Evaluating Short-Term Musculoskeletal Pain Changes in Desk-Based Workers Receiving a Workplace Sitting-Reduction Intervention

Influence of short bouts of stair climbing on young adults during prolonged sitting on posture, discomfort, and musculoskeletal performance outcomes: a counterbalanced pilot randomised crossover trial

Prolonged sitting is postulated to influence musculoskeletal performance (cervical flexor endurance, balance, and agility), discomfort and alter cervical spine angles during work-based computer use. Stair climbing breaks may be a great addition at typical and home offices however remain unexplored for its impact on musculoskeletal performance. In our counterbalanced pilot crossover trial, 24 adults were randomised to three interventions: (1) prolonged sitting, (2) interrupted by 2 min of self-paced, and (3) externally paced stair climbing for 2 h. Cervical spine angles were measured every 30 min while balance, agility, endurance, and discomfort were assessed before and after 120 min. Stair climbing interruptions have favourable effects on agility (F = 8.12, p = 0.009, ηp2 = 0.26) and musculoskeletal discomfort, but failed to improve other musculoskeletal outcomes associated with prolonged sitting. Brief stair climbing interruptions are effective in improving discomfort and agility while pragmatic trials are warranted for translated effects.

Use of an upright power wheelchair in spinal cord injury: a case series

Objective

To explore independence, usability, and self-reported quality of life (QOL) in eligible persons with spinal cord injury (SCI) who used a standing powered wheelchair over a 12-week period. Setting: VA SCI research facility.

Participants

Four participants with chronic SCI who use a wheelchair as the primary means of mobility.

Intervention

A standing power wheelchair was used three times a week (3.5 h/session) for 12 weeks in a supervised setting. Main Outcome Measures: safety, usability and feasibility, blood pressure in seated and standing positions, bowel, bladder, and pain item banks from the SCI-QOL Physical-Medical-Health domain, and overall user satisfaction with the device.

Results

Participants consistently maintained normal blood pressure responses between seated and standing positions throughout the training sessions and learned to perform all the mobility tasks safely and independently. Participants reported improvements on the SCI-QOL and were generally satisfied with the upright standing power wheelchair.

Conclusions

In this small case series of chronic, non-ambulatory individuals with SCI, the standing powered wheelchair was shown to be safe and efficacious.

A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT

Background

Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time.

Objective

Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up.

Design

A three-arm cluster randomised controlled trial.

Setting

Councils in England.

Participants

Office workers.

Intervention

SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months.

Main outcome measures

The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected.

Results

A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively.

Limitations

The study was carried out in one sector, limiting generalisability.

Conclusions

The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time.

Future work

There is a need for longer-term follow-up, as well as follow-up within different organisations.

Trial registration

Current Controlled Trials ISRCTN11618007.

Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia

BACKGROUND

Lower back pain (LBP) is a common musculoskeletal disorder that may affect students' daily lives. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior has not been established, and improving knowledge in this area may help develop preventive strategies and optimize college students' quality of life.

METHODS

A cross-sectional study of 1420 college students in Saudi Arabia was conducted, and participants who attended Saudi Universities were recruited from May 2021 to November 2021. An established validated online survey assessed LBP, sleep quality, time spent sedentary (sedentary duration), health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Generalized Linear Regression was used to assess the associations between LBP severity and lifestyle behaviors after controlling for covariates.

RESULTS

LBP was prevalent among college students from Saudi Arabia. Most of the sample were young (23.81 ± 6.02), and female (83.7%). There were significant differences between students with and without LBP regarding age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=0.2, p < .001, CI: 16 to 0.24), and sedentary duration (ß=0.03, p = .01, CI:0.009 to 0.06).

CONCLUSIONS

This study helped define the prevalence of LBP in college students in Saudi Arabia and evaluated the association between LBP and lifestyle behaviors. The findings showed that students with higher levels of poor sleep quality or sedentary behavior had higher levels of pain. Promoting sleep quality and reducing sedentary behavior may help establish preventive strategies for LBP in college students.

Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 pandemic: a 1-Year longitudinal survey

BACKGROUND

Efforts to limit the spread of COVID-19 have included public space closures, mask usage, and quarantining. Studies regarding the impact of these measures on the psychosocial and behavioral health outcomes of the workforce have focused frequently on healthcare employees. To expand the literature base, we deployed a one-year longitudinal survey among mostly non-healthcare employees assessing changes in select psychosocial outcomes, health behaviors, and COVID-19-related transmission prevention behaviors and perceptions.

METHODS

We deployed the CAPTURE baseline survey across eight companies from November 20, 2020-February 8, 2021. The baseline survey included questions on psychosocial outcomes, health behaviors, and COVID-19 transmission prevention behaviors, with several questions containing a retrospective component to cover the time period prior to the pandemic. Additional questions on vaccination status and social support were subsequently added, and the updated survey deployed to the same baseline participants at three, six, and 12 months after baseline survey deployment. We analyzed data descriptively and performed Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare data within and between time points.

RESULTS

A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees completing all four time points. Employees reported higher stress, anxiety, fatigue, and feelings of being unsafe across all time points compared to pre-pandemic. Time spent sleeping increased initially but returned to pre-pandemic levels at follow-up. Lower rates of physical activity and higher rates of non-work screen time and alcohol consumption relative to pre-pandemic were also reported. Over 90% of employees perceived wearing a mask, physical distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very important' in preventing the spread of COVID-19 across all time points.

CONCLUSIONS

Relative to pre-pandemic, poorer psychosocial outcomes and worsened health behaviors were observed across all time points, with values worse at the baseline and 12-month time points when COVID-19 surges were highest. While COVID-19 prevention behaviors were consistently deemed to be important by employees, the psychosocial outcome and health behavior data suggest the potential for harmful long-term effects of the pandemic on the well-being of non-healthcare employees.

Interventions for preventing back pain among office workers - a systematic review and network meta-analysis

OBJECTIVE

Back pain is common in the working population. This systematic review with network meta-analysis (NMA) aimed to compare the effects of interventions for preventing back pain among office workers.

METHODS

We searched eight databases and additional sources up to March 2021. We included randomized controlled trials (RCT) and cluster RCT focusing on office workers, comparing work-related interventions aimed at preventing back pain (defined as pain in any part of the spine) to a control condition and assessing back pain and/or work absence. Further outcomes considered were adverse events and participants' satisfaction. We performed both frequentist and component NMA. Risk of bias (RoB) was evaluated using RoB 2 and certainty of the evidence (CoE) was assessed using GRADE.

RESULTS

We screened 9809 records and included 24 studies with a total of 7080 participants. RoB was assessed as "some concerns" or "high" for all studies and outcomes. Included studies investigated multicomponent interventions, ergonomics, physical activity, education, behavioral interventions and no/minimal interventions. Effects were mostly not statistically significant and based on low/very low CoE. Physical activity probably reduces days of work absence slightly [mean difference (MD) -1.10, 95% confidence interval (CI) -2.07- -0.13], and combining physical activity and ergonomics may reduce back pain intensity (standardized MD -0.41, 95% CI -0.80- -0.02) when compared to no/minimal intervention. A large proportion of participants were satisfied with the interventions, adverse events were rarely assessed.

CONCLUSIONS

We observed mostly minor effects of interventions on back pain and work absence among office workers. The practical relevance of these effects is questionable.

Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes.

DESIGN

Cluster three arm randomised controlled trial with follow-up at three and 12 months.

SETTING

Local government councils in Leicester, Liverpool, and Greater Manchester, UK.

PARTICIPANTS

78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool.

INTERVENTIONS

Clusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice).

MAIN OUTCOMES MEASURES

The primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures.

RESULTS

Mean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL -22.2 min/day, 95% confidence interval -38.8 to -5.7 min/day, P=0.003; SWAL plus desk -63.7 min/day, -80.1 to -47.4 min/day, P<0.001) compared with the control group. The SWAL plus desk intervention was found to be more effective than SWAL at changing sitting time (-41.7 min/day, -56.3 to -27.0 min/day, P<0.001). Favourable differences in sitting and prolonged sitting time at three and 12 month follow-ups for both intervention groups and for standing time for the SWAL plus desk group were observed during work hours and on workdays. Both intervention groups were associated with small improvements in stress, wellbeing, and vigour, and the SWAL plus desk group was associated with improvements in pain in the lower extremity, social norms for sitting and standing at work, and support.

CONCLUSIONS

Both SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN11618007.

Worker health impacts from working from home during the COVID-19 pandemic

BACKGROUND: COVID-19 was first reported in December 2019 in Wuhan, China. With the rapid spread of the virus, the World Health Organization (WHO) in March 2020 declared the initial outbreak of the disease a pandemic. OBJECTIVE: To assess the challenges and consequences of working from home on worker health during the COVID-19 pandemic. METHOD: Cross-sectional and descriptive study developed in Curitiba, Paraná, Brazil, from December 2020 to January 2021. An online questionnaire was used to interview workers working from home and later a statistical analysis was performed. RESULTS: 327 workers from various fields of activity participated, mainly those from the south of the country, women, and workers who develop activities in education. In addition, results show anxiety and/or irritability, weight gain, discouragement, headaches and muscle and joint problems. CONCLUSION: Most participants found an increase in working hours while working from home, with several breaks during the day and adequate furniture. However, there was a worsening of physical pain and changes in symptoms of anxiety, weight gain, discouragement and headaches.

The Ergonomic Association between Shoulder, Neck/Head Disorders and Sedentary Activity: A Systematic Review

Background

Work-associated upper limb and neck disorders are common occupational disorders throughout the world. These disorders are usually observed more in workers who spend a long time sitting, referred to as sedentary activity (SA). The immediate and distorted risk of sedentary-related problems was considered high in Europe, Australia, and the United States. Even though mediation is convenient, it is likely to reduce office workers' risks of developing cervical and upper body pain due to sedentary work. This systematic review addresses risk factors and evaluates the relationship between SA and upper body disorders in office workers (i.e., shoulder and neck/head).

Methods

PubMed, Scopus, and Web of Science were searched for articles published between January 2010 and August 2021 in the English language. The three keywords “sedentary,” “upper body elements,” and “work” (and their derivatives) were searched to identify studies and carry out this systematic review. The articles were searched so that all three keywords or at least a derivation of each keyword should appear. Findings. Of the 40 articles that met the enclosure criteria, 32 studies examined the association of SA and upper body elements during both office and computer work. However, three articles were evaluated in the sit-stand work environment, and in the remaining five studies, one was evaluated during teaching, two during hospital work, and two during mixed working conditions.

Conclusions

Research related to SA focuses mainly on extended risk factors, but there was no focus on other aspects, such as muscle and tendon contractions. As there is a convincing connection between SA and the upper body, our close examination identifies the need to institutionalize a system for collecting, analyzing, and describing the impact and short-term effects of SA on the upper body. Additionally, some suggestions were made to minimize the risk in a sedentary working environment.

Different sit:stand time ratios within a 30-minute cycle change perceptions related to musculoskeletal disorders

Regular standing interruptions to sedentary work are recommended, but their dosage is understudied. To measure perception variations associated with different sit:stand ratios, 16 people used six ratios (30:0, 27:3, 24:6, 21:9, 18:12 and 15:15) within 30-min cycles in their normal office environment. At start and end of each workday, study participants recorded their perception of 11 factors on a 10-point scale. Musculoskeletal discomfort in 10 body regions was measured before and after exposure to sit-stand ratios. Overall preferred ratios were recorded. Sit:stand ratio affected all perceived factors, with impact varying. Standing at least 6 min improved results most overall; however, individual perceived factors were least impacted by any of 30:0, 27:3, 24:6 or 21:9. Preferred sit:stand ratios were 15:15, 18:12 and 21:9. Typically, least liked ratios involved briefest standing (30:0, 27:3, 24:6) although two participants least liked 15:15. Understanding these variations contributes to appropriate standing dosage recommendations.

Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis

BACKGROUND

Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions.

METHODS

Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies' risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review.

RESULTS

Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP - OR = 1.19(1.03 - 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 - 1.92)] and neck/shoulder pain [OR = 1.73(1.46 - 2.03)], but not with extremities pain [OR = 1.17(0.65 - 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting.

CONCLUSIONS

We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases.

PROTOCOL REGISTRATION

PROSPERO ID # CRD42020166412 (Amended to limit the scope).

The impact of e-learning during COVID-19 pandemic on students' body aches in Palestine

Musculoskeletal pain is a major concern in our life due to its negative effects on our ability to perform daily functions. During COVID-19 pandemic, several countries switched their teaching programs into e-learning, where students spend long hour using electronic devices. The use of these devices was associated with several musculoskeletal complains among the students. The aim of this study is to evaluate the different body aches associated with e-learning on university students. The subjects of this study were students from An-Najah University in Palestine. 385 questionnaires were filled using Google forms questionnaire and all the subjects were using e-learning due to COVID-19 pandemic. Our study showed that a large percentage of participants used electronic devices for e-learning during the pandemic. The Duration of these devices use was correlated with duration and degree of pain, and associated with the difficulty in ability to perform several daily activities. Furthermore, most of the students used the sitting position with supine bent forward during the device usage. Thus, the university students that participated in this study had an increase in body aches during the e-learning process, and the aches duration and severity increases if the duration of electronic devices usage increase.

Rise and Recharge: Exploring Employee Perceptions of and Contextual Factors Influencing an Individual-Level E-Health Smartphone Intervention to Reduce Office Workers' Sedentary Time at Work

This feasibility study explored the contextual factors influencing office workers' adherence to an e-health intervention targeting total and prolonged sedentary time over 12 weeks. A three-arm quasi-randomized intervention included prompts at 30 or 60 min intervals delivered via a smartphone application, and a no-prompt comparison arm. Fifty-six office workers completed baseline (64% female) and 44 completed the 12 week follow-up (80% retention). Ecological momentary assessments (EMA) captured contextual data, with 82.8 ± 24.9 EMA prompt questionnaires completed weekly. Two focus groups with n = 8 Prompt 30 and 60 participants were conducted one-month post-intervention to address intervention acceptability and feasibility. Contextual findings indicate that when working on a sedentary task (i.e., reading or screen-based work) and located at an individual workstation, hourly prompts may be more acceptable and feasible for promoting a reduction in total and prolonged sedentary time compared to 30 min prompts. Interpersonal support also appears important for promoting subtle shifts in sedentary working practices. This novel study gives a real-time insight into the factors influencing adherence to e-health prompts. Findings identified unique, pragmatic considerations for delivering a workplace e-health intervention, indicating that further research is warranted to optimize the method of intervention delivery prior to evaluation of a large-scale intervention.

Self-Estimated Functional Inability Because of Pain Questionnaire for Athletes: A Reliability and Construct Validity Study

Objective

The purpose of this study was to measure the reliability, internal consistency, construct validity, and floor and ceiling effects of the Brazilian version of the Self-Estimated Functional Inability Because of Pain Questionnaire for athletes (SEFIP-sport).

Methods

This was a validity questionnaire study developed in a university community. Athletes or practitioners of any sport undertaking regular practice (weekly frequency of at least twice a week for at least 6 months), with the ability to read and write in Brazilian Portuguese, were included. We evaluated disability by means of the SEFIP-sport and the Roland-Morris Disability Questionnaire for general pain, pain intensity by means of a numerical rating scale, quality of life by means of the Short-Form Health Survey, and predicted disability by means of the Örebro Musculoskeletal Pain Questionnaire.

Results

Two hundred and twenty-one athletes or regular practitioners of sport were recruited and included in the study. We observed adequate values of reliability (κ ≥ 0.40, intraclass correlation coefficient = 0.91), internal consistency (Cronbach's α ≥ 0.81), and correlations (r _s ≥ -0.376) of the total SEFIP-sport score with the numerical rating scale; the pain, vitality, and social aspects domains of the Short-Form Health Survey; the Roland-Morris questionnaire; and the Örebro Musculoskeletal Pain Questionnaire.

Conclusion

The Brazilian Portuguese version of the SEFIP-sport demonstrated adequate psychometric properties for use in athletes.

Rise and Recharge: Effects on Activity Outcomes of an e-Health Smartphone Intervention to Reduce Office Workers' Sitting Time

This feasibility study evaluated the effects of an individual-level intervention to target office workers total and prolonged sedentary behaviour during working hours, using an e-health smartphone application. A three-arm (Prompt-30 or 60 min Intervention arm and a No-Prompt Comparison arm), quasi-randomised intervention was conducted over 12 weeks. Behavioural outcomes (worktime sitting, standing, stepping, prolonged sitting, and physical activity) were monitored using accelerometers and anthropometrics measured at baseline, 6 weeks and 12 weeks. Cardiometabolic measures were taken at baseline and 12 weeks. Fifty-six office workers (64% female) completed baseline assessments. The Prompt-60 arm was associated with a reduction in occupational sitting time at 6 (-46.8 min/8 h workday [95% confidence interval = -86.4, -6.6], p < 0.05) and 12 weeks (-69.6 min/8 h workday [-111.0, -28.2], p < 0.05) relative to the No-Prompt Comparison arm. Sitting was primarily replaced with standing in both arms (p > 0.05). Both Intervention arms reduced time in prolonged sitting bouts at 12 weeks (Prompt-30: -27.0 [-99.0, 45.0]; Prompt-60: -25.8 [-98.4, 47.4] min/8 h workday; both p > 0.05). There were no changes in steps or cardiometabolic risk. Findings highlight the potential of a smartphone e-health application, suggesting 60 min prompts may present an optimal frequency to reduce total occupational sedentary behaviour.

"Oh-oh, the others are standing up... I better do the same". Mixed-method evaluation of the implementation process of 'Take a Stand!' - a cluster randomized controlled trial of a multicomponent intervention to reduce sitting time among office workers

Background

Multicomponent workplace-based interventions aimed at reducing sitting time among office workers are becoming increasingly popular. ‘Take a Stand!’ was such an intervention, reducing sitting time by 71 min after 1 month and 48 min after 3 months. However, it is unclear how the implementation process of ‘Take a Stand!’ affected these results. The present study explored how individual factors and organizational context influenced implementation and effect in ‘Take a Stand!’

Methods

This was a mixed-methods study, combining data from interviews, questionnaires and accelerometers. Directed content analysis was used for analysing interviews with participants, ambassadors and managers from the 10 intervention offices in the ‘Take a Stand!’ study. Categories for analysis were taken from Framework for Evaluating Organizational-level Interventions. Interview data were combined with questionnaire and activity data, and multilevel analysis was undertaken to assess how changes in sitting time varied depending on the assessed factors. In addition, interview data were used to underpin results from the multilevel analysis.

Results

Concurrent institutional changes were found to be a barrier for the intervention by ambassadors, while participants and managers did not find it to be an issue. Management support was consistently highlighted as very important. Participants evaluated ambassadors as being generally adequately active but also, that the role had a greater potential.

The motivational and social aspects of the intervention were considered important for the effect. This was supported by regression analyses, which showed that a strong desire to change sitting time habits, strong motivation towards the project, and a high sense of collective engagement were associated to less sitting time at 3 months of about 30 min/8 h working day compared to participants with low scores. Influence from other participants (e.g. seeing others raise their tables) and the use of humour were continuously highlighted by participants as positive for implementation. Finally, the intervention was found to influence the social climate at the workplace positively.

Conclusion

Individual motivation was related to the sitting time effect of ‘Take a Stand!’, but the organizational culture was relevant both to the implementation and effect within the office community. The organizational culture included among others to ensure general participation, to uphold management and peer-support, and maintain a positive environment during the intervention period.

Trial registration

ClinicalTrials.gov, NCT01996176. Prospectively registered 21 November 2013.

Supporting Workers to Sit Less and Move More Through the Web-Based BeUpstanding Program: Protocol for a Single-Arm, Repeated Measures Implementation Study

BACKGROUND

The web-based BeUpstanding Champion Toolkit was developed to support work teams in addressing the emergent work health and safety issue of excessive sitting. It provides a step-by-step guide and associated resources that equip a workplace representative-the champion-to adopt and deliver the 8-week intervention program (BeUpstanding) to their work team. The evidence-informed program is designed to raise awareness of the benefits of sitting less and moving more, build a supportive culture for change, and encourage staff to take action to achieve this change. Work teams collectively choose the strategies they want to implement and promote to stand up, sit less, and move more, with this bespoke and participative approach ensuring the strategies are aligned with the team's needs and existing culture. BeUpstanding has been iteratively developed and optimized through a multiphase process to ensure that it is fit for purpose for wide-scale implementation.

OBJECTIVE

The study aimed to describe the current version of BeUpstanding, and the methods and protocol for a national implementation trial.

METHODS

The trial will be conducted in collaboration with five Australian workplace health and safety policy and practice partners. Desk-based work teams from a variety of industries will be recruited from across Australia via partner-led referral pathways. Recruitment will target sectors (small business, rural or regional, call center, blue collar, and government) that are of priority to the policy and practice partners. A minimum of 50 work teams will be recruited per priority sector with a minimum of 10,000 employees exposed to the program. A single-arm, repeated-measures design will assess the short-term (end of program) and long-term (9 months postprogram) impacts. Data will be collected on the web via surveys and toolkit analytics and by the research team via telephone calls with champions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework will guide the evaluation, with assessment of the adoption/reach of the program (the number and characteristics of work teams and participating staff), program implementation (completion by the champion of core program components), effectiveness (on workplace sitting, standing, and moving), and maintenance (sustainability of changes). There will be an economic evaluation of the costs and outcomes of scaling up to national implementation, including intervention affordability and sustainability.

RESULTS

The study received funding in June 2018 and the original protocol was approved by institutional review board on January 9, 2017, with national implementation trial consent and protocol amendment approved March 12, 2019. The trial started on June 12, 2019, with 48 teams recruited as of December 2019.

CONCLUSIONS

The implementation and multimethod evaluation of BeUpstanding will provide the practice-based evidence needed for informing the potential broader dissemination of the program.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000682347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372843&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/15756.

Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers

BACKGROUND

The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers.

OBJECTIVES

To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses.

MAIN RESULTS

We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence).

AUTHORS' CONCLUSIONS

Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.

An Integrative, Systematic Review Exploring the Research, Effectiveness, Adoption, Implementation, and Maintenance of Interventions to Reduce Sedentary Behaviour in Office Workers

Sedentary behaviour is associated with poor health outcomes, and office-based workers are at significant health risk, as they accumulate large proportions of their overall sitting time at work. The aim of this integrated systematic review was to collate and synthesize published research on sedentary behaviour interventions in the workplace that have reported on at least one an aspect of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Studies were included if they involved adult office workers, were conducted in an office setting, and changes in sedentary behaviour had been measured as a primary outcome. Five electronic databases were searched yielding 7234 articles, with 75 articles (61 individual interventions) meeting the inclusion criteria. Reach indicators were the most frequently reported RE-AIM dimensions, which were reported on average 59% of the time. Efficacy/effectiveness was the second most reported dimension at 49% reporting across all of the indicators. Implementation indicators were reported an average of 44% of the time, with indicators of adoption and maintenance reported as the lowest of all indicators at 13% and 8%, respectively. Recommendations are provided to improve reporting across all RE-AIM dimensions, which is an important first step to enable the effective translation of interventions into real world settings.