4 RESULTS
4.6 A PPENDIX (S TUDY V)
Study V was a Cochrane systematic review in which the literature searches identified
1,995 references. Ten RCTs (2,745 employees) were included in our investigation. Two
of them were assessed as having low risk of bias (see Figure 7), and eight of them
examined office workers, few of whom were on sick leave. Thus, workplace
interventions were seldom designed to improve RTW.
Figure 7. Risk of bias assessment of ten included studies
The workplace interventions were provided separately or as different combinations of intervention programmes. Altogether, six types of intervention combinations were used in six studies: one had four components
[248], one had three components
[249], and four had different combinations of two components
[250-253]. Five studies provided single-component workplace interventions focused on mental health education
[254], physical education, relaxation and breaks
[251, 255], and physical environmental modifications
[256, 257]
. Table 9 presents an overview of the interventions in the ten included studies, using the authors‘ own terms and mapped onto uniform terminology of the ICF
[102].
The included studies examined three types of interventions targeting the ICF the Body Functions domain: education for mental health, education for physical health, and
relaxation/breaks. The mental health education interventions focused on behavioural change, stress management, and coping with high work demands. The other two types were combined into one group (see Table 9), because they both targeted
musculoskeletal body functions, principles of ergonomics, anatomy, musculoskeletal
disorders, and the importance of physical activity. They taught pause exercises, how to
use a relaxed work posture, proper positioning, the importance of rest breaks, and strategies to improve relaxation. Interventions targeting the Activity domain were seen less often, and these were described as modifying work tasks, workload, work
techniques, work positions, and work hours. They were defined during group meetings or workplace visits. Interventions targeting the Environmental domain modified the physical environment, and they were often individually tailored subsequent to an assessment performed during a workplace visit or a group session that identified individual needs. Some of these (e.g., downward-tilting computer keyboards or screen angle modifications) were also given to all employees in the included workplaces. In most cases, several adjustments and alterations of the existing furniture and work equipment were provided. Education for physical health, relaxation, breaks, and physical modifications to the environment were the interventions examined most often in the included studies. No interventions targeted modifications of the two ICF domains social or attitudinal environments and participation or personal factors.
All ten of the included studies assessed pain as an outcome, and data were available for seven of those. In all the studies, there was low quality evidence that showed no
significant differences between workplace interventions and no intervention for pain prevalence or severity. If present, significant results in favour of workplace
interventions were not sustained across follow-up times.
Only three studies assessed sick leave as an outcome, and data were available for only
one of those. There was moderate quality evidence (one study, 415 workers)
[248]that a
four-component WI was significantly more effective in reducing sickness absence in
the intermediate term (OR 0.56, 95% CI 0.33 to 0.95), but not in the short term (OR
0.83, 95% CI 0.52 to 1.34) or the long term (OR 1.28, 95% CI 0.73 to 2.26). These
negative findings might be explained by the fact that only a small proportion of the
workers were on sick leave.
Table 9. The content of workplace interventions in ten randomized controlled trials
Study Intervention(s)
Detailed intervention descriptions according to ICF terminology
Dose Body function mental health
education
Body function physical education and relaxation
breaks
Activity modifications Environmental physical modifications
Bernaards 2007 Work style group (WS)
Lifestyle physical activity group (WSPA)
WS: Increasing awareness of coping with high work demands, and adjusting workplace accordingly
WS: Awareness of effects of taking break, body posture, and workplace adjustments WSPA: Moderate to heavy physical activities
Six meetings, 15 to 60
minutes each, over 6 months. Trained counsellor and standardized protocol. Fostervold 2006
Computer screen angle: high line of sight (HLS)/low line of sight (LLS)
15º lower (HLS) or 30º lower
(LLS) than a horizontal line to the midpoint of the screen
Continuous change
Haukka 2008
Participatory ergonomic intervention (PEI)
Phase 1: Pre-implementation, active workshop to identify mental workload
Phase 1: Active workshop with ergonomic identification of risks and planning of solutions
Phase 2: Implementation of 402 ergonomic changes
Phase 2: Implementation of 402 ergonomic changes
11 months, six 3-hour workshops over 9 to12 months
Horneij 2001
Workplace stress management group
Identify and reach goals and strategies for stress (from lack of social support, low decision latitude, high psychological work load)
12 groups (1.5 hours)
seven meetings over 7 weeks + two follow-up meetings after 3 and 6 months; supervisors invited to two meetings
Hedge 1999
Downward-tilting keyboard on a tray
Downward-tilting computer
keyboard on a tray
Continuous change
Kamwendo 1991
Traditional neck school (TNS) Reinforced neck school (RNS)
RNS: Interview by a psychologist regarding psychosocial work factors to create a personal coping strategy
TNS: Education about body function and ergonomics, including pause-gymnastics and relaxation
RNS: Workplace visit,
discussion of ergonomic adjustments
TNS: 4 hours RNS: 4 + 2 hours
Table 9. Continued
Study/ Intervention(s)
Detailed intervention descriptions according to ICF terminology
Dose Body function mental health
education
Body function physical education and relaxation
breaks
Activity modifications Environmental physical modifications
Ketola 2002
Intensive ergonomics (IE) Ergonomic education (EE)
IE: Worksite visit; to take
breaks during work and pay attention to work posture;
active. Active participation of the employee. EE: Group training session: Encourage to take short pauses
IE: Worksite visit to outline layout environmental conditions of the workroom, and adjustments of the workstation
EE: Group training session to encourage employees to evaluate their own workstation and implement change, and ask for equipment if needed
IE: 1.5 to 2 hours EE: 1 hour
Morken 2002a
Croup sessions about coping with MSDs at the workplace
Group meetings on 10 different topics, such as MSDs and coping with symptoms of those disorders
Group meetings on 10 different topics, such as working techniques and positions
Group meetings on 10 different topics, such as optimal design of the workplace
10 meetings, three groups received the same interventions but included different stakeholders
van den Heuvel 2003 Rest breaks (RB)
Rest breaks (RB) + exercise (E)
RB: Five minutes rest every 35 minutes introduced by a computer program. E: Four physical exercises
RB: 5 min rest every 35 min and 7 sec rest every 5 min
E: Physical exercises of for 45 sec
Voerman 2007
Ambulant myo-feedback training (MT) Ergonomic counselling (EC)
MTEC: Instructed to relax in response to the myo-feedback
EC: Workplace visit including ergonomic investigation (work task, work hours, workload)
EC: Workplace visit including ergonomic investigation and modifying the existing work station
MTEC and EC: 4 weeks. MT: Sounds that are playing and heard when muscles need
relaxation;ergonomic counselling weekly by a therapist