ERGONOMIC BEST PRACTICES refers to the most effective techniques, methods or processes for preventing risks and injuries and controlling costs related to injuries. While best practices are often based on standards related to the best available scientific evidence, the evidence can change over time. Successful ergonomic practices evolve, requiring practitioners to keep up-to-date on the available evidence. The challenge is how to separate scientifically credible evidence from the methods of marketing. What is an SH&E manager to do when multiple product representatives attest to the science supporting their products? How can a safety professional sift through the mass of scientific publications? The occupational safety and health research community has sought to better clarify how it can bring evidence to the SH&E professional. Lavis, Posada, Haines, et al. (2004) have proposed a generic model of how science informs evidence-based decision making. Consider the example of back belts. Once a solution touted as a "best practice" for preventing back injuries, especially in materials handling jobs, back belt purchases took off in the 1980s and 1990s (Atkinson, 2001). Why? Research coming out of ergonomic laboratories and field studies was indicating the potential biomechanical benefits and user comfort associated with back belt use (Mitchell, Lawler, Bowen, et al., 1994). Back belts were considered a practical and cost-effective back injury prevention strategy (Allen & Wilder, 1996). As a result, wearing back belts became commonplace. However, as the results from workplace studies emerged, the effectiveness of back belts in reducing back injuries was not clear (Van Poppel, Koes, van der Ploeg, et al., 1998). Based on the literature, NIOSH (1996) officially chose to not support back belt use. Following the publication of the NIOSH alert, several other studies appeared that refuted (Wassell, Gardner, Landsittel, et al., 2000) or supported back belt use (Krause & McArthur, 1996; Krause, Schaffer, Rice, et al., 2002). A 2003 systematic review of research concluded that the evidence did not support back belt use in preventing back injuries (Ammendolia, Kerr & Bombardier, 2005). Innovations may be sparked by new ideas and some basic science, but actionable messages, especially those related to best practices, should evolve from a more systematic synthesis of research. It should look at the body of evidence, not just a few studies (Figure 1).
Those interested in applying research to practice must sift through the hundreds of studies that provide the evidence base for decision making and synthesize that pool of information. In healthcare, systematic reviews have become the language of scientific consensus, bringing together a large number of diverse research studies to answer the question, What drug, medical device or medical treatment works? One example is the Cochrane Back Review Group (see sidebar on p. 26). A systematic review provides a concise and transparent synthesis of research evidence, making it a valuable decision-making tool for practitioners and researchers. Systematic reviews provide an objective literature synopsis on a specific topic and have the following advantages: 1) Unlike a narrative review, a systematic review assesses individual study quality and only synthesizes the evidence from studies of sufficient quality. By eliminating the information from the lower-quality studies, this step allows for great confidence in the overall findings and messages.
