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The Evidence Base for Occupational Health Interventions

Original Editor - Jess Bell

Top Contributors - Jess Bell, Kim Jackson, Tarina van der Stockt, Lucinda hampton and Alexandra Stead

Introduction

It is estimated that around 60% of the world’s population spends approximately 60% of their waking hours at work, making the workplace a powerful setting for influencing health behaviour.[1]

Occupational Health (OH) traditionally had a narrow focus: assessing fitness for work and preventing or rehabilitating conditions directly related to the work environment. Early OH research reflected this focus, concentrating on hazards, disease trends and work-related ill health.[2] The OH field has since expanded. It now considers the impact of health on work, as well as return-to-work strategies and the management of long-term conditions in the workplace.[2]

History of Occupational Health Research

During the early 20th century, certain government agencies began to monitor and record trends in public health and disease.[2] It was not until the end of the 20th century that countries, such as the US, the United Kingdom, Italy, and Japan, started to develop OH research agendas.[2] Priorities vary between countries based on economic and sociocultural background, safety regulations, and work demographics.[3] Funding has traditionally been scarce for OH research, so it is important that researchers understand their own national priorities in order to target funding and ensure that research benefits the community.[3]

Burden of Work-Related Injury and Ill Health

Musculoskeletal conditions are among the leading causes of years lived with disability worldwide, and they carry substantial financial costs for both individuals and wider society.[4][5][6] In the US alone, work-related musculoskeletal conditions are estimated to cost $45–54 billion per year.[7] They also have a significant impact on the workplace. In Great Britain, an estimated 511,000 workers experienced work-related musculoskeletal disorders in 2024/25, resulting in 7.1 million lost working days.[8] This is second only to stress, depression, and anxiety, which accounted for 22.1 million lost working days in 2024/25.[8] It’s also important to remember that musculoskeletal and mental health conditions frequently co-occur[9][10]; therefore, physiotherapists working in occupational health settings should consider psychological factors as part of their routine assessment and management.

Limitations of Occupational Health Research

The evidence base for OH interventions remains limited in both quantity and methodological quality. Many conclusions have been drawn from studies with bias or other methodological flaws.[2] This is problematic, as physiotherapists have a professional obligation to base their practice on sound evidence and to be able to justify the interventions they recommend to employers, policymakers, and funders.[2] Despite these limitations, some overarching themes have emerged from the OH literature.

Occupational Health Research Trends

Exercise and Strength Training

There is consistent evidence supporting physical activity and strength training as a core component of workplace musculoskeletal interventions, particularly for preventing and managing low back, neck, and upper extremity conditions, though the overall quality of evidence varies across studies.[11][12][13] [14][15]

Work-based Intervention and Return-to-work Programmes

In 2021, Corp et al.[16] conducted a systematic review of clinical guidelines and found that work-based interventions and return-to-work programmes are recommended for low back pain. In the same year, Russo et al.[17] looked at the effects of workplace interventions on low back pain clinical outcomes in a worker population. Their meta-analysis found that there were improvements in pain, disability, fear-avoidance of physical activity, and quality of life for participants who received a workplace intervention compared to controls. Participants who received the workplace intervention also experienced reduced recurrence rates.[17]

Ergonomic Interventions

A 2018 Cochrane review by Hoe et al.[18] examined ergonomic interventions for preventing work-related neck and upper limb musculoskeletal conditions in office workers. They found insufficient or inconsistent evidence for most approaches.[18] A broader systematic review by Sundstrup et al.[15] also found limited evidence for ergonomic interventions among workers in physically demanding roles. A 2025 systematic review and meta-analysis by Santos et al.[19] found that ergonomic interventions produced statistically significant reductions in work-related musculoskeletal pain across multiple body regions (back, ankles, wrists, and neck). However, the effect size was small, and the authors concluded that ergonomic interventions are insufficient as standalone treatments and should be combined with exercise or physical rehabilitation programmes.[19]

Reducing Workplace Sitting

A 2018 Cochrane review by Shrestha et al.[1] found low-quality evidence that sit-stand desks reduce sitting time in the short to medium term, with no evidence available on longer-term effects. Evidence for other approaches, including physical workplace changes, policy changes, and multicomponent interventions, was rated as low to very low quality.[1]

Active Micro-breaks

A 2022 systematic review by Koumantakis et al.[20] found that active micro-breaks—incorporating exercise, stretching, or ergonomic strategies—were more beneficial than passive breaks for reducing pain and fatigue and improving mood, and concluded that micro-breaks are beneficial for both sedentary and standing workers.

Job Rotation

A 2014 systematic review by Leider et al.[21] examined the effects of rotating workers between tasks as a strategy to reduce musculoskeletal complaints. The available evidence was weak, and no firm conclusions could be drawn on the benefits of job rotation.

Multi-domain Return-to-work Interventions

Single-component interventions tend to underperform relative to multi-domain interventions. The evidence is strongest for return-to-work programmes that combine coordinated care between the worker, employer, and health professional with practical workplace modifications or accommodations.[22] Work modification and accommodation includes adjusting tasks, hours, or environments to match a worker's current capacity. This approach is a well-supported component of effective return-to-work programmes. Cullen et al.[22] synthesised evidence from 36 medium- and high-quality studies across three domains: health-focused, service coordination, and work modification. They found strong evidence that multi-domain interventions (i.e., interventions from two or more domains) significantly reduced time away from work for musculoskeletal, pain-related and mental health conditions. The evidence for single-domain interventions was mixed. Some single-domain interventions had no effect on lost time and function, whereas others showed positive effects.[22]

Early Employer Contact and Dialogue

A key finding across the return-to-work literature is that timing matters. Sennehed et al.'s WorkUp randomised controlled trial found that workers whose primary care physiotherapists established early contact with their employer—in addition to receiving physiotherapy—showed greater improvements in work ability than those who received physiotherapy alone.[23] This finding is supported by qualitative evidence. Kreuger et al.[24] interviewed employees on long-term sick leave and their employers. They found that early and ongoing communication, joint meetings involving occupational health professionals, and clear information about return-to-work responsibilities were important prerequisites for successful return to work.

Summary

The occupational health evidence base has variable quality, but some consistent themes have emerged. Exercise and strength training have the strongest support for preventing and managing work-related musculoskeletal conditions, while multi-domain return-to-work programmes outperform single-component approaches. For other interventions, including ergonomic equipment, sit-stand desks, and job rotation, further evidence is required before strong recommendations can be made.[2] The scale of work-related ill health, across both musculoskeletal and mental health conditions, makes continued development of this evidence base a priority.

References

  1. ↑ 1.0 1.1 1.2 Shrestha N, Kukkonen-Harjula KT,, Verbeek JH, Ijaz S, Hermans V, Pedisic Z. Workplace interventions for reducing sitting at work (Cochrane Review). Cochrane Database of Systematic Reviews 2018;(6): CD010912.pub4.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Skamagki G. The evidence base for occupational health interventions. Plus. 2020.
  3. ↑ 3.0 3.1 Lalloo D, Demou E, Smedley J, Madan I, Asanati K, Macdonald EB. Current research priorities for UK occupational physicians and occupational health researchers: A modified Delphi study. Occupational and Environmental Medicine. 2018; 75(11): 830–836.
  4. ↑ Humphreys JH, Verstappen SMM. The burden of musculoskeletal disease. Medicine. 2022;50(2):82-4.
  5. ↑ Qiu K, Wang C, Mo X, Yang G, Huang L, Wu Y, Pan Z. The global macroeconomic burden of musculoskeletal disorders. Int J Surg. 2025 Nov 1;111(11):7857-7866.
  6. ↑ Guan SY, Zheng JX, Zhang SX, Xu S, Shuai Z, Cai HY, Pan F. Global burden of musculoskeletal disorders in adults aged 50 and over, 1990-2021: risk factors and sociodemographic inequalities. J Cachexia Sarcopenia Muscle. 2025 Aug;16(4):e70008.
  7. ↑ Shaw WS, Dugan AG,Garza J, Tetrick LE. Pain, musculoskeletal injuries, and return to work. In Fisher GG, Ford MT, Quick JC, editors. Handbook of occupational health psychology, 3rd ed. Washington, DC, US: American Psychological Association, 2024. p.341-359.
  8. ↑ 8.0 8.1 Health and Safety Executive (HSE). Health and safety at work: Summary statistics for Great Britain 2025. Available from: https://www.hse.gov.uk/statistics/assets/docs/hssh2425.pdf (accessed 20 February 2026).
  9. ↑ Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care. JAMA Netw Open. 2023 Jun 1;6(6):e2320520.
  10. ↑ Neupane S, KC P, Goldberg M, Nygård CH. Multi-trajectory of musculoskeletal and mental disorders: a multi-cohort study. Eur J Public Health. 2025 Oct 27;35(Suppl 4):ckaf161.179.
  11. ↑ Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occupational and Environmental Medicine. 2016; 73(1): 62-70.
  12. ↑ Pieper C, Schröer S, Eilerts A. L. Evidence of workplace interventions-A systematic review of systematic reviews. International Journal of Environmental Research and Public Health. 2019. 16(19).
  13. ↑ Moreira-Silva I, Teixeira PM, Santos R, Abreu S, Moreira C, Mota J. The effects of workplace physical activity programs on musculoskeletal pain: a systematic review and meta-analysis. Workplace Health Saf. 2016 May;64(5):210-22.
  14. ↑ Skamagki G, King A, Duncan M, Wåhlin C. A systematic review on workplace interventions to manage chronic musculoskeletal conditions. Physiother Res Int. 2018 Oct;23(4):e1738.
  15. ↑ 15.0 15.1 Sundstrup E, Seeberg KGV, Bengtsen E, Andersen LL. A systematic review of workplace interventions to rehabilitate musculoskeletal disorders among employees with physical demanding work. J Occup Rehabil. 2020 Dec;30(4):588-612. d
  16. ↑ Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, van der Windt DA. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain. 2021 Feb;25(2):275-95.
  17. ↑ 17.0 17.1 Russo F, Papalia GF, Vadalà G, Fontana L, Iavicoli S, Papalia R, Denaro V. The effects of workplace interventions on low back pain in workers: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021 Nov 30;18(23):12614.
  18. ↑ 18.0 18.1 Hoe VC, Urquhart DM, Kelsall HL, Zamri EN, Sim MR. Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database Syst Rev. 2018 Oct 23;10(10):CD008570.
  19. ↑ 19.0 19.1 Santos W, Rojas C, Isidoro R, Lorente A, Dias A, Mariscal G, et al. Efficacy of ergonomic interventions on work-related musculoskeletal pain: a systematic review and meta-analysis. J Clin Med. 2025 Apr 28;14(9):3034.
  20. ↑ Vitoulas S, Konstantis V, Drizi I, Vrouva S, Koumantakis GA, Sakellari V. The effect of physiotherapy interventions in the workplace through active micro-break activities for employees with standing and sedentary work. Healthcare (Basel). 2022 Oct 18;10(10):2073.
  21. ↑ Leider P, Boschman J, Frings-Dresen M, Molen, HF. Effects of job rotation on musculoskeletal complaints and related work exposures: a systematic literature review. Ergonomics. 2014; 58(1): 1-15.
  22. ↑ 22.0 22.1 22.2 Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners. J Occup Rehabil. 2018; 28: 1-15.
  23. ↑ Sennehed CP, Holmberg S, Axén I, Stigmar K, Forsbrand M, Petersson IF, Grahn B. Early workplace dialogue in physiotherapy practice improved work ability at 1-year follow-up-WorkUp, a randomised controlled trial in primary care. Pain. 2018. 159(8), 1456–1464.
  24. ↑ Kreuger DCC, Donker-Cools BHPM, Oomens S, Luymes C, Anema JR, Schaafsma FG. The return-to-work journey: experiences with communication and collaboration among employees and employers during long-term sick leave and return-to-work. Disabil Rehabil. 2025 Aug;47(16):4168-4175.
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