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

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.

Introduction. Eldercare organizations face high sickness absence rates and staff turnover and rely heavily on temporary workers to fill staffing gaps. Temporary workers may experience differences in job demands and resources compared to permanent workers, but this has been largely understudied.

Aim. To compare perceived job demands and resources between permanent and temporary Swedish eldercare workers.

Methods. Permanent and temporary eldercare workers in a Swedish municipality were invited to answer a digital survey on work environment conditions. Differences between permanent and temporary workers in job demands and resources were analyzed using multivariate analysis of variance adjusted for age, sex, place of birth, and percent of full-time work and univariate analyses were conducted to consider differences in specific factors.

Results. 1076 permanent and 675 temporary workers received the survey and the final study sample included 451 permanent and 151 temporary workers. Multivariate analyses revealed that temporary workers reported statistically significant lower job demands compared to permanent workers, but no statistically significant differences in resources were found between the groups. Univariate analyses showed that temporary workers reported lower quantitative demands, perceived exertion, and time spent bending forward, than permanent workers. These data suggest comparable support across groups, but a higher workload among permanent workers.

Conclusion. Our findings indicate that temporary workers experienced lower job demands than permanent workers, but that no notable difference was found in resources. Interventions aimed at distributing job demands more evenly among eldercare workers with different employment forms may be necessary.

Background

Physical behaviours over a 24-hour period are important for health. However, we do not know if interventions using a “24-hour time-use approach” are more effective in improving 24-hour time-use behaviours than the traditional “reduce sitting at work approach”. Thus, the aim of our non-randomised controlled study was to investigate this in a high-risk group of overweight and obese Brazilian office workers.

Methods

Forty-five office workers were allocated to three non-randomised controlled groups; “Reduce sitting at work” (n = 15) receiving an intervention focused on reducing sitting time at work; the “24-hour” (n = 15) receiving an intervention aiming to reduce sitting at work as well as promoting behavioural changes around 24 hours (e.g., sedentary lifestyle, benefits of physical activity, and healthy sleep hygiene); or “control” (n = 15) without any intervention. Daily time spent in physical behaviours (sitting, standing, active, and in bed) was monitored for 7 days using a thigh-worn accelerometer at baseline, and at the 3- and 6-month follow-ups. Intervention effects were analysed using linear mixed models, adjusted for baseline values, age, and sex, with a compositional data analysis approach.

Results

At baseline, the demographic characteristics and 24-hour physical behaviours of the groups were similar. No significant intervention effect was observed between the intervention groups for the overall 24-hour composition, except for time-in-bed, which decreased for Reduce sitting at work compared to 24-hour group from baseline to the 6-month follow-up (p-value = 0.02). Compared to the control group, both intervention approaches resulted in less time spent sitting, more time standing, and less time-in-bed from baseline to the 3-month follow-up, but these effects were not sustained at the 6-month follow-up. Notably, domain-specific (i.e., work and leisure) analysis revealed that most changes in the overall 24-hour composition occurred due to changes in behaviours during working hours.

Conclusions

Among Brazilian overweight and obese office workers, the “24-hour time-use approach” may not lead to better improvements in overall 24-hour composition of physical behaviours compared to the traditional “reduce sitting at work approach”.

Background: Flexible work arrangements (FWA) allow for work demands to extend into non-work hours, challenging employees' detachment from work. The extent of detachment may influence sleep and physical activity. However, organizational initiatives to influence detachment, and thus likely the 24-hour compositions of physical behaviors, among workers with FWA are sparse.

Aim: To examine the effects of a workplace intervention on the 24-hour composition of physical behaviors among office workers with flexible work.

Methods: The intervention introduced work strategies to promote detachment through an individual-level course on how to use digital tools and a workgroup-level workshop to develop common rules and routines in flexible work. Accelerometer and diary data were collected at baseline in an intervention group (eventually received both intervention activities, n=27) and a control group (no intervention, n=21), and again at a 12-month follow-up after the intervention to document sleep, physical activity, and inactivity.  Using compositional data analysis, we calculated two log-transformed ratios (ILR): 1) sleep relative to time awake and 2) physical activity relative to inactivity within time awake. Intervention effects were analyzed using Repeated Measures ANOVA.

Results: In the intervention group, sleep increased from 26% at baseline to 29% at follow-up, while time being active remained at 6% and inactivity decreased from 68% to 65%. In the control group, sleep decreased from 29% to 27%, time being active increased from 5% to 6%, and inactivity increased from 66% to 67%. Intervention effects on sleep were significant, while no significant difference in physical activity was observed between the groups.

Conclusions: The intervention was effective in increasing sleep in the intervention group compared to the control group but did not affect physical activity relative to inactivity. Employers may thus facilitate sleep in workers with FWA by implementing strategies promoting detachment at individual and workgroup levels.

Introduction: Flexible work arrangements (FWAs) may allow employees to structure their work to promote sufficient physical activity and sleep, which are key components of health-promoting physical behaviors that are important for musculoskeletal health. However, FWAs may challenge employees' ability to detach from work, which may result in less physical activity and sleep. Since detachment may be associated with sleep patterns and physical activity in FWAs, interventions promoting detachment could facilitate these behaviors. Despite this, interventions targeting detachment and its potential impact on physical behaviors, including sleep, remain scarce. This study examines the effects of a workplace intervention on the 24-hour composition of physical behaviors among office workers with flexible work.

Methods: The intervention comprised an individual-level course developing digital skills to increase the ability to plan, structure, prioritize, and gain control over work, and a workgroup-level workshop to create common rules and routines for flexible work. Accelerometer and diary data were collected to document sleep and physical activity at baseline in an intervention group (receiving both intervention activities, n=27) and a control group (no intervention, n=21), and at a 12-month follow-up of both groups after the intervention. Using compositional data analysis, we calculated two log-transformed ratios, i.e. ILR1: sleep relative to time awake, and ILR2: physical activity relative to inactivity within time awake. Intervention effects were analyzed using Repeated Measures MANOVA and ANOVA. 

Results: In the intervention group, sleep increased from 26% of the day at baseline to 29% at follow-up, corresponding to an increase of about 45 minutes, while active time remained at 6% and inactivity decreased from 68% to 65% of the day. In contrast, the control group experienced a decline in sleep from 29% to 27%, a slight increase in active time from 5% to 6%, and a rise in inactivity from 66% to 67%. The intervention significantly affected sleep relative to time awake (ILR 1), whereas no significant differences in physical activity relative to inactivity (ILR 2) were observed between the groups.

Discussion: Our findings suggest that the intervention helped office workers to increase their time in sleep relative to time awake, likely through better detachment from work. The effect on physical activity was insignificant, indicating that the intervention primarily facilitated recovery during sleep rather than promoted activity throughout the day. Although health outcomes were not directly measured, the findings may inspire musculoskeletal disorder (MSD) prevention in flexible work, as insufficient recovery is a known risk factor for MSDs. 

Conclusion: The intervention successfully increased sleep in the intervention group compared to the control group but did not significantly affect physical activity relative to inactivity. This suggests employers can support better recovery from work among employees with flexible work by implementing strategies to enhance detachment at individual and workgroup levels. Improved recovery through longer sleep may, in turn, contribute to preventing MSDs. 

Movement behaviors research has evolved from focusing on single behaviors to multiple behaviors within a 24-h perspective. However, it is unknown if 24-h movement behavior profiles are consistently associated across multiple health outcomes. Thus, we aimed to investigate this. We used data from 807 adults who wore thigh accelerometers and recorded daily sleep/work times over 1–4 days and were categorized into four 24-h movement behavior profiles: “Chimpanzees” (balanced distribution of movement behaviors in work and leisure; n = 226, reference), “Lions” (more active work and sleep, and less active leisure; n = 179), “Ants” (more active overall, less sedentary work and similar sleep, n = 244), and “Koalas” (more sedentary and sleep, and less active overall n = 158). Cardiorespiratory fitness and systolic blood pressure were measured, while low back pain and self-rated health were self-reported. Linear or ordinal logistic regression assessed the cross-sectional associations between these profiles and outcomes, adjusting for age, sex, BMI, smoking, alcohol, occupational lifting/carrying, and work type. We found that referencing Chimpanzees, Lions were detrimentally associated with cardiorespiratory fitness (B = −2.70 mLO2/min/kg, p < 0.01), but beneficially associated with systolic blood pressure (B = −3.49 mmHg, p < 0.05) and low back pain (odds ratio, OR = 0.67, p = 0.03). Koalas were detrimentally associated with systolic blood pressure (B = 3.66 mmHg, p < 0.05) and cardiorespiratory fitness (B = −2.83 mLO2/min/kg, p < 0.01). Ants were detrimentally associated with self-reported health (OR = 1.78, p < 0.01). We conclude that no 24-h movement behavior profile was consistently (i.e., solely beneficial or detrimental) associated with the health outcomes. These findings indicate that research and practice about 24-h movement behaviors need to consider multiple outcomes.

Introduction: The combination at work of physical activity behaviours (e.g. sitting, standing, and physical activity) and psychosocial factors (e.g. influence and leadership quality) may be more important for preventing work-related pain than each of the exposures isolated (i.e., sitting or influence at work). However, this needs to be tested using accurate measurements of physical behaviours. We aimed to investigate the independent and combined associations of physical behaviours and psychosocial factors with pain in a sample of eldercare workers with high occurrence of pain.

Methods: We analysed cross-sectional data on 191 eldercare workers in a Swedish municipality. Participants responded to a web-survey and took part in technical measurements of physical behaviours using thigh-worn accelerometers over 7 days. We determined the proportion of time spent in sitting, standing and active behaviours during working hours for each participant. We then used the Aitchison distance to calculate the closeness (on a scale from 0 “worst possible” to 100 “ideal”) to the composition recommended by the EU (60%,30%,10% for sitting, standing and active, respectively). Leadership quality and influence at work were assessed using COPSOQIII. Pain intensity (0-10 scale) and worsening of pain due to work (0-5 scale) were used as outcomes in MANCOVA models with closeness and psychosocial factors as predictors.

Results: We found that being closer to the recommended composition of sitting, standing and being active at work was associated with lower pain intensity (F=6.3, p=0.01) and less worsening of pain due to work (F=9.2, p=0.003), independent of leadership quality and influence at work. We found no statistically significant interactions between closeness and psychosocial factors regarding these outcomes, but both higher leadership quality and influence at work showed associations with lower pain. 

Discussion: Physical behaviours and psychosocial factors at work were independently associated with pain in eldercare workers, while combining the exposures did not contribute to any additional explained variance in pain. These results should be interpreted with caution due to the cross-sectional design and risk of confounding by non-measured factors.

Conclusion: Musculoskeletal pain in eldercare workers was associated with the composition of sitting, standing and active, expressed in terms of closeness to EU guidelines, and physical and psychosocial exposures did not interact. Further research is required to understand the effects on musculoskeletal health of combining physical and psychosocial exposures, including their temporal patterns, in various occupational settings.

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.

Objectives The growing care demands of an aging population and a smaller workforce is a big societal problem. Therefore, knowledge on how to organize eldercare work without hampering workers` health is needed. We aimed to investigate if workers` daily number of residents cared for over 14 months is associated with low-back pain in eldercare workers.

Methods We included 513 eldercare workers from 122 wards. In each ward, we gathered quarterly data over 14 months on the number of residents, workers, and work schedules and calculated the daily numbers of residents each worker cared for. Workers reported intensity and days with low-back pain via monthly text messages over 14 months. Using generalized linear mixed models adjusted for confounders, we investigated the association between the number of residents workers cared for daily and low-back pain among those workers.

Results In 3-month periods over 14 months, caring for ≥1 resident per day was associated with a 4% [95% confidence interval (CI) 1.02–1.07] increased risk of more days with low-back pain, and a 2% (95% CI 1.00–1.03) increase in low-back pain intensity among workers.

Conclusions Eldercare workers are at a higher risk of experiencing low-back pain during periods when they care for a greater number of residents each day. Maintaining a consistent number of residents and workload for workers over a 14-month period could serve as an effective organizational strategy to prevent low-back pain.