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. 2019 Jul 23;7(7):CD012886.
doi: 10.1002/14651858.CD012886.pub2.

Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers

Tessy Luger  1 , Christopher G Maher, Monika A Rieger, Benjamin Steinhilber
Affiliations

Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers

Tessy Luger et al. Cochrane Database Syst Rev. .

Abstract

Background: Work-related musculoskeletal disorders are a group of musculoskeletal disorders that comprise one of the most common disorders related to occupational sick leave worldwide. Musculoskeletal disorders accounted for 21% to 28% of work absenteeism days in 2017/2018 in the Netherlands, Germany and the UK. There are several interventions that may be effective in tackling the high prevalence of work-related musculoskeletal disorders among workers, such as physical, cognitive and organisational interventions. In this review, we will focus on work breaks as a measure of primary prevention, which are a type of organisational intervention.

Objectives: To compare the effectiveness of different work-break schedules for preventing work-related musculoskeletal symptoms and disorders in healthy workers, when compared to conventional or alternate work-break schedules.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, SCOPUS, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform, to April/May 2019. In addition, we searched references of the included studies and of relevant literature reviews.

Selection criteria: We included randomised controlled trials (RCTs) of work-break interventions for preventing work-related musculoskeletal symptoms and disorders among workers. The studies were eligible for inclusion when intervening on work-break frequency, duration and/or type, compared to conventional or an alternate work-break intervention. We included only those studies in which the investigated population included healthy, adult workers, who were free of musculoskeletal complaints during study enrolment, without restrictions to sex or occupation. The primary outcomes were newly diagnosed musculoskeletal disorders, self-reported musculoskeletal pain, discomfort or fatigue, and productivity or work performance. We considered workload changes as secondary outcomes.

Data collection and analysis: Two review authors independently screened titles, abstracts and full texts for study eligibility, extracted data and assessed risk of bias. We contacted authors for additional study data where required. We performed meta-analyses, where possible, and we assessed the overall quality of the evidence for each outcome of each comparison using the five GRADE considerations.

Main results: We included six studies (373 workers), four parallel RCTs, one cross-over RCT, and one combined parallel plus cross-over RCT. At least 295 of the employees were female and at least 39 male; for the remaining 39 employees, the sex was not specified in the study trial. The studies investigated different work-break frequencies (five studies) and different work-break types (two studies). None of the studies investigated different work-break durations. We judged all studies to have a high risk of bias. The quality of the evidence for the primary outcomes of self-reported musculoskeletal pain, discomfort and fatigue was low; the quality of the evidence for the primary outcomes of productivity and work performance was very low. The studies were executed in Europe or Northern America, with none from low- to middle-income countries. One study could not be included in the data analyses, because no detailed results have been reported.Changes in the frequency of work breaksThere is low-quality evidence that additional work breaks may not have a considerable effect on musculoskeletal pain, discomfort or fatigue, when compared with no additional work breaks (standardised mean difference (SMD) -0.08; 95% CI -0.35 to 0.18; three studies; 225 participants). Additional breaks may not have a positive effect on productivity or work performance, when compared with no additional work breaks (SMD -0.07; 95% CI -0.33 to 0.19; three studies; 225 participants; very low-quality evidence).We found low-quality evidence that additional work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 1.80 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 15 participants), when compared to work breaks as needed (i.e. microbreaks taken at own discretion). There is very low-quality evidence that additional work breaks may have a positive effect on productivity or work performance, when compared to work breaks as needed (MD 542.5 number of words typed per 3-hour recording session; 95% CI 177.22 to 907.78; one study; 15 participants).Additional higher frequency work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 11.65 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 10 participants; low-quality evidence), when compared to additional lower frequency work breaks. We found very low-quality evidence that additional higher frequency work breaks may not have a considerable effect on productivity or work performance (MD -83.00 number of words typed per 3-hour recording session; 95% CI -305.27 to 139.27; one study; 10 participants), when compared to additional lower frequency work breaks.Changes in the duration of work breaksNo trials were identified that assessed the effect of different durations of work breaks.Changes in the type of work breakWe found low-quality evidence that active breaks may not have a considerable positive effect on participant-reported musculoskeletal pain, discomfort and fatigue (MD -0.17 on a 1-7 NRS scale; 95% CI -0.71 to 0.37; one study; 153 participants), when compared to passive work breaks.Relaxation work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue, when compared to physical work breaks (MD 0.20 on a 1-7 NRS scale; 95% CI -0.43 to 0.82; one study; 97 participants; low-quality evidence).

Authors' conclusions: We found low-quality evidence that different work-break frequencies may have no effect on participant-reported musculoskeletal pain, discomfort and fatigue. For productivity and work performance, evidence was of very low-quality that different work-break frequencies may have a positive effect. For different types of break, there may be no effect on participant-reported musculoskeletal pain, discomfort and fatigue according to low-quality evidence. Further high-quality studies are needed to determine the effectiveness of frequency, duration and type of work-break interventions among workers, if possible, with much higher sample sizes than the studies included in the current review. Furthermore, work-break interventions should be reconsidered, taking into account worker populations other than office workers, and taking into account the possibility of combining work-break intervention with other interventions such as ergonomic training or counselling, which may may possibly have an effect on musculoskeletal outcomes and work performance.

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Conflict of interest statement

Tessy Luger: None known

Christopher Maher: I have received competitive grants from government agencies and industry to support my research. As an invited speaker at conferences, I have had my expenses covered and also received small gifts such as a box of chocolates or a bottle of wine. I have received honoraria for marking theses, reviewing grants and preparing talks.

Monika A. Rieger: Our Institute receives an unrestricted grant by Südwestmetall (employers' association of the metal and electric industry Baden‐Württemberg) which covered about half of the costs of the Institute for several years. The cooperation treaty between Südwestmetall, University of Tübingen, Medical Faculty of the University of Tübingen, University Hospital of Tübingen rules all aspects which are necessary to secure the 'unrestrictedness', and a board of independent trustees monitors this regulation.

Benjamin Steinhilber: None known

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Additional work breaks versus no additional work breaks, Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue (follow‐up 4 or 10 weeks).
1.2
1.2. Analysis
Comparison 1 Additional work breaks versus no additional work breaks, Outcome 2 Productivity or work performance (follow‐up 4 or 10 weeks).
2.1
2.1. Analysis
Comparison 2 Additional work breaks versus work breaks as needed, Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue (follow‐up 4 weeks).
2.2
2.2. Analysis
Comparison 2 Additional work breaks versus work breaks as needed, Outcome 2 Productivity or work performance (follow‐up 4 weeks).
3.1
3.1. Analysis
Comparison 3 Additional higher frequency work breaks versus additional lower frequency work breaks, Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue (follow‐up 4 weeks).
3.2
3.2. Analysis
Comparison 3 Additional higher frequency work breaks versus additional lower frequency work breaks, Outcome 2 Productivity or work performance (follow‐up 4 weeks).
4.1
4.1. Analysis
Comparison 4 Active work breaks versus passive work breaks, Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue (follow‐up 5 weeks).
5.1
5.1. Analysis
Comparison 5 Relaxation work breaks versus physical work breaks, Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue (follow‐up 5 weeks).
6.1
6.1. Analysis
Comparison 6 Additional work breaks versus no additional work breaks (sensitivity analysis), Outcome 1 Participant‐reported musculoskeletal outcomes (pain, discomfort or fatigue).
6.2
6.2. Analysis
Comparison 6 Additional work breaks versus no additional work breaks (sensitivity analysis), Outcome 2 Productivity or work performance.
7.1
7.1. Analysis
Comparison 7 Additional work breaks versus work breaks as needed (sensitivity analysis), Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue.
8.1
8.1. Analysis
Comparison 8 Additional higher frequency work breaks versus additional lower frequency work breaks (sensitivity analysis), Outcome 1 Participant‐reported musculoskeletal pain, discomfort or fatigue.
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NCT01996176 {published data only}
    1. NCT01996176. Take a Stand! ‐ an intervention to reduce occupational sitting time [Take a Stand ! ‐ a cluster randomized controlled intervention study at four office‐based workplaces aiming to reduce occupational sitting time]. clinicaltrials.gov/ct2/show/NCT01996176 (first received 27 November 2013).
NCT02951624 {published data only}
    1. NCT02951624. The effect of frequency and duration of breaks in sitting time on metabolic cardiovascular risk factors (BPS2). clinicaltrials.gov/ct2/show/NCT02951624 (first received 1 November 2016).
NCT02960750 {published data only}
    1. NCT02960750. Effectiveness of a workplace "sit less and move more" web‐based program in Spanish office employees (Walk@WorkSpain) [Effectiveness of a workplace "sit less and move more" web‐based program (Walk@WorkSpain) on occupational sedentary behavior, habitual physical activity, physical risk factors for chronic disease and efficiency‐related outcomes in Spanish office employees]. clinicaltrials.gov/ct2/show/NCT02960750 (first received 10 November 2016).
NCT03163953 {published data only}
    1. NCT03163953. Promoting physical activity and break in office workers [Survey and promoting physical aActivity in employees and entrepreneurial projects of software park Thailand under the office of science and technology (NSTDA)]. clinicaltrials.gov/ct2/show/NCT03163953 (first received 23 May 2017).
NCT03375749 {published data only}
    1. NCT03375749. StandUP UBC: reducing workplace sitting [StandUP UBC: impact of a low‐cost standing desk on reducing workplace sitting]. clinicaltrials.gov/ct2/show/NCT03375749 (first received 18 December 2017).
NCT03468894 {published data only}
    1. NCT03468894. Breaking up sitting with a treadmill desk in office workers [Breaking up prolonged sitting time in office workers with light‐intensity walking: a pilot randomized controlled trial]. clinicaltrials.gov/ct2/show/NCT03468894 (first received 19 March 2018).
NCT03560544 {published data only}
    1. NCT03560544. The effect of breaking up sitting in the workplace on cardiometabolic risk and worker productivity [Pilot study of a tailored intervention to break up sitting in the workplace on cardiometabolic risk and worker productivity]. clinicaltrials.gov/ct2/show/NCT03560544 (first received 18 June 2018).
NCT03715816 {published data only}
    1. NCT03715816. Work breaks during simulated minimally invasive surgery [Work breaks during minimally invasive surgery ‐ target‐group specific development of work break schedules]. clinicaltrials.gov/ct2/show/NCT03715816 (first received 23 October 2018).
NCT03840304 {published data only}
    1. NCT03840304. Effect of Yoga@Work program [Effectiveness of Yoga@Work program on neck and shoulder pain in information technology (IT) employees]. clinicaltrials.gov/ct2/show/NCT03840304 (first received 15 February 2019).
NCT03863340 {published data only}
    1. NCT03863340. Short interventions to prevent trapezius muscle fatigue in computer work [Trapezius muscle fatigue of long duration: a likely neuromuscular control issue]. clinicaltrials.gov/ct2/show/NCT03863340 (first received 5 March 2019).
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References to ongoing studies

NCT03559153 {published data only}
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