RR869 - Improving the diagnostic criteria for work-related upper limb disorders for use in prevention and patient care

Musculoskeletal disorders of the upper limb (ULDs) may be caused or aggravated by work, and may limit capacity to work. However, their optimal classification remains controversial, with substantial disagreement among experts.

We propose five requirements of a satisfactory classification scheme: 1) definitions that are clear, well documented, unambiguous and feasible to apply; 2) relevant and credible coverage; 3) repeatable findings; 4) agreement with a good reference standard (where there is one); and 5) practical utility in informing follow-on actions, such as risk control and better patient care.

The evidence on classification by these criteria has been explored through literature searches and consultation with research experts from Europe and North America.

We conclude that several schemes fulfil criteria 1-3, though the fourth is limited by questionable reference standards. Regarding utility, simple case definitions serve as well as complex ones for many preventive applications, including surveillance; differences are also sufficiently small to encourage data pooling. Less is known about optimal case definitions to guide patient care, and recommendations to improve research reporting are offered.

Optimal case definitions may vary with purpose. However, there is scope for moving towards a simpler, more rational, and better harmonised approach to classifying ULDs in many circumstances.

This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

Assistance in the use of Adobe Acrobat PDF files is available on our FAQs page.

Updated 2021-04-23