time series (ITS). Effect sizes of similar interventions were pooled into a meta-analysis in January 2007. RESULTS: Of 7522 titles found, four ITS studies and one controlled ITS study met the inclusion criteria. The overall methodologic quality was low. No indications of publication bias were found. Findings from a safety-campaign study and a drug-free-workplace study indicated that both interventions significantly reduced the level and the trend of injuries. Three studies that evaluated legislation did not decrease the level (ES 0.69; 95% CI=-1.70, 3.09) and made the downward trend (ES 0.28; 95% CI=0.05, 0.51) of injuries less favorable. CONCLUSIONS: Limited evidence was found for the effectiveness of a multifaceted safety campaign and a multifaceted drug program, but no evidence was found that legislation is effective to prevent nonfatal or fatal injuries in the construction industry.