Background: Job exposure matrices (JEMs) are widely used in occupational epidemiology to estimate biomechanical exposures in a trade. However, JEMs are insensitive to variability among workers within the same job, potentially leading to less accurate exposures and increased uncertainty of exposure-outcome associations. Task-based exposure assessment, in which individual exposures are derived from task-specific exposures weighted by the time spent on each task, has been suggested to improve accuracy.

Objective: To examine and compare the accuracy of task-based and job-based assessment of physical behaviors - sitting, standing, and moving - in grocery retail.

Methods: The study was conducted in two Swedish medium-sized grocery stores. Accelerometry was used to measure ‘true’ physical behaviors continuously over three full working days for all participating employees (n=36; 16 women, 20 men). Job-based exposure estimates were derived by averaging sitting, standing, and moving across all workers, representing a JEM. Nine discrete tasks were defined in collaboration with employees and owners in the stores. For 35 of the workers, task timelines were videotaped for four hours and linked to accelerometry to construct a gender-neutral (unisex) task exposure matrix (TEM). All 36 participants completed diaries for the three days, reporting time spent on each task, and task-based estimates of ‘true’ exposures through the three days were calculated for each worker as the weighted average of task exposures based on the diary-reported task distribution. Physical behaviors were analyzed using procedures from compositional data analysis (CoDA), including describing and comparing the performance of job-based and task-based approaches using Aitchison distances to the measured, ‘true’ exposures.

Results: The prerequisites for successful task-based assessment were satisfied, including physical behavior contrasts between tasks and heterogeneity in task composition between workers. task-based estimates were on average closer to ‘true’ exposures than job-based estimates, but the magnitude of improvement was modest (23%) and varied between women (35%) and men (12%). Thirty-three percent of the 36 ‘true’ job exposures were better predicted by the job-based approach, and substantial variability in exposure persisted within tasks.

Conclusion: task-based assessment offered only modest improvement in accuracy over job-based estimates and the cost-efficiency of the task-based approach compared to the less costly job-based strategy can be questioned. Task-based assessment may therefore be most useful when task information is needed for documentation or interventions, rather than solely for improving exposure estimation.

Background: Trunk motor variability (MV) is key to understanding the development of fatigue and low back pain (LBP) in repetitive lifting, since it addresses the versatility of neuromuscular control of the multiple vertebral segments and thus the action of numerous muscles working actively together. Our goal in this scoping review was to clarify the predictive and reactive roles of trunk motor variability in occupational lifting, to inform future research and practical interventions for preventing and managing low back issues among manual workers.

Methods: We searched for full-length original articles written in English from the following three databases: MEDLINE, Scopus, and Web of Science. The search terms were structured to capture lifting, trunk, motor variability, fatigue and LBP.

Results: Sixteen studies were identified, covering both predictive associations, i.e., whether baseline differences in MV predict fatigue or pain, and reactive associations, i.e., how MV differs due to experimentally induced fatigue or the presence of pain. Most studies assessed kinematic MV (trunk angles, coordination) and a smaller subset examined kinetic variability using muscle activity measured through EMG-derived metrics. The predictive evidence, albeit from only one study, indicates that greater baseline MV is correlated with increased lifting endurance. As a reactive variable, MV increases with acute fatigue, while chronic pain tends to reduce MV or alter its complexity and structure. Diverse methods to quantify MV limited direct comparisons between several studies.

Discussion: Associations between trunk MV, fatigue, and LBP emerged, and were in accordance with results from both isometric exercise and dynamic tasks involving other body regions, such as the upper and lower extremities. However, the generalizability of the fatigue-pain-MV associations to occupational settings is questionable given the current evidence, since the reviewed studies involved small samples of individuals performing controlled lifting tasks in laboratory environments.

We investigated effects on economic (cost savings), environmental (CO2 emission), and social sustainability (factors reflecting a positive psychosocial environment at work) of a 6-mo intervention from November 2021 through April 2022, during which employees were offered scheduled telework in a municipality in Sweden. Economic and environmental sustainability were estimated by the municipality whereas social sustainability was assessed by the researchers. Using analysis of covariance, we examined outcomes in 3 groups, ie scheduled teleworkers (n = 36), non-scheduled teleworkers (n = 55), and office workers (n = 11). The results indicated that scheduled telework resulted in reduced costs since unutilized premises could be disposed, and less CO2 emission due to a combination of reduced commuting time, lower energy use, and less need to construct new buildings. However, the 3 groups did not differ significantly regarding social sustainability. The results support the notion that telework can lead to positive outcomes in terms of decreased premises costs and environmental footprint, without deteriorating social sustainability.

Background

Repetitive work is associated with increased risk for occupational musculoskeletal health problems. Job rotation (JR) is an organizational approach for increasing variation within workers and promoting health, although evidence for the effectiveness of JR is limited.PurposeTo evaluate the extent of JR implementation and assess JR effectiveness on increasing within-worker muscle activity variability and improving health.

Methods

Together with laundromat management and staff, we created a team-based JR with a five-day rotation cycle and performed a pre-post intervention case study with a 12-month follow-up period. We assessed the extent to which the company had implemented the JR (delivery and adherence). We measured trapezius and forearm muscle activity for all tasks at baseline and created a task exposure matrix that we used to estimate within-worker variance over five days at baseline, for the planned JR, and for the actual JR observed at follow-up. Planned and actual JR variance estimates were compared to baseline to determine the theoretical and actual effects of the JR intervention. Changes in health-related outcomes were assessed at follow-up using questionnaires.

Results

At follow-up, the company had successfully delivered the JR to 65% of day-shift workers. For these workers, the planned JR had the potential to increase the mean within-worker job-level variance by 35% compared with baseline, and the actual JR achieved approximately 80% of that increase at follow-up. Over 45% of JR workers reported decreased work demands, fatigue, and need for recovery at follow-up compared to baseline. However, there was also a slight increase in the number of JR workers reporting musculoskeletal symptoms at follow-up.

Conclusion

This case study demonstrated that JR can increase within-worker variance in muscle activity, and that this change may decrease perceived occupational demands, fatigue, and need for recovery; however further consideration of the longer-term effects on musculoskeletal symptoms is warranted.

Aim

To summarize the literature on quantitative measures of physical demands in eldercare, with attention to differences between temporary and permanent workers, and to identify gaps to guide future physiological research.

Methods

We searched Scopus, Web of Science, and PubMed for English and Swedish peer-reviewed studies on physical demands in eldercare. Risk of bias was assessed, and descriptive data extracted.

Results

We identified 37 relevant articles where physical demands were assessed via self-report (n = 23), biomechanical modeling (n = 6), and direct measurement (n = 8). Risk of bias assessment showed generally insufficient descriptions of study settings and poor descriptions of instruments assessing physical demands. Workers reported physical demands ranging from 40 to 98% maximum (different scales across studies). Biomechanical models showed peak forces in the lower back up to 5092 N during lifts and transfers. Direct measurements indicated that workers spent half to two-thirds of the day on feet, had oxygen uptakes 0.59–0.63 L/min, and mean heart rates 89–107 bpm across the workday. No study provided estimates specifically for temporary workers.

Conclusion

Results suggested that eldercare work is perceived as demanding by the workers, who spend considerable time on feet, and that it comprises tasks with high spinal loads, but shows low cardiovascular demands. These findings offer a foundation for future studies exploring the short- and long-term physiological implications of occupational exposure in eldercare, including the effect of targeted interventions. Future studies are also needed that consider physical exposure differences between homecare and nursing home settings and between permanent and temporary workers, preferably using direct measurements.

Objective: Psychological detachment facilitates recovery from work, but detachment is sometimes difficult in flexible work arrangements (FWAs). This study examined the effects of a co-created two-step workplace intervention that introduced new work strategies to facilitate psychological detachment and promote recovery in office workers with FWAs. The intervention comprised an individual-level course on digital tools and work strategies, followed by a workgroup-level workshop to develop common rules and routines in FWAs.

Methods: Office workers with FWAs in a Swedish governmental agency (intervention group, n = 97; control group, n = 70) completed a web-based questionnaire on three occasions between 2018 and 2020: at baseline 3 months before the intervention; after the individual-level course 6 months after baseline, and after the workgroup-level workshop 12 months after baseline. Effects of the intervention on need for recovery (NFR) as mediated by psychological detachment, and moderation of these effects by baseline NFR, were estimated with adjustment for covariates.

Results: At the 6- and 12-month follow-ups, we found no unmoderated statistically significant changes in NFR mediated by psychological detachment. However, the intervention appeared more beneficial for employees with high baseline NFR compared to those with low NFR, with moderated mediation by detachment at the 12-month follow-up.

Conclusions: Introducing new work strategies and common rules and routines for flexible work may be an effective intervention to facilitate detachment and reduce the need for recovery among office workers with particularly high needs.

Background

Workers in home care have high sick leave rates, predominantly because of musculoskeletal pain. The Goldilocks Work Principle proposes that health should be promoted by a “just right” composition of work tasks. Weekly workloads differ substantially between home care workers, suggesting that certain workers may have workloads that are too high, impacting their musculoskeletal health. The aim of this study was to evaluate the effectiveness of a “GoldiCare” intervention redistributing weekly workloads to become more equal among the homecare workers. Outcomes were pain in the neck/shoulder and lower back, and the implementation of the intervention was also evaluated. 

Methods

A 16-week cluster randomized controlled trial was conducted with 125 workers from 11 home care units, divided into six intervention units and five control units. The operation coordinators of each intervention unit were educated in the Goldilocks Work Principle and provided with a planning tool to facilitate an even distribution of high care need clients. The control group continued their usual work. Primary outcomes were pain intensity in the neck/shoulder and lower back (0 to 10). Secondary outcomes included fatigue (0 to 10), composition of physical behaviors and postures (accelerometers), adherence to the intervention (weekly usage rates of the planning tool), and performance of the intervention (percentage of workers with an even distribution of workload). 

Results

The analysis showed no difference between the intervention and control groups in change in lower back pain (0.07, 95%CI[-0.29;0.43]), neck/shoulder pain (-0.06, 95%CI[-0.49;0.36]) or fatigue (0.04, 95%CI[-0.52;0.61]. No significant changes were observed in the composition of physical behaviors (p=0.067) or postures (p=0.080-0.131) between the two groups. The intervention was succesfully implemented in three units of the six, with adherence ranging from 82-100% across the intervention period. The remaining three units had an adherence of 0-47%. No improvement in performance was observed.

Conclusion

No significant intervention effects were observed on musculoskeletal pain, fatigue, or the composition of physical behaviors and postures. The findings suggest that the intervention was not adequately implemented within the organization. Consequently, we cannot discern whether the lack of positive results were due to poor implementation or an ineffective intervention. Results thus highlight the need for a more comprehensive understanding of organizational structures within home care to facilitate more effective implementations. The hypothetical effectiveness of a fully implemented intervention remains unknown.

Background

Eldercare work is physically demanding, which may contribute to high rates of sickness absence. Understanding the temporal patterns of time on feet and sitting, the latter assumed to represent recovery, and how they depend on organizational and individual factors is key to a better work organization that can effectively promote health, but this has not been studied before.

Aim

To describe temporal patterns of time on feet and sitting among homecare and nursing home workers and examine their associations with setting, job demands and resources, job title, and age.

Methods

Swedish homecare (n = 101) and nursing home (n = 73) workers wore accelerometers for 7 consecutive days to assess physical behaviors. Short (≤5 min), moderate (>5 to ≤30 min), and long (>30 min) bouts of time on feet and sitting were identified, with their relative distribution expressed in 5 ratios and analyzed using compositional data analysis procedures. Workers also completed a questionnaire on job organizational factors (job demands and resources) and individual factors (job title and age). MAN(C)OVA models were used to analyze differences in behaviors between eldercare settings, with organizational and individual factors being added in 2 consecutive models. Univariate analyses followed the multivariate models.

Results

Homecare and nursing home workers spent most of the workday on their feet (51.9% and 56.9%, respectively). The only statistically significant difference between settings was that homecare workers spent 30.1% less time sitting in long bouts relative to moderate and short compared to nursing home workers (P = 0.011), and this difference remained after adding covariates. Higher age was associated with more time on feet relative to sitting (P = 0.002, η2 = 0.06) and more time on feet in long bouts relative to moderate and short bouts (P = 0.001, η2 = 0.06) with medium effect sizes, as well as to more time on feet in moderate bouts relative short bouts (P = 0.011, η2 = 0.04), and less sitting in long bouts relative to moderate and short bouts (P = 0.019, η2 = 0.03) with small effect sizes.

Conclusions

Temporal patterns varied by setting and age, with homecare workers sitting less in long bouts than nursing home workers, and older workers spending more time on feet than younger workers. These findings suggest that work setting and worker characteristics are associated with temporal patterns of physical behavior, although most effects were small-to-moderate and their practical relevance remain uncertain and warrants further study.