Improving work for the body - a participatory ergonomic intervention aiming at reducing physical exertion and musculoskeletal pain among childcare workers (the TOY-project): study protocol for a wait-list cluster-randomized controlled trial

Risks, solutions and implementation of a participatory ergonomic intervention in 16 day nurseries: A process evaluation of the TOY wait-list cluster-randomized controlled trial

More evidence-based initiatives to reduce physical work demands during childcare work to prevent ill health and promote the ability to care for the children among childcare workers are needed. In a process evaluation performed alongside a two-arm, cluster-randomized study with a waiting-list control among 16 day nurseries lasting 20-weeks that significantly reduced musculoskeletal pain-related sickness absence we investigated 1) risk factors and solutions perceived by the childcare workers, and 2) implementation of the intervention. Most of the perceived risk factors were categorized as physical (70 %) with most of the suggested solutions also being categorized as physical (61 %). The remaining risk factors were categorized as organizational risk factors (16 %) and psychosocial risk factors (13 %). The remaining solutions were distributed almost equally between the organizational (20 %) and psychosocial categories (19 %). About half (51 %) of the action plans showed high implementation success. Of 16 workshops, 100 % were delivered with a fidelity of 83 %. Average participation, exposure, responsiveness and implementation were 68 %, 56 %, 83 % and 47 %. The implementation score differed for timing of intervention but not for nursery characteristics. This study showed that complex and diverse participatory ergonomic interventions should focus on physical, organizational and psychosocial factors to have a positive effect.

Participatory ergonomics: What works for whom and why? A realist review

Participatory workplace interventions to improve workforce musculoskeletal health are infrequently analysed regarding why they work, for whom or under what circumstances. This review sought to identify intervention strategies which achieved genuine worker participation. In total, 3388 articles on participatory ergonomic (PE) interventions were screened; 23 were suitable to analyse within a realist framework identifying contexts, mechanisms of change, and outcomes. The interventions which succeeded in achieving worker participation were characterised by one or more of these contexts: workers' needs as a core starting point; a positive implementation climate; clear distribution of roles and responsibilities; allocation of sufficient resources; and managerial commitment to and involvement in occupational safety and health. Interventions that were organised and delivered in this way generated relevance, meaning, confidence, ownership and trust for the workers in an interrelated and multi-directional manner. With such information, PE interventions may be carried out more effectively and sustainably in the future.Practitioner summary: This review focuses on the question: which mechanisms support genuine worker participation, in what context and with which necessary resources, to reduce musculoskeletal disorders. Results emphasise the importance of starting with workers' needs, making the implementation climate egalitarian, clarifying the roles and responsibilities of all involved, and providing sufficient resources.Abbreviations: PE: participatory ergonomic(s); WMSD: Work-related musculoskeletal disorders; EU: European Union; MSD: Muskuloskeletal disorders; OSH: Occupational health and safety; C: context; M: mechanism; O: outcome; CMOCs: CMO configurations; NPT: Normalization process theory; OECD: The Organisation for Economic Co-operation and Development: EU-OSHA: European Occupational Safety and Health Agency.

Ergonomic comparison of different incontinence products and effects on time and physical demands on carers

BACKGROUND

Caregivers are at a high risk of musculoskeletal injuries. Efficiency in handling and changing patients' absorbent incontinence products may reduce the burden of caring.

AIMS

This study aimed to compare various types of absorbent incontinence products from an ergonomic perspective and assess the length of time required for handling these products and the physical demand on caregivers' backs, hands and fingers.

METHODS

A within-subject design was selected for two studies involving 64 experienced nurses. The first study was conducted at a test centre in Germany, while the second was performed at a hospital in France. Objective data, such as the time required to apply or change a product and physical stress on the back and hands/wrists, as well as users' subjective assessment of product handling were investigated.

FINDINGS

Both objective and subjective assessments showed that elastic slips were superior to other slip products. The traditional and belted slips were the second-best products in the objective and subjective assessments respectively.

CONCLUSION

Choice of incontinence product influences the time required and the physical demands associated with handling. Both aspects can be considerably reduced with the use of appropriate absorbent incontinence products.

The Use of Time Flow Analysis to Describe Changes in Physical Ergonomic Work Behaviours Following a Cluster-Randomized Controlled Participatory Ergonomic Intervention

AIM

Evaluations of participatory ergonomic interventions are often challenging as these types of interventions are tailored to the context and need of the workplace in which they are implemented. We aimed to describe how time flow analysis can be used to describe changes in work behaviours following a participatory ergonomic intervention.

METHOD

This study was based on data from a two-arm cluster-randomized controlled trial with 29 childcare institutions and 116 workers (intervention: n = 60, control: n = 56). Physical behaviours at work were technically measured at baseline and 4-month follow-up. Physical behaviours were expressed in terms of relative work time spent forward bending of the back ≥30°, kneeling, active (i.e. walking, stair climbing and running) and sedentary. Average time flow from baseline to follow-up were calculated for both groups to investigate if work time was allocated differently at follow-up.

RESULTS

A total of 116 workers (60 in the intervention and 56 in the control group) had valid accelerometer at baseline and follow-up. The largest group difference in time flowing from baseline to follow-up was observed for forward bending of the back and time spent kneeling. Compared to the control, the intervention group had less time flowing from forward bending of the back to kneeling (intervention: +11 min day, control: +16 min day) and more time flowing from kneeling to sedentary behaviours (intervention: +15 min day, control: +10 min day).

CONCLUSION

The results of this study showed that time flow analysis can be used to reveal changes in work time-use following a participatory ergonomic intervention. For example, the analysis revealed that the intervention group had replaced more work time spent kneeling with sedentary behaviours compared to the control group. This type of information on group differences in time reallocations would not have been possible to obtain by comparing group differences in work time-use following the intervention, supporting the usefulness of time flow analysis as a tool to evaluate complex, context-specific interventions.

Cost-Effectiveness and Return-on-Investment of a Participatory Ergonomics Intervention Among Childcare Workers: An Economic Evaluation in a Randomized Controlled Trial

OBJECTIVES

To evaluate the cost-effectiveness and return-on-investment (ROI) of 20-week ergonomic intervention to reduce physical exertion at work compared with usual-practice among childcare workers.

METHODS

One hundred ninety workers from 16 institutions were cluster-(institute)-randomized to intervention (n = 96) and usual-practice (n = 94) group. The intervention group participated in three workshops to develop/implement action plans improving ergonomic conditions. The rating of physical exertion (RPE) was measured at baseline and 20-weeks. Employer-perspective-based costs of intervention, absenteeism, and presenteeism were estimated.

RESULTS

Although statistically non-significant, one-unit reduction in RPE was associated with saving of 592 EUR/worker. Per-EUR invested by the employer was associated with 1.6 EUR (95% CI: -3.1; 6.5) return in the intervention compared with usual practice.

CONCLUSION

The intervention tended to gain monetary benefit for the employer. The results should be replicated in larger populations for improved precision of economic evaluation estimates.Trial registration: ISRCTN10928313.

Physical Work Demands of Childcare Workers in Denmark: Device-Based Measurements and Workplace Observations Among 199 Childcare Workers from 16 Day Nurseries

Objectives

Childcare workers in Denmark have high prevalence of musculoskeletal pain (MSP) and sickness absence, but the existing knowledge of their physical work demands is limited, hampering preventive initiatives. This study aimed to assess the physical work demands with accelerometers and workplace observations of childcare workers handling children age 0–3.

Methods

Data collection consisted of an electronic survey, anthropometric measurements, accelerometer measurements providing information of physical activity types and postures with Acti4 software from five consecutive workdays, as well as 4-h visual workplace observation per childcare worker from 16 Danish nurseries.

Results

In total, 199 childcare workers were enrolled in the study. A total of 4181 working hours of accelerometer measurements and 722 h of workplace observations were carried out. Accelerometer measurements showed that they spent about half of the working day (44.8%) in sedentary postures, and the rest standing (22.8%), moving (13.0%), walking (14.6%), running (0.1%), and climbing stairs (0.7%), with 4.1% in knee straining postures (kneeling and squatting) and 4.3% forward trunk inclination >60°. Workplace observations showed that they carried children 1.8% of the working hours.

Conclusions

Physical work demands of Danish childcare workers are characterized by about half of the workday being sedentary, and the remaining of the workday being quite evenly distributed between standing and dynamic activities, with low exposures to carrying children. Their exposure to forward bending of the trunk and knee straining postures could impose a risk for MSP and sickness absence, and preventive initiatives should be considered.

Inter-Rater Reliability of Ergonomic Work Demands for Childcare Workers Using the Observation Instrument TRACK

The aim of this study is to evaluate the inter-rater reliability of a newly developed instrument-TRACK (observaTion woRk demAnds Childcare worK) for observations of ergonomic work demands in childcare work. Two trained raters conducted thirty hours of concurrent observation of fifteen childcare workers in three different day nurseries. Inter-rater reliability of ergonomic work demands was evaluated using Gwet's Agreement Coefficient (AC₁) and interpreted by the Landis and Koch benchmark scale. Twenty ergonomic work demand items were evaluated. Inter-rater reliability was 'almost perfect' for nine items (AC₁ 0.81-1.00), 'substantial' for four items (AC₁ 0.61-0.80), 'moderate' for four items (AC₁ 0.41-0.60), 'fair' for two items (AC₁ 0.21-0.40), and 'slight' (AC₁ 0.00-0.20) for one item. No items had 'poor' (AC₁ < 0.00) agreement. The instrument is reliable for assessing ergonomic work demands in childcare in real-life settings.

Can childcare work be designed to promote moderate and vigorous physical activity, cardiorespiratory fitness and health? Study protocol for the Goldilocks-childcare randomised controlled trial

BACKGROUND

Despite extensive efforts, issues like obesity and poor physical capacity remain challenges for a healthy work life in several occupations. The Goldilocks work principle offers a new approach, encouraging design of productive work to promote physical capacity and health. This paper presents the protocol for the Goldilocks-childcare study, a randomised controlled intervention trial aiming to evaluate the effectiveness of implementing the Goldilocks work principle in childcare. The primary aim of the intervention is to increase time in moderate to vigorous physical activity (MVPA) by having the childcare workers act as active role models for children in daily playful physical activities, and thereby improve cardiorespiratory fitness and health of the workers.

METHODS

The study is a cluster-randomised trial with a usual-practice wait-list control group. The 10-week intervention consists of two phases. In the first, the childcare workers will participate in two participatory workshops aiming to a) develop playful physical activities ('Goldilocks-games') for children in which childcare workers participate as active role models at MVPA intensity, and b) develop action plans for implementation of the Goldilocks-games in daily work routines. In the second phase, childcare institutions will implement the Goldilocks-games. The primary outcome is working time spent in MVPA, and secondary outcomes are cardiorespiratory fitness, sleeping heart rate, perceived need for recovery, and productivity. Primary outcome and process evaluation will be based on direct measurements of physical activity and heart rate, determination of cardiorespiratory fitness, and questionnaires.

DISCUSSION

If proven effective, the Goldilocks work principle has a large potential for promoting sustainable health and working lives of childcare workers.

TRIAL REGISTRATION

ISRCTN, ISRCTN15644757, Registered 25th December 2019.