%0 Journal Article
%T Work above shoulder level and shoulder complaints: a systematic review.
%A Wærsted M
%A Koch M
%A Veiersted KB
%J Int Arch Occup Environ Health
%V 93
%N 8
%D Nov 2020
%M 32572582
%F 2.851
%R 10.1007/s00420-020-01551-4
%X <B>OBJECTIVE: </B>To investigate the association and the exposure-response relationship between work above shoulder height and shoulder pain or disorders.<BR><B>METHODS: </B>A systematic search was performed in Medline, Embase, and Health and Safety Science Abstracts. Included were articles with prospective cohort, case-control, cross-sectional, or intervention study designs. Quality assessment was based on an evaluation scheme adjusted to study design and normalized to 100%. The cut-off for sufficient quality to include articles was above 40% and cut-off for high-quality articles was above 50% of maximal score. The level of strength of evidence for an association between exposure and effect was assessed according to the GRADE guidelines.<BR><B>RESULTS: </B>Thirty-four articles were included. Articles that document large effects (higher risk estimates; OR ≥ 2) have higher quality score, include analyses of severe arm elevation, more often use clinical outcome, and report an exposure-response relationship compared to studies reporting lower risk estimates. The studies that reported large effects were all significant. An exposure-response relationship was found in many high-quality studies when relating exposure intensity of arm elevation (level of arm elevation, amplitude) as well as duration of arm elevation, especially > 90°.<BR><B>CONCLUSIONS: </B>We conclude on a limited evidence for an association between arm elevation at work and shoulder disorders. Severe arm elevation with elbows above shoulder level (i.e., > 90°) shows a moderate evidence for an association with shoulder disorders.