Multidimensional interventions
|
Rasmussen et al., 2015 (1010. Rasmussen CDN, Holtermann A, Bay H, Søgaard K, Birk Jørgensen M. A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial. PAIN. 2015;156(9):1786-94., Denmark |
Cluster |
1) Physical exercises |
Participatory ergonomics (prevent effort and pain) |
3 months |
Nursing and kitchen assistants, and cleaning staff, as well as caretakers (workers employed in elderly care in nursing homes or home care)
|
The analyses produced significantly reduced the number of days of low back pain, pain intensity, and discomfort after the intervention when compared to the control group. |
This study assessed four groups, each doing an activity at different times. |
594 participants
|
1) Physical training (introduce different types of physical exercises to present different types of physical activities: 1) body awareness and body postures; 2) strength and coordination training; 3) general physical activity. |
21 clusters divided into four groups
|
2) Cognitive-behavioral therapy |
Study population assessed = 586
|
- Group 1: 5 clusters/12 teams, n = 126 participants; |
A multidimensional workplace intervention consisting of physical training and CBT effectively reduced the number of days of low back pain, pain intensity, and discomfort among workers in workplaces with elderly people. |
2) Cognitive-behavioral training (CBT): workshops focused on changing maladaptive pain behaviors and cognitive processes. |
- Group 2: 5 clusters/14 teams, n = 146 participants; |
- Group 3: 5 clusters/13 teams, n = 158 participants; |
- Group 4: 6 clusters/15 teams, n = 164 participants |
Jay et al., 2015 (1111. Jay K, Brandt M, Hansen K, Sundstrup E, Jakobsen MD, Schraefel MC, et al. Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians: randomized controlled trial. Pain Physician. 2015;18:459-71., Denmark |
Individual RCT |
1) Physical exercises |
The experimental intervention treatment (PCMT group) consisted of four main elements: |
10 weeks |
Workers of a large pharmaceutical company
|
- Pain reduction in the PCMT and control groups: 52% and 15%, respectively; |
2) Cognitive-behavioral training |
1) Individualized motor control training. |
Control group (n = 56): an email was sent to people encouraging them to participate in existing initiatives, such as weekly training with elastic bands and active breaks. |
- Significant associations for change in pain with the number of physical-cognitive training sessions per week and number of mindfulness sessions. |
2) Individualized resistance and specific training for the area affected by pain. |
- Significant reduction in musculoskeletal pain when compared to the control group after the intervention. |
- Mindfulness |
3) Cognitive training and behavior change education, emphasizing specific individual concerns about pain and movement. |
Intervention group - PCMT (n = 56): Group-based mindfulness training; 20-minute physical training with flexible schedules; guided mindfulness |
- The authors hoped to reduce pain through the influence of stress, because if stress decreases, pain decreases too, and vice versa; however, while mindfulness can help reduce pain, dose-response analysis showed an opposite effect. |
4) Mindfulness. |
- Participation in mindfulness sessions increased the perception of pain at each session attended. |
Stevens et al., 2019 (1212. Stevens ML, Boyle E, Hartvigsen J, Mansell G, Søgaard K, JørgensenMB, et al. Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care. Int Arch Occup Environ Health. 2019;92:49-58. Disponível em: https://doi.org/10.1007/s00420-018-1350-3 https://doi.org/10.1007/s00420-018-1350-...
, Denmark |
Cluster |
1) Physical exercises |
Participatory ergonomics training: two 3-hour workshops and two 1-hour assessment sessions focused on reducing physical effort at work, changing work tasks perceived as physically demanding. |
3 months |
Elderly care workers
|
Effects of the intervention to reduce fear avoidance by increasing the use of assistive devices, but not on perception of muscle strength or physical effort. |
1) Physical exercise program: 12 weekly 1-hour sessions (various types of physical activity). |
N = 420 |
2) Cognitive-behavioral training |
2) Cognitive-behavioral training program: 2 three-hour workshops focused on the use of cognitive processes to change maladaptive pain behaviors. |
Control group: did not perform any activity. |
The intervention reduced beliefs about avoiding fear and increased the use of assistive devices at work, but it did not lead to changes in low back pain patterns (number of days with low back pain, pain intensity, and days with some discomfort). |
Intervention group: performed proposed activities. |
Becker et al., 2017 (1313. Becker A, Angerer P, Müller A. The prevention of musculoskeletal complaints: a randomized controlled trial on additional effects of a work-related psychosocial coaching intervention compared to physiotherapy alone. Int Arch Occup Environ Health. 2017;90(4):357-71. Disponível em: https://doi.org/10.1007/s00420-017-1202-6 https://doi.org/10.1007/s00420-017-1202-...
. Germany |
Individual RCT |
1) Physical therapy |
1) Physical therapy
|
10 weeks |
Nurses from five hospitals located in the Paderborn region, in Germany
|
Significant improvement was observed in both groups over time. |
The standard treatment for musculoskeletal complaints is guided monitored movement therapy. In addition, an appreciation for posture and proprioceptive movements must be developed to reduce fear of movement. |
Control group (34): received only the exercises from the physical therapy program. |
Tendency of more pain due to the maximum degree of movement in the intervention group. |
2) Coaching |
Preventive physical therapy was performed at five physical therapy practice sites. |
The result of the time × group interaction showed that combined intervention of physical therapy and coaching, when compared to physical therapy alone, helps improve current mobility. |
2) Coaching
|
Intervention group (34): received physical therapy exercises and psychosocial coaching intervention. |
Combined intervention of physical therapy and coaching, when compared to physical therapy alone, reduced the level of pain in daily movements at the first follow-up. |
Coaching focuses on a private consultation with qualified personnel and management of individual development issues at work. |
Becker et al., 2020 (1414. Becker A, Angerer P, Weber J, Müller A. The prevention of musculoskeletal complaints: long-term effect of a work-related psychosocial coaching intervention compared to physiotherapy alone - a randomized controlled trial. Int Arch Occup Environ Health. 2020;93:877-89. Disponível em: https://doi.org/10.1007/s00420-020-01538-1 https://doi.org/10.1007/s00420-020-01538...
, Germany |
Individual RCT |
1) Physical therapy |
Both groups received physical therapy exercises over a 10-week period (focused on individual functional status and job-specific physical demands; 10 × 45 min.). In addition, the intervention group received work-related psychosocial coaching during this period. This psychosocial coaching intervention consisted of 1 × 120 minutes of introduction to the theoretical model of selection, optimization, and compensation. |
10 weeks |
Nurses
|
A significant effect of the intervention was observed on maximal spinal motion restriction for imputed data sets only, which means a higher decrease in disability in the IG than in the CG at the third follow-up. No other significant effect of the intervention was observed. |
2) Coaching |
Control group (n = 31): received physical therapy only. |
Intervention group (n = 32): received physical therapy and coaching sessions. |
Individual interventions
|
Pereira et al., 2019 (1515. Pereira M, Comans T, Sjøgaard G, Straker L, Melloh M, O'Leary S, et al. The impact of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion interventions on office worker productivity: A cluster-randomized trial. Scand J Work Environ Health. 2019;45(1):42-52. Disponível em: https://doi.org/10.5271/sjweh.3760 https://doi.org/10.5271/sjweh.3760...
, Australia |
Cluster |
1) Ergonomic guidance |
Group 1) EET -> Workplace ergonomics and specific physical training for the neck: exercise at work in groups for 20 minutes, three times a week. |
12 weeks |
Office workers
|
At the end of the program, EET participants with neck pain had lower absenteeism over 12 months when compared to participants in the EHP group. |
There was no control group, the study had two groups with different activities for compariso. |
2) Physical exercises |
Group 2) EHT -> Workplace ergonomics and health promotion information: received a weekly series of health promotion seminars, each lasting one hour for 12 weeks. |
EET -> Workplace ergonomics and specific physical training for the neck: exercise at work in groups for 20 minutes, three times a week. |
EHT -> Workplace ergonomics and health promotion information: received a weekly series of health promotion seminars, each lasting one hour for 12 weeks. 12 weeks. |
Akyurek et al., 2020 (1616. Akyurek G, Avci N, Ekici G. The effects of "Workplace Health Promotion Program" in nurses: A randomized controlled trial and one-year follow-up. Health Care for Women International. 2020;43(9):980-96. Disponível em: https://doi.org/10.1080/07399332.2020.1800013 https://doi.org/10.1080/07399332.2020.18...
, Türkiye |
Individual RCT |
1) Physical exercises |
Workplace Health Promotion Programs (WHPP): |
5 weeks |
Nurses
|
The authors reported in the results that, after the WHPP, the intervention group had a significant |
1) Physical exercises: |
- Progressive muscle relaxation (PMR). |
Control group (n = 15): rested in a room with reading materials, but without other activities. Individuals were instructed not to change their activities or forms of relaxation for one year. |
2) Ergonomic guidance |
- Postural exercises (specific strengthening and stretching). |
improvement in pain, fatigue, stress, coping skills, and quality of professional life immediately after the end of the program, when compared to baseline data. The results (improvements) were maintained after one year. |
- Breathing exercises. |
Intervention group (n = 15): performed the entire proposed activity twice a week. |
2) Ergonomic guidance (postural guidance, chair position, among others). |
Jakobsen et al., 2015 (1717. Jakobsen MD, Sundstrup E, Brandt M, Jay K, Aagaard P, Andersen LL. Effect of workplace- versus home-based physical exercise on musculoskeletal pain among healthcare workers: a cluster randomized controlled trial. Scand J Work Environ Health. 2015;41(2):153-63. Disponível em: https://doi.org/10.5271/sjweh.3479 https://doi.org/10.5271/sjweh.3479...
, Denmark |
Cluster |
Physical exercises |
Any physical exercise at work or at home. |
10 weeks |
Healthcare professionals from three Danish hospitals.
|
- Pain intensity decreased in the WORK group. |
Control group (physical exercise at home - HOME) |
- Both groups were encouraged to do the exercise for 5 to 10 minutes every week for 10 weeks. |
- Participants received a bag with exercise equipment. |
- Muscle strength (lumbar spine) increased in the WORK group. |
- Folders explaining the exercises. |
Both groups: |
Intervention group (physical exercise in the workplace - WORK) |
- Higher reduction in the use of analgesics in the WORK group. |
- Supervised high-intensity strength training with Thera-Band elastic bands and kettlebells during working hours at the hospital. |
- Ergonomic training and education on patient transfer and use of assistive devices. |
- 10 exercises. |
- The study showed a significant decrease in the intensity of musculoskeletal pain, an increase in muscle strength, and a reduction in the use of analgesics among healthcare workers in response to exercise for 10 weeks in the workplace when compared to exercise performed at home. |
- 5 coaching sessions of 30 to 45 minutes to motivate participants to practice exercise. |
- One of the objectives of coaching was to encourage participation in the intervention - whether physical exercise or coaching sessions (stimulate other colleagues). |
Jakobsen, et al., 2017 (1818. Jakobsen MD, Sundstrup E, Brandt M, Andersen LL. Factors affecting pain relief in response to physical exercise interventions among healthcare workers. Scand J Med Sci Sports. 2017;27:1854-63. Disponível em: https://doi.org/10.1111/sms.12802 https://doi.org/10.1111/sms.12802...
, Denmark |
Cluster |
Physical exercises |
Any physical exercise at work or at home, both groups were encouraged to exercise for 5 to 10 minutes per week. |
10 weeks |
Healthcare professionals from three Danish hospitals.
|
The authors identified that a higher adherence to training also led to better results. |
Both groups: - Ergonomic training and guidance on patient transfer and use of assistive devices. |
Control group (n = 89, 9 clusters) (physical exercise at home - HOME). |
However, the study showed that even when the analysis was adjusted for training adherence (among other parameters), performing physical exercise, and receiving motivational coaching in the workplace more effectively reduced musculoskeletal pain intensity in low back, neck, and shoulders when compared to performing exercise at home. |
Intervention group (n = 111, 9 clusters) (physical exercise in the workplace - WORK). |
Jakobsen et al., 2018 (1919. Jakobsen MD, Sundstrup E, Brandt M, Andersen LL. Effect of physical exercise on musculoskeletal pain in multiple body regions among healthcare workers: Secondary analysis of a cluster randomized controlled trial. Musculoskelet Sci Pract. 2018;34:89-96. Disponível em: https://doi.org/10.1016/j.msksp.2018.01.006 https://doi.org/10.1016/j.msksp.2018.01....
, Denmark |
Cluster |
Physical exercises |
Intervention: physical exercise at work or at home (5 to 10 minutes). |
10 weeks |
Healthcare professionals from three hospitals
|
According to the study authors, although adherence was higher in the group that performed the intervention in the workplace, in the analyses, adjustments were made for training adherence and the WORK group presented better results. |
*Groups:
|
# WORK |
- Supervised strength training. |
Control group (9 clusters, n = 89): was part of the HOME group and performed the exercises at home. |
- 2 to 20 workers per session. |
- 4 to 6 exercises (from pre-established exercises). |
*The coaching sessions, with motivation to participate in the program, may have impacted the results. |
- The group that exercised at work (WORK) also participated in 5 motivational training sessions of 30 to 45 minutes in a group of 5 to 12 participants. |
Intervention group (9 clusters, n = 111): was part of the WORK group and participated in the proposed activities. |
# HOME |
- Participants were instructed to exercise for 10 minutes, five times a week, and perform 4 exercises (out of 10 proposed exercises). |
- The group at home (HOME) performed the activities during leisure time. |
Korshøj et al., 2018 (2020. Korshøj M, Jørgensen MB, Lidegaard M, Mortensen OS, Krustrup P, Holtermann A, Søgaard K. Decrease in musculoskeletal pain after 4 and 12 months of an aerobic exercise intervention: a worksite RCT among cleaners. Scand J Public Health. 2018;46(8):846-53. Disponível em: https://doi.org/10.1177/1403494817717833 https://doi.org/10.1177/1403494817717833...
, Denmark |
Cluster |
Physical exercises |
First phase of the intervention: |
12 weeks |
Cleaning companies in the suburban area of Copenhagen, Denmark, recruited by contact.
|
- 4 months: no significant changes, except in the hip; |
Control group (reference): 2 classes/lectures of 2 hours/class. |
Intervention group: 2 × 30 min. --> 32 sessions (16 hours). |
Second phase of the intervention: |
Control group (reference): 3 classes/lectures of 2 hours/class. |
Control group (reference) (20 clusters, n = 59): lectures with guidance about healthy lifestyle. |
- 12 months: significant changes in shoulders, arms, wrists, and trends in knees, feet, and ankles; |
Intervention group: exercise group: 2 × 30 min. --> 52 sessions (26 hours). |
In the second phase, exercise supervision of the intervention group gradually decreased, as follows: |
- period from baseline up to 4 weeks: 6 supervised sessions, |
- period from 4 to 8 weeks: 5 supervised sessions, |
Intervention group (20 clusters, n = 57): physical activity (at or near the location, during working hours). |
- the study showed significant results in upper limbs; however, it showed worsening in lower limbs. |
- period from 8 to 12 weeks: 4 supervised sessions, |
- period from 12 to 16 weeks: 2 supervised sessions, |
- period from 16 to 20 weeks: 1 supervised session. |
Participation was recorded only when the instructor was present. |
Moreira et al., 2020 (2121. Moreira RFC, Moriguchi CS, Carnaz L, Foltran FA, Silva LCCB, Coury HJCG. Effects of a workplace exercise program on physical capacity and lower back symptoms in hospital nursing assistants: a randomized controlled trial. Int Arch Occup Environ Health. 2020;94:275-84. Disponível em: https://doi.org/10.1007/s00420-020-01572-z https://doi.org/10.1007/s00420-020-01572...
, Brazil |
Individual RCT |
Physical exercises |
Intervention: therapeutic exercise program twice a week for 12 weeks, each session of 30 minutes. |
12 weeks |
Active nursing assistants at a general hospital in Brazil.
|
Results of low back pain: positive, pain relief (measurements before and after the intervention), although it is not possible to predict long-term effects. |
Control group (n = 44): did not receive any intervention, only after the end of the analyses. |
Intervention group (n = 46): received proposed intervention. |
Doda et al., 2015 (2222. Doda D, Rothmore P, Pisaniello D, Briggs N, Stewart S, Mahmood M, Hiller JE. Relative benefit of a stage of change approach for the prevention of musculoskeletal pain and discomfort: a cluster randomised trial. Occup Environ Med. 2015;72(11):784-79. Disponível em: https://doi.org/10.1136/oemed-2015-102916 https://doi.org/10.1136/oemed-2015-10291...
, Australia |
Cluster |
Behavioral approach (SOC - Stages of Change model) |
Interventions addressed various types of recommendations to control MSD, including redesign of tools, workstations, work processes, purchase of new equipment, job rotation, workplace inspection programs, manual handling training, and exercises. |
12 weeks |
29 work groups from 23 medium-sized companies (20 to 200 employees) and large companies (more than 200 employees)
|
Interventions adapted according to the SOC model showed relative benefit, particularly for low back pain and discomfort. |
- In total, 25 interventions (13 standardized and 12 customized) were monitored in 21 companies from eight industrial sectors. The interventions were implemented by the manager for workers. The ergonomist monitored the interventions every three months, through a telephone call to the manager. |
Group of personalized interventions based on the SOC model (15 groups from 14 companies, n = 109) and group of standardized interventions (14 groups from 12 companies, n = 133). |
The main focus of the study question was not the effect of the intervention at the individual level. |
Viester et al., 2015 (2323. Viester L, Verhagen EALM, Bongers PM, van der Beek AJ. The effect of a health promotion intervention for construction workers on work-related outcomes: results from a randomized controlled trial. Int Arch Occup Environ Health. 2015;88(6):789-98. Disponível em: https://doi.org/10.1007/s00420-014-1007-9 https://doi.org/10.1007/s00420-014-1007-...
, The Netherlands |
Individual RCT |
Behavioral approach |
- Lifestyle coaching program |
12 weeks |
Workers of a large construction company.
|
The prevalence of musculoskeletal symptoms decreased; however, the reduction was not statistically significant. |
- Personalized lifestyle information, lifestyle coaching sessions, exercise instructions, and the VIP (vitality in practice) under construction with Toolbox. |
Control group (n = 152): received usual care, without any other intervention. |
- Participants received a ‘personal energy plan’ form to write goals and action plans. |
Intervention group (n = 162): performed proposed intervention. |
Danquah et al., 2017 (2424. Danquah IH, Kloster S, Holtermann A, Aadahl M, Tolstrup JS. Effects on musculoskeletal pain from "Take a Stand!" - a cluster-randomized controlled trial reducing sitting time among office workers. Scand J Work Environ Health. 2017;43(4):350-57. Disponível em: https://doi.org/10.5271/sjweh.3639 https://doi.org/10.5271/sjweh.3639...
, Denmark/Greenland |
Cluster |
Behavioral approach |
The Take a Stand! intervention included five elements: (1) appointment of local ambassadors, management and support; (2) environmental changes; (3) a lecture; (4) a workshop aiming to ensure local adaptation of the individual at office and workplace level; and (5) emails and text messages. The intervention focused on four strategies to reduce sitting time: use of a desk with support for sitting, taking breaks for extended periods, standing up, adoption of walking meetings, and setting common office-level goals. |
3 months |
Office workers
|
When comparing the intervention and control groups after 1 and 3 months, taking into account baseline levels, a small reduction was observed in total pain score. |
Control group (9 offices, n = 144): instructed to maintain their usual activities. |
After 3 months, the prevalence of neck-shoulder pain was slightly reduced in the intervention group when compared to the control group, but for back and extremity pain, no change was found (exploratory analyses). For total pain score, a small reduction was observed in the intervention group when compared to the control group at 1- and 3-month follow-up. |
Intervention group (10 offices, n = 173): followed the proposed intervention program. |