A participatory ergonomics intervention to re-design work and improve the musculoskeletal health of paramedics: protocol for a cluster randomised controlled trial.

BACKGROUND: In this paper, we present the protocol for a cluster randomised controlled trial to evaluate the effectiveness and implementation of a participative risk management intervention to address work-related musculoskeletal disorders (WMSDs). The aims of the study include to evaluate the implementation process and the impact of the intervention on work related musculoskeletal pain and discomfort and exposure to physical and psychosocial hazards in paramedics over a 12-month period. METHODS: The intervention in this study is to implement A Participative Hazard Identification and Risk Management (APHIRM) toolkit in an ambulance service. Eighteen work groups containing eligible participants (registered paramedics) will be randomised into the intervention or wait-list control arm in one of three rolling recruitment periods. The APHIRM toolkit survey will be offered at baseline and 12 months later, to all current eligible participants in each work group allocated to the trial. The intervention work groups will receive the remainder of the APHIRM toolkit procedures. Identifying data about individual participants will not be collected in the survey, to protect participant privacy and encourage participation. Changes in primary (musculoskeletal pain and discomfort) and secondary (exposure to physical and psychosocial hazards at work) outcomes measured in the survey will be analysed comparing the baseline and follow up response of the cluster. A process evaluation is included to analyse the implementation and associated barriers or facilitators. DISCUSSION: This study is important in providing a comprehensive approach which focusses on both physical and psychosocial hazards using worker participation, to address WMSDs, a well-known and significant problem for ambulance services. The effectiveness of the intervention in work groups will be rigorously evaluated. If significant positive results are observed, the intervention may be adopted in ambulance services, both nationally and internationally. TRIAL REGISTRATION: ISRCTN77150219. Registered 21 November 2021.

Do work-family conflict or family-work conflict mediate relationships between work-related hazards and stress and pain?

INTRODUCTION: Previous research has identified associations between work-family conflict (WFC) and health outcomes (e.g., musculoskeletal pain). This study investigated whether WFC and family-work conflict explain relationships between exposure to work-related hazards and musculoskeletal pain and stress for workers undertaking some or all of their work at home. Possible differences by home workspace location were also explored. METHODS: Longitudinal survey data were collected from workers in Australia engaged in work from home for at least two days per week. Data was collected at four timepoints approximately 6 months apart (Baseline [October 2020] n = 897; Wave 1 [May/June 2021] n = 368; Wave 2 [October/November 2021] n = 336; Wave 3 [May 2022] n = 269). Subjective measures of work-related psychosocial hazards, occupational sitting and physical activity, musculoskeletal pain, and stress were collected via an online questionnaire. Mediation analyses were conducted using the R package "mediation." Analyses were also conducted with the data set stratified by home office location, using R version 4.1.3. RESULTS: Both WFC and family-work conflict acted as mediators between psychosocial work-related hazards and musculoskeletal pain and stress. WFC mediated more relationships than family-work conflict. Location of home workspace was important, particularly for those working in a space at home where they may be subject to interruptions. CONCLUSION: Addressing WFC is a legitimate means through which musculoskeletal pain and stress can be reduced. Organizational risk management strategies need to address all work-related risks, including those stemming from work-life interaction.

The effect of preference and actual days spent working from home on stress and musculoskeletal pain in older workers.

OBJECTIVES: The rapid shift to working from home (WFH) due to the COVID-19 pandemic provided a unique opportunity to examine the relationship between preferred and actual days spent working from home on employees musculoskeletal pain (MSP) and stress in older workers. METHODS: This study uses three waves of data from the Employees Working from Home (EWFH) study collected in May 2021 (n = 451), November 2021 (n = 358) and May 2022 (n = 320) during the COVID-19 pandemic. A generalised mixed-effect model was used to model the relationships between preference and actual days spent WFH, stress and MSP. Exploratory mediation analysis was conducted to further explore significant relationships between actual days WFH and outcomes. RESULTS: WFH was associated with increasing stress levels in older participants, when the actual number of days WFH increased (B: 0.051, 95% CI: 0.008, 0.094) and when the number of days WFH exceeded their preferences (B: 0.218, 95% CI: 0.087, 0.349). Actual number of days spent WFH and stress in older employees was mediated through their sense of community (Indirect effect: 0.014, 95% CI: 0.003, 0.03; p = 0.006). The relationship between WFH and MSP was variable. For older employees, WFH more than their preferred number of days was associated with a higher likelihood of reporting MSP (OR: 4.070, 95% CI: 1.204, 13.757). CONCLUSIONS: Findings from this study support the need for flexible policies to support WFH which take into account employees preferences. For older workers, a sense of community was found to be important and proactive attempts to restore this will be important for maintain their health and supporting sustainable employment.

A scoping review of workplace health promotion interventions for chronic diseases in Australia.

OBJECTIVE: The aim of this study is to systematically chart and summarize the literature pertaining to workplace health promotion (WHP) interventions targeting the five main modifiable lifestyle risk factors for chronic disease, including smoking, nutrition, alcohol, physical activity, overweight/obesity (SNAPO) in Australian workers. METHODS: A scoping review was performed using the framework of Arksey and O'Malley. MEDLINE, EMBASE, CINAHL, and SCOPUS were searched to identify peer-reviewed publications that evaluated primary or secondary WHP interventions which targeted one or more modifiable risk factor (SNAPO). RESULTS: A total of fifty-six articles were included in the review. The findings revealed a heterogeneous nature of WHP intervention design and evaluation. The majority of the interventions focussed on physical activity, with fewer targeting the other four main modifiable risk factors. Health care and white-collar workers were most frequently targeted, with less attention paid to other worker groups. The review also found that many interventions had a duration of three months or less. CONCLUSIONS: Significant gaps have been identified in relation to the occupational role, risk factors targeted, and intervention length. This review also highlights the need for further research to be conducted to determine the efficacy of interventions to facilitate the development of a framework for WHP interventions to reduce the risk and prevalence of chronic disease.

Employees Working from Home: Do Leadership Factors Influence Work-Related Stress and Musculoskeletal Pain?

In March 2020, the COVID-19 pandemic necessitated a rapid public health response, which included mandatory working from home (WFH) for many employees. However, given the rapid change from traditional ways of working, evidence is limited on the role of leaders, managers, and supervisors in supporting their employees' physical and mental health whilst WFH. The study aimed to examine the impact of leaders through their management of psychosocial working conditions on employees' stress and musculoskeletal pain (MSP) levels whilst WFH. METHODS: Data from 965 participants (230 males, 729 females, 6 other) involved in the Employees Working from Home (EWFH) study, collected in October 2020, and April and November 2021, were analysed. Generalised mixed-effect models were used to test relationships between psychosocial leadership factors and employees' stress and MSP levels. RESULTS: Higher quantitative demands are associated with increased stress (B: 0.289, 95%CI 0.245, 0.333), presence of MSP (OR: 2.397, 95%CI 1.809, 3.177), and increased MSP levels (RR: 1.09, 95%CI 1.04, 1.14). Higher levels of vertical trust decreased stress (B: -0.094, 95%CI -0.135, -0.052) and presence of MSP (OR: 0.729, 95%CI 0.557, 0.954). Role clarity decreased stress (B: -0.055, 95%CI -0.104, -0.007) and levels of MSP (RR: 0.93, 95%CI 0.89, 0.96). Working with interruptions was associated with increased stress (B: 0.199, 95%CI 0.119, 0.280) and MSP (OR: 1.834, 95%CI 1.094, 3.072). CONCLUSION: Leaders will need to take a broad view of job design, taking into account physical and psychosocial aspects of work, to effectively support employees WFH and manage stress and MSP.

Using EMA and Physiological Data to Explore the Relationship between Day-to-Day Occupational Stress, Musculoskeletal Pain and Mental Health among University Staff: A Study Protocol.

Exposure to work-related stressors is associated with poor physical and mental health outcomes for workers. The role of chronic stressors on health outcomes has been explored, but less is known about the potential role of exposure to day-to-day stressors on health. This paper describes the protocol for a study that aims to collect and analyze day-to-day data on work-related stressors and health outcomes. Participants will be workers engaged in predominantly sedentary work at a university. Self-report data on work-related stressors, musculoskeletal pain, and mental health will be collected three times per day for 10 work days through ecological momentary assessment via online questionnaires. These data will be combined with physiological data collected continuously via a wristband throughout the working day. The feasibility and acceptability of the protocol will be assessed via semi-structured interviews with participants and adherence to the study protocol. These data will inform the feasibility of using the protocol in a larger study to investigate the relationship between exposure to work-related stressors and health outcomes.

Working from home during the COVID 19 pandemic: a longitudinal examination of employees' sense of community and social support and impacts on self-rated health.

BACKGROUND: The COVID 19 pandemic resulted in the introduction of public health measures including mandated and recommended work from home orders to reduce transmission. This provided a unique opportunity to examine sense of community and social support within the workplace and self-rated general health. This paper examines employees' workplace sense of community and social support across one year of the COVID 19 pandemic and associated self-rated general health. METHODS: Analysis of longitudinal data (October 2020, May 2021, and November 2021) from the Employees Working from Home study conducted in Victoria, Australia during the COVID 19 pandemic was undertaken. Trajectory analyses were used to describe workplace sense of community and social support over time. Multinomial logistic regression was used to determine the associations between demographics, gender, caring responsibilities, and group membership based on the Growth Mixture Modelling. Generalised Mixed Models were used to measure effects of sense of community and social support on self-rated health. RESULTS: Increasing sense of community and social support in the workplace resulted in increased self-rated health. Trajectory analysis found two stable and distinct groups for sense of community. Social support varied with time; however, trajectory membership was not dependent on gender or caring responsibilities and had no relationship with return to the office. CONCLUSION: Sense of community and social support in the workplace are important determinants of employees' health, and as such, workplace strategies to improve sense of community and social support are required not only for employees working from home, but also those who have returned to the office, particularly as hybrid work arrangements become more common.

Working From Home During COVID-19: Does Work-Family Conflict Mediate the Relationship Between Workplace Characteristics, Job Satisfaction, and General Health?

OBJECTIVE: The aim of the study is to investigate whether work-family conflict and/or family-work conflict mediated the relationship between workplace characteristics and general health and job satisfaction in a sample of workers working from home in a recommended/mandatory context due to COVID-19 measures. METHODS: Data were collected via online questionnaire as part of the Employees Working from Home study. Analyses in this article used data collected at 2 time points 6 months apart, including 965 complete responses from the first questionnaire and 451 complete responses from the second questionnaire. RESULTS: Relationships between predictor and outcome variables were in the directions expected, and both work-family conflict and family-work conflict mediated these relationships. CONCLUSIONS: Work-life interaction partly explains the relationship between work characteristics and general health and job satisfaction health in a population undertaking involuntary working from home.

Strategies to manage working from home during the pandemic: the employee experience.

Many Australian workers were mandated to work from home during the COVID-19 pandemic. Using a qualitative approach, this study aimed to identify optimal work from home management strategies, by analysing the experience of Australian employees working from home (WFH) during this time. A purposive sample, drawn from the Australian Employees Working from Home Study, of managers and non-managers from a range of sectors, was invited to participate in focus groups. Data were analysed using thematic analysis and mapped to the work-systems framework approach to determine strategies implemented to support WFH. Most participants' experiences were more negative than positive, in part due to extreme lockdowns including curfews, with childcare and school closures compounding their WFH experiences. Effective workplace-initiated strategies to optimise WFH included: management support of flexible work hours; provision of necessary equipment with ICT support; regular online communication; performance management adjustments; and manager training.

Working from home in Australia during the COVID-19 pandemic: cross-sectional results from the Employees Working From Home (EWFH) study.

OBJECTIVES: To investigate the impacts, on mental and physical health, of a mandatory shift to working from home during the COVID-19 pandemic. DESIGN: Cross sectional, online survey. SETTING: Online survey was conducted from September 2020 to November 2020 in the general population. PARTICIPANTS: Australian residents working from home for at least 2 days a week at some time in 2020 during the COVID-19 pandemic. MAIN OUTCOME MEASURES: Demographics, caring responsibilities, working from home arrangements, work-related technology, work-family interface, psychosocial and physical working conditions, and reported stress and musculoskeletal pain. RESULTS: 924 Australians responded to the online questionnaire. Respondents were mostly women (75.5%) based in Victoria (83.7%) and employed in the education and training and healthcare sectors. Approximately 70% of respondents worked five or more days from home, with only 60% having a dedicated workstation in an uninterrupted space. Over 70% of all respondents reported experiencing musculoskeletal pain or discomfort. Gendered differences were observed; men reported higher levels of family to work conflict (3.16±1.52 to 2.94±1.59, p=0.031), and lower levels of recognition for their work (3.75±1.03 to 3.96±1.06, p=0.004), compared with women. For women, stress (2.94±0.92 to 2.66±0.88, p<0.001) and neck/shoulder pain (4.50±2.90 to 3.51±2.84, p<0.001) were higher than men and they also reported more concerns about their job security than men (3.01±1.33 to 2.78±1.40, p=0.043). CONCLUSIONS: Preliminary evidence from the current study suggests that working from home may impact employees' physical and mental health, and that this impact is likely to be gendered. Although further analysis is required, these data provide insights into further research opportunities needed to assist employers in optimising working from home conditions and reduce the potential negative physical and mental health impacts on their employees.

Workplace physical and psychosocial hazards: A systematic review of evidence informed hazard identification tools.

Prevention of musculoskeletal disorders (MSDs) requires the identification of physical and psychosocial hazards. This systematic review aimed to identify accessible and validated tools, for the assessment of workplace physical and psychosocial hazards, and consolidate the results into a matrix for use by work health and safety (WHS) professionals. Web of Science, Medline, ProQuest Central, and PsychInfo electronic databases, along with grey literature, were searched (Jan 1990 to July 2020). Studies that included tools with evidence of validity for the identification of physical hazards, psychosocial hazards, or both were included. A total of 83 tools were identified and then reviewed to ensure the tools were accessible. The final matrix included a total of 26 tools (16 physical, 4 psychosocial, and 6 comprehensive [physical and psychosocial]). Evidence on best practice for MSD mitigation supports the need for a comprehensive approach; however, the current review identified limitations in the availability of such tools to support WHS professionals.

Work-related musculoskeletal pain in prosthetists and orthotists: a comparison between Australia and other countries.

BACKGROUND: Musculoskeletal pain (MSP) is a substantial societal and personal burden resulting in loss of employment and reduced productivity. Prosthetics and orthotics professionals working in Australia have previously reported a high prevalence of MSP; however, little is known about the prosthetic and orthotic communities in other countries. OBJECTIVES: To explore the prevalence and range of workplace exposures associated with MSP in a convenience sample of the international prosthetic and orthotic profession. STUDY DESIGN: A cross-sectional study using a convenience sample was conducted with prosthetists and orthotists worldwide. METHODS: Prosthetists and orthotists were invited to participate in a survey to explore work-related factors associated with MSP. Bivariate and regression modelling was used to examine associations between self-reported demographic and workplace characteristics including job satisfaction, work-life balance, and physical and psychosocial hazards. RESULTS: Seventy-six percent of respondents (n = 173) reported MSP in the previous 6 months. However, MSP was associated with different factors in Australia compared with other countries. Among Australia-based prosthetists and orthotists, MSP was associated with sex, physical hazards, and psychosocial hazards. For the international sample, MSP was only associated with length of employment. CONCLUSIONS: Three-quarters of all respondents reported having MSP. Differences in associations between MSP and other factors by respondents' geographical location suggest the need for context-specific identification of hazards to enable the development of targeted and contextually appropriate prevention strategies.

Does work-family conflict play a role in the relationship between work-related hazards and musculoskeletal pain?

BACKGROUND: Previous research identified an association between work-family conflict and musculoskeletal pain. This study explores how conflict arising from participating in both the work and nonwork domains might influence the relationships between musculoskeletal pain experienced by workers and particular work-related hazards. METHODS: A cross-sectional survey of data was collected from 401 workers in Belgium across seven organizations in the service and production sector. Subjective measures of the physical and psychosocial work environments, and musculoskeletal pain, were collected by questionnaire, using either an online or paper version. Moderation analyses were conducted using PROCESS v. 3.5 and SPSS v. 26. RESULTS: Work-related hazards appeared to directly influence musculoskeletal pain differently for men and women. In addition, low levels of work-family conflict and supervisor support combined interactively to reduce low back pain in women. For men, the combination of high physical demands and relatively high work-family conflict were associated with increased levels of low back pain. CONCLUSIONS: Addressing the work-life interface is worthy of further investigation as a legitimate means through which musculoskeletal pain can be reduced. Musculoskeletal risk management strategies need to include risk factors related to the work-life interface, along with those related to physical and psychosocial work-related hazards.

Working at Home: The Impacts of COVID 19 on Health, Family-Work-Life Conflict, Gender, and Parental Responsibilities.

OBJECTIVE: To examine the impact of working at home on general health, pain, stress, and work-family and family-work conflict, and differences based on gender and parental responsibilities. METHODS: A convenience sample of 658 adults completed an online questionnaire. Regression modeling examined the effects and interactions of gender and parental responsibility on general health, musculoskeletal discomfort/pain frequency and severity, stress, and work-family and family-work conflict. RESULTS: Women reported more pain and discomfort, regardless of the presence of children, than men with children. Women with children experienced increased stress compared with men with children. Women without children experienced less work-family conflict, and those without children experienced less family-work conflict than men with children. CONCLUSIONS: The impact on pain, stress, and work-family and family-work conflict, due to mandated working at home, is gendered and influenced by parental responsibilities.

A rapid review of mental and physical health effects of working at home: how do we optimise health?

BACKGROUND: The coronavirus (COVID-19) pandemic has resulted in changes to the working arrangements of millions of employees who are now based at home and may continue to work at home, in some capacity, for the foreseeable future. Decisions on how to promote employees' health whilst working at home (WAH) need to be based on the best available evidence to optimise worker outcomes. The aim of this rapid review was to review the impact of WAH on individual workers' mental and physical health, and determine any gender difference, to develop recommendations for employers and employees to optimise workers' health. METHOD: A search was undertaken in three databases, PsychInfo, ProQuest, and Web of Science, from 2007 to May 2020. Selection criteria included studies which involved employees who regularly worked at home, and specifically reported on physical or mental health-related outcomes. Two review authors independently screened studies for inclusion, one author extracted data and conducted risk of bias assessments with review by a second author. RESULTS: Twenty-three papers meet the selection criteria for this review. Ten health outcomes were reported: pain, self-reported health, safety, well-being, stress, depression, fatigue, quality of life, strain and happiness. The impact on health outcomes was strongly influenced by the degree of organisational support available to employees, colleague support, social connectedness (outside of work), and levels of work to family conflict. Overall, women were less likely to experience improved health outcomes when WAH. CONCLUSIONS: This review identified several health outcomes affected by WAH. The health/work relationship is complex and requires consideration of broader system factors to optimise the effects of WAH on workers' health. It is likely mandated WAH will continue to some degree for the foreseeable future; organisations will need to implement formalised WAH policies that consider work-home boundary management support, role clarity, workload, performance indicators, technical support, facilitation of co-worker networking, and training for managers.

The relationship between workplace characteristics and work ability in residential aged care: What is the role of work-life interaction?

AIMS: To examine whether the work-life interface (through work-family conflict and overall work-life balance) moderates the relationship between work ability and workplace demands and resources. DESIGN: This study used a cross-sectional survey design to collect data from 426 employees working in residential aged care. METHODS: A paper-based questionnaire was distributed to all permanent and casual employees at eight aged care facilities in Melbourne, Australia, between June - September 2013. Moderation analyses were conducted using PROCESS v. 2.13 in SPSS v. 22. RESULTS/FINDINGS: As expected, workplace demands and resources directly influenced workers' work ability. In addition, moderate-to-high levels of work-family conflict and low-to-moderate levels of satisfaction with work-life balance combined interactively with particular workplace demands and resources (relationships with management, physical demands, and safety climate) to reduce work ability. CONCLUSIONS: This study advances understanding of how work-life balance and work-life conflict can influence work ability levels and shows that addressing the work-life interface may be a legitimate means to improve work ability, potentially leading to continued workforce participation. IMPACT: Staff retention in the residential aged care sector needs to be addressed. One possible means of achieving this is through improving work ability. This study expanded knowledge of how the work-life interface may influence work ability. The research demonstrated that relationships between work ability and particular workplace demands and resources were moderated by the work-life interface. This finding has implications for how human resources managers of residential aged care facilities may improve workforce retention-through facilitating employees to manage the work-life interface better.

Self-reported musculoskeletal disorder pain: The role of job hazards and work-life interaction.

BACKGROUND: Previous research identified an association between work-family conflict and musculoskeletal pain. This study explores how the work-life interface might affect pain experienced by residential aged care staff. METHODS: A cross-sectional survey of 426 employees in residential aged care was analyzed to assess the impacts of workplace hazards, work-family conflict, and work-life balance on self-reported musculoskeletal pain. RESULTS: Work-family conflict acts as a mediator of the relationships between workplace hazards and the total number of body regions at which musculoskeletal pain was experienced. Work-life balance only acts as a mediator for particular hazards and only if work-family conflict is not taken into account. CONCLUSIONS: Addressing work-life interaction, and in particular work-family conflict, warrants further investigation as a legitimate means through which musculoskeletal disorder risk can be reduced. Policies and practices to improve work-life interaction and reduce work-family conflict should be considered as integral components of musculoskeletal disorder risk management strategies.