Cochrane method for systematic review and meta-analysis of interventions to prevent occupational noise-induced hearing loss – abridged
Revisão sistemática e metanálise Cochrane de intervenções para prevenção de perda auditiva ocupacional induzida por ruído – abreviada
Christina Tikka; Jos Verbeek; Erik Kateman; Thais Catalani Morata; Wouter Dreschler; Silvia Ferrite
Abstract
Purpose: Assess the effect of non-pharmaceutical interventions at work on noise exposure or occupational hearing loss compared to no or alternative interventions.
Research strategies: Pubmed, Embase, Web of Science, OSHupdate, Cochrane Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched.
Selection criteria: Randomized Controlled Trials (RCT), Controlled Before-After studies (CBA) and Interrupted Time-Series studies (ITS) evaluating engineering controls, administrative controls, personal hearing protection devices, and hearing surveillance were included. Case studies of engineering controls were collected.
Data analysis: Cochrane methods for systematic reviews, including meta-analysis, were followed.
Results: 29 studies were included. Stricter legislation can reduce noise levels by 4.5 dB(A) (very low-quality evidence). Engineering controls can immediately reduce noise (107 cases). Eleven RCTs and CBA studies (3725 participants) were evaluated through Hearing Protection Devices (HPDs). Training of earplug insertion reduces noise exposure at short term follow-up (moderate quality evidence). Earmuffs might perform better than earplugs in high noise levels but worse in low noise levels (very low-quality evidence). HPDs might reduce hearing loss at very long-term follow-up (very low-quality evidence). Seventeen studies (84028 participants) evaluated hearing loss prevention programs. Better use of HPDs might reduce hearing loss but other components not (very low-quality evidence).
Conclusion: Hearing loss prevention and interventions modestly reduce noise exposure and hearing loss. Better quality studies and better implementation of noise control measures and HPDs is needed.
Keywords
Resumo
Objetivo: Avaliar o efeito de intervenções no trabalho sobre a exposição ao ruído ou a perda auditiva em comparação com ausência ou intervenções alternativas.
Estratégia de pesquisa: Buscas em Pubmed, Embase, Web of Science, OSHupdate, Cochrane Central e CINAHL.
Critérios de seleção: Incluídos ensaios clínicos randomizados (ECR), estudos controlados pré/pós-intervenção (ECPPI) e estudos de séries temporais interrompidas (SIT) avaliando controles de engenharia, administrativos, equipamentos de proteção auditiva (EPAs) e vigilância auditiva. Coletados estudos de caso de engenharia.
Análise dos dados: Cochrane para revisões sistemáticas, incluindo metanálise.
Resultados: Foram incluídos 29 estudos. Legislação mais rigorosa pode reduzir níveis de ruído em 4,5 dB(A) (evidência de qualidade muito baixa). Controles de engenharia podem reduzir imediatamente o ruído (107 casos). Onze ECR e ECPPI (3.725 participantes) avaliaram EPAs. Treinamento para inserção do EPA reduz a exposição ao ruído no acompanhamento de curto prazo (evidência de qualidade moderada). Protetores tipo concha podem ter desempenho melhor do que protetores de inserção em níveis altos de ruído, mas piores em níveis mais baixos (evidência de qualidade muito baixa). EPAs podem reduzir a perda auditiva no acompanhamento de muito longo prazo (evidência de qualidade muito baixa). Dezessete estudos (84.028 participantes) avaliaram programas de prevenção de perdas auditivas. Um melhor uso do EPA pode reduzir a perda auditiva, mas outros componentes não (evidência de qualidade muito baixa).
Conclusão: As intervenções para prevenção da perda auditiva reduzem modestamente a exposição ao ruído e a perda auditiva. Estudos de melhor qualidade e melhor implementação de medidas de controle de ruído e EPA são necessários.
Palavras-chave
Referências
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Submetido em:
23/05/2019
Aceito em:
10/09/2019
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