Effectiveness of preventive interventions and Randomised Controlled Trials in Occupational Health: an overview of the last five decades Preventive interventions and Randomised Controlled Trials in Occupational Health

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Stefano Mattioli
Jos Verbeek
Simone Mattei
Stefania Curti


Preventive interventions, evidence-based prevention;, randomised controlled trials;, systematic reviews;, PubMed;, bibliometrics


Introduction: Evidence-Based Medicine, as a new scientific paradigm, modified the approach to diagnosis, ­treatment and prevention of diseases based on the best available scientific evidence synthesized in systematic reviews since the last decade of the past century. To evaluate its influence, we assessed the trend in the number and proportion of ­randomised controlled trials (RCTs) and systematic reviews of preventive interventions in occupational health (OH) over the last five decades. Methods: PubMed has been searched using established search filters regarding occupational determinants of diseases, OH preventive interventions, RCTs and systematic reviews. The number of hits were ­assessed per decade. We estimated the number of pertinent studies in the systematically recruited samples of retrieved citations. Results: Over the years, the number of studies concerning the effectiveness of preventive interventions in OH increased 3.5-fold from 986 in 1970-1979 to 3,428 in 2010-2019. RCTs of preventive interventions increased more than 60-fold from 6 in the seventies to 370 in the last decade. Systematic reviews first appeared at the end of the past century with a 30-fold increase (from 4 to 120) over the last three decades. Discussion: The number of high-quality studies, such as RCTs and systematic reviews evaluating the effectiveness of preventive interventions in OH, has increased more rapidly than other studies on this topic. The Evidence-Based Medicine philosophy, diffused by researchers worldwide, has promoted the evaluation of the effectiveness of preventive interventions in OH.


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1. Verbeek JH. Archie Cochrane is with us again. Occup Environ Med. 2010;67(11):721.
2. Cochrane AL. 1931-1971: a critical review, with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics, 1979;1-11.
3. Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992;268(17):2420-5.
4. Chalmers I. The Cochrane collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care. Ann N Y Acad Sci. 1993;703:156-63; discussion 163-5.
5. Robson LS, Shannon HS, Goldenhar LM, Hale AR. Guide to evaluating the effectiveness of strategies for preventing work injuries: How to show whether a safety intervention really works. DHHS (NIOSH) Publication No.2001-119, Cincinnati, OH, 2001.
6. Curti S, Sauni R, Spreeuwers D, et al. Interventions to increase the reporting of occupational diseases by physicians. Cochrane Database Syst Rev. 2015;(3):CD010305.
7. Henneberger PK, Patel JR, de Groene GJ, et al. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2019;10(10):CD006308.
8. Verbeek J, Mattioli S, Curti S. Systematic Reviews in Occupational Health and Safety: where are we and where should we go? Med Lav. 2019;110(5):331-341.
9. Sibbald B, Roland M. Understanding controlled trials. Why are randomised controlled trials important? BMJ. 1998;316(7126):201.
10. Mattioli S, Zanardi F, Baldasseroni A, et al. Search strings for the study of putative occupational determinants of disease. Occup Environ Med. 2010;67(7):436-43.
11. Verbeek J, Salmi J, Pasternack I, et al. A search strategy for occupational health intervention studies. Occup Environ Med. 2005;62(10):682-7.
12. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins J, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.
13. Cochran WG, ed. Sampling techniques. 2nd edn. New York: John Wiley and Sons, Inc, 1963.
14. van Poppel MN, Koes BW, Smid T, Bouter LM. A systematic review of controlled clinical trials on the prevention of back pain in industry. Occup Environ Med. 1997;54(12):841-7.
15. Mattioli S, Baldasseroni A, Mancini G, Fierro M, Violante FS. Studi di efficacia di attività preventive nelle comunicazioni ai congressi della Società Italiana di Medicina del Lavoro e Igiene Industriale (1989-2003). Med Lav. 2005;96(6):513-48.
16. Mattioli S, Farioli A, Cooke RM, et al. Hidden effectiveness? Results of hand-searching Italian language journals for occupational health interventions. Occup Environ Med. 2012;69(7):522-4.
17. Ruotsalainen JH, Verbeek JH, Salmi JA, et al. Evidence on the effectiveness of occupational health interventions. Am J Ind Med. 2006;49(10):865-72.
18. Torgerson DJ. Contamination in trials: is cluster randomisation the answer? BMJ. 2001;322(7282):355-7.
19. Edwardson CL, Yates T, Biddle SJH, et al. Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial. BMJ. 2018;363:k3870.
20. Cochrane Effective Practice and Organisation of Care Group. What study designs should be included in an EPOC review and what should they be called? Available at: https://epoc.cochrane.org/ (accessed on July 26, 2021)
21. Risør BW, Casper SD, Andersen LL, Sørensen J. A multi-component patient-handling intervention improves attitudes and behaviors for safe patient handling and reduces aggression experienced by nursing staff: A controlled before-after study. Appl Ergon. 2017;60:74-82.

22. Agnesi R, Fedeli U, Bena A, et al. Statutory prevention of work injuries in Italy: an effectiveness evaluation with interrupted time series analysis in a sample of 5000 manufacturing plants from the Veneto region. Occup Environ Med. 2016;73(5):336-341.
23. Ijaz S, Verbeek JH, Mischke C, Ruotsalainen J. Inclusion of nonrandomized studies in Cochrane systematic reviews was found to be in need of improvement. J Clin Epidemiol. 2014;67(6):645-653.
24. Rollin L, Darmoni S, Caillard JF, Gehanno JF. Searching for high-quality articles about intervention studies in occupational health--what is really missed when using only the Medline database? Scand J Work Environ Health. 2010;36(6):484-487.