Incentives for smoking cessation Notley, Caitlin; Gentry, Sarah; Livingstone‐Banks, Jonathan ...
Cochrane database of systematic reviews,
07/2019, Volume:
2019, Issue:
7
Journal Article
Peer reviewed
Open access
Background
Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in ...workplaces, in clinics and hospitals, and within community programmes.
Objectives
To determine the long‐term effect of incentives and contingency management programmes for smoking cessation.
Search methods
For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018.
Selection criteria
We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed‐population setting (e.g. community, work‐, clinic‐ or institution‐based), and also studies in pregnant smokers.
Data collection and analysis
We used standard Cochrane methods. The primary outcome measure in the mixed‐population studies was abstinence from smoking at longest follow‐up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow‐up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel‐Haenzel random‐effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster‐randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations.
Main results
Thirty‐three mixed‐population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.
Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits.
We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives.
Authors' conclusions
Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives. There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations.
Workplace interventions for reducing sitting at work Shrestha, Nipun; Kukkonen‐Harjula, Katriina T; Verbeek, Jos H ...
Cochrane database of systematic reviews,
12/2018, Volume:
2018, Issue:
12
Journal Article
Peer reviewed
Open access
Background
A large number of people are employed in sedentary occupations. Physical inactivity and excessive sitting at workplaces have been linked to increased risk of cardiovascular disease, ...obesity, and all‐cause mortality.
Objectives
To evaluate the effectiveness of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, OSH UPDATE, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 9 August 2017. We also screened reference lists of articles and contacted authors to find more studies.
Selection criteria
We included randomised controlled trials (RCTs), cross‐over RCTs, cluster‐randomised controlled trials (cluster‐RCTs), and quasi‐RCTs of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before‐and‐after studies. The primary outcome was time spent sitting at work per day, either self‐reported or measured using devices such as an accelerometer‐inclinometer and duration and number of sitting bouts lasting 30 minutes or more. We considered energy expenditure, total time spent sitting (including sitting at and outside work), time spent standing at work, work productivity and adverse events as secondary outcomes.
Data collection and analysis
Two review authors independently screened titles, s and full‐text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required.
Main results
We found 34 studies — including two cross‐over RCTs, 17 RCTs, seven cluster‐RCTs, and eight controlled before‐and‐after studies — with a total of 3,397 participants, all from high‐income countries. The studies evaluated physical workplace changes (16 studies), workplace policy changes (four studies), information and counselling (11 studies), and multi‐component interventions (four studies). One study included both physical workplace changes and information and counselling components. We did not find any studies that specifically investigated the effects of standing meetings or walking meetings on sitting time.
Physical workplace changes
Interventions using sit‐stand desks, either alone or in combination with information and counselling, reduced sitting time at work on average by 100 minutes per workday at short‐term follow‐up (up to three months) compared to sit‐desks (95% confidence interval (CI) −116 to −84, 10 studies, low‐quality evidence). The pooled effect of two studies showed sit‐stand desks reduced sitting time at medium‐term follow‐up (3 to 12 months) by an average of 57 minutes per day (95% CI −99 to −15) compared to sit‐desks. Total sitting time (including sitting at and outside work) also decreased with sit‐stand desks compared to sit‐desks (mean difference (MD) −82 minutes/day, 95% CI −124 to −39, two studies) as did the duration of sitting bouts lasting 30 minutes or more (MD −53 minutes/day, 95% CI −79 to −26, two studies, very low‐quality evidence).
We found no significant difference between the effects of standing desks and sit‐stand desks on reducing sitting at work. Active workstations, such as treadmill desks or cycling desks, had unclear or inconsistent effects on sitting time.
Workplace policy changes
We found no significant effects for implementing walking strategies on workplace sitting time at short‐term (MD −15 minutes per day, 95% CI −50 to 19, low‐quality evidence, one study) and medium‐term (MD −17 minutes/day, 95% CI −61 to 28, one study) follow‐up. Short breaks (one to two minutes every half hour) reduced time spent sitting at work on average by 40 minutes per day (95% CI −66 to −15, one study, low‐quality evidence) compared to long breaks (two 15‐minute breaks per workday) at short‐term follow‐up.
Information and counselling
Providing information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short‐term follow‐up (MD −19 minutes per day, 95% CI −57 to 19, two studies, low‐quality evidence). However, the reduction was significant at medium‐term follow‐up (MD −28 minutes per day, 95% CI −51 to −5, two studies, low‐quality evidence).
Computer prompts combined with information resulted in no significant change in sitting time at work at short‐term follow‐up (MD −14 minutes per day, 95% CI −39 to 10, three studies, low‐quality evidence), but at medium‐term follow‐up they produced a significant reduction (MD −55 minutes per day, 95% CI −96 to −14, one study). Furthermore, computer prompting resulted in a significant decrease in the average number (MD −1.1, 95% CI −1.9 to −0.3, one study) and duration (MD ‐74 minutes per day, 95% CI −124 to −24, one study) of sitting bouts lasting 30 minutes or more.
Computer prompts with instruction to stand reduced sitting at work on average by 14 minutes per day (95% CI 10 to 19, one study) more than computer prompts with instruction to walk at least 100 steps at short‐term follow‐up.
We found no significant reduction in workplace sitting time at medium‐term follow‐up following mindfulness training (MD −23 minutes per day, 95% CI −63 to 17, one study, low‐quality evidence). Similarly a single study reported no change in sitting time at work following provision of highly personalised or contextualised information and less personalised or contextualised information. One study found no significant effects of activity trackers on sitting time at work.
Multi‐component interventions
Combining multiple interventions had significant but heterogeneous effects on sitting time at work (573 participants, three studies, very low‐quality evidence) and on time spent in prolonged sitting bouts (two studies, very low‐quality evidence) at short‐term follow‐up.
Authors' conclusions
At present there is low‐quality evidence that the use of sit‐stand desks reduce workplace sitting at short‐term and medium‐term follow‐ups. However, there is no evidence on their effects on sitting over longer follow‐up periods. Effects of other types of interventions, including workplace policy changes, provision of information and counselling, and multi‐component interventions, are mostly inconsistent. The quality of evidence is low to very low for most interventions, mainly because of limitations in study protocols and small sample sizes. There is a need for larger cluster‐RCTs with longer‐term follow‐ups to determine the effectiveness of different types of interventions to reduce sitting time at work.
Background
The World Health Organization (WHO) recommends undertaking 150 minutes of moderate‐intensity physical activity per week, but most people do not. Workplaces present opportunities to ...influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.
Objectives
To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long‐term health outcomes.
Search methods
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'.
Selection criteria
We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured.
Data collection and analysis
We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre‐specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow‐up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity.
Main results
We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high‐income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi‐component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow‐up after completion of the intervention ranged from three to ten months.
Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition.
When pedometer interventions are compared to minimal interventions at follow‐up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low‐certainty evidence; no meta‐analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low‐certainty evidence).
Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) ‐0.64, 95% confidence interval (CI) ‐1.45 to 0.18; 3 studies; low‐certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: ‐0.08 mmHg, 95% CI ‐3.26 to 3.11; 2 studies; moderate‐certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low‐certainty evidence). No studies compared biochemical measures or disease risk scores at follow‐up after completion of the intervention versus a minimal intervention.
Comparison of pedometer interventions to alternative physical activity interventions at follow‐up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low‐certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low‐density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow‐up after completion of the intervention were not compared to an alternative physical activity intervention.
Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions.
Authors' conclusions
Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer‐based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision‐makers considering allocating resources to large‐scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term.
Future studies should be designed to identify the effective components of multi‐component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.
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, s, 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 ‐.96 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.
Background
The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation.
Objectives
1. To categorize workplace interventions for smoking ...cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking.
2. To collect and evaluate data on costs and cost effectiveness associated with workplace interventions.
Search methods
We searched the Cochrane Tobacco Addiction Group Specialized Register (July 2013), MEDLINE (1966 ‐ July 2013), EMBASE (1985 ‐ June 2013), and PsycINFO (to June 2013), amongst others. We searched s from international conferences on tobacco and the bibliographies of identified studies and reviews for additional references.
Selection criteria
We selected interventions conducted in the workplace to promote smoking cessation. We included only randomized and quasi‐randomized controlled trials allocating individuals, workplaces, or companies to intervention or control conditions.
Data collection and analysis
One author extracted information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the studies, and a second author checked them. For this update we have conducted meta‐analyses of the main interventions, using the generic inverse variance method to generate odds ratios and 95% confidence intervals.
Main results
We include 57 studies (61 comparisons) in this updated review. We found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self‐help materials, nicotine replacement therapy, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (odds ratio (OR) for cessation 1.71, 95% confidence interval (CI) 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self‐help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long‐term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking.
Authors' conclusions
1. We found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere. Self‐help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low.
2. We failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta‐analysed data.
3. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long‐term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates.
4. Further research would be valuable in low‐income and developing countries, where high rates of smoking prevail and smoke‐free legislation is not widely accepted or enforced.
Background
Flexible working conditions are increasingly popular in developed countries but the effects on employee health and wellbeing are largely unknown.
Objectives
To evaluate the effects ...(benefits and harms) of flexible working interventions on the physical, mental and general health and wellbeing of employees and their families.
Search methods
Our searches (July 2009) covered 12 databases including the Cochrane Public Health Group Specialised Register, CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Social Science Citation Index; ASSIA; IBSS; Sociological s; and ABI/Inform. We also searched relevant websites, handsearched key journals, searched bibliographies and contacted study authors and key experts.
Selection criteria
Randomised controlled trials (RCT), interrupted time series and controlled before and after studies (CBA), which examined the effects of flexible working interventions on employee health and wellbeing. We excluded studies assessing outcomes for less than six months and extracted outcomes relating to physical, mental and general health/ill health measured using a validated instrument. We also extracted secondary outcomes (including sickness absence, health service usage, behavioural changes, accidents, work‐life balance, quality of life, health and wellbeing of children, family members and co‐workers) if reported alongside at least one primary outcome.
Data collection and analysis
Two experienced review authors conducted data extraction and quality appraisal. We undertook a narrative synthesis as there was substantial heterogeneity between studies.
Main results
Ten studies fulfilled the inclusion criteria. Six CBA studies reported on interventions relating to temporal flexibility: self‐scheduling of shift work (n = 4), flexitime (n = 1) and overtime (n = 1). The remaining four CBA studies evaluated a form of contractual flexibility: partial/gradual retirement (n = 2), involuntary part‐time work (n = 1) and fixed‐term contract (n = 1). The studies retrieved had a number of methodological limitations including short follow‐up periods, risk of selection bias and reliance on largely self‐reported outcome data.
Four CBA studies on self‐scheduling of shifts and one CBA study on gradual/partial retirement reported statistically significant improvements in either primary outcomes (including systolic blood pressure and heart rate; tiredness; mental health, sleep duration, sleep quality and alertness; self‐rated health status) or secondary health outcomes (co‐workers social support and sense of community) and no ill health effects were reported. Flexitime was shown not to have significant effects on self‐reported physiological and psychological health outcomes. Similarly, when comparing individuals working overtime with those who did not the odds of ill health effects were not significantly higher in the intervention group at follow up. The effects of contractual flexibility on self‐reported health (with the exception of gradual/partial retirement, which when controlled by employees improved health outcomes) were either equivocal or negative. No studies differentiated results by socio‐economic status, although one study did compare findings by gender but found no differential effect on self‐reported health outcomes.
Authors' conclusions
The findings of this review tentatively suggest that flexible working interventions that increase worker control and choice (such as self‐scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes. In contrast, interventions that were motivated or dictated by organisational interests, such as fixed‐term contract and involuntary part‐time employment, found equivocal or negative health effects. Given the partial and methodologically limited evidence base these findings should be interpreted with caution. Moreover, there is a clear need for well‐designed intervention studies to delineate the impact of flexible working conditions on health, wellbeing and health inequalities.
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, s 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 breaks
There 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 breaks
No trials were identified that assessed the effect of different durations of work breaks.
Changes in the type of work break
We 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.
Background
The World Health Organization and the World Economic Forum have recommended further research to strengthen current knowledge of workplace health programmes, particularly on effectiveness ...and using simple instruments. A pedometer is one such simple instrument that can be incorporated in workplace interventions.
Objectives
To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.
Search methods
Electronic searches of the Cochrane Central Register of Controlled Trials (671 potential papers), MEDLINE (1001), Embase (965), CINAHL (1262), OSH UPDATE databases (75) and Web of Science (1154) from the earliest record to between 30th January and 6th February 2012 yielded 3248 unique records. Reference lists of articles yielded an additional 34 papers. Contact with individuals and organisations did not produce any further records.
Selection criteria
We included individual and cluster‐randomised controlled trials of workplace health promotion interventions with a pedometer component in employed adults. The primary outcome was physical activity and was part of the eligibility criteria. We considered subsequent health outcomes, including adverse effects, as secondary outcomes.
Data collection and analysis
Two review authors undertook the screening of titles and s and the full‐text papers independently. Two review authors (RFP and MC) independently completed data extraction and risk of bias assessment. We contacted authors to obtain additional data and clarification.
Main results
We found four relevant studies providing data for 1809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting.
Three studies compared the pedometer programme to a minimally active control group, but the results for physical activity could not be combined because each study used a different measure of activity. One study observed an increase in physical activity under a pedometer programme, but the other two did not find a significant difference. For secondary outcomes we found improvements in body mass index, waist circumference, fasting plasma glucose, the quality of life mental component and worksite injury associated with the pedometer programmes, but these results were based on limited data from one or two small studies. There were no differences between the pedometer programme and the control group for blood pressure, a number of biochemical outcomes and the quality of life physical component. Sedentary behaviour and disease risk scores were not measured by any of the included studies.
One study compared a pedometer programme and an alternative physical activity programme, but baseline imbalances made it difficult to distinguish the true improvements associated with either programme.
Overall, there was insufficient evidence to assess the effectiveness of pedometer interventions in the workplace.
There is a need for more high quality randomised controlled trials to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. To improve the quality of the evidence available, future studies should be registered in an online trials register, publish a protocol, allocate time and financial support to reducing attrition, and try to blind personnel (especially those who undertake measurement). To better identify the effects of pedometer interventions, future studies should report a core set of outcomes (total physical activity in METs, total time sitting in hours and minutes, objectively measured cardiovascular disease and type II diabetes risk factors, quality of life and injury), assess outcomes in the long term and undertake subgroup analyses based upon demographic subgroups (e.g. age, gender, educational status). Future studies should also compare different types of active intervention to test specific intervention components (eligibility, duration, step goal, step diary, settings), and settings (occupation, intervention provider).
Authors' conclusions
There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.
Background
Exposure to light plays a crucial role in biological processes, influencing mood and alertness. Daytime workers may be exposed to insufficient or inappropriate light during daytime, ...leading to mood disturbances and decreases in levels of alertness.
Objectives
To assess the effectiveness and safety of lighting interventions to improve alertness and mood in daytime workers.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, seven other databases; ClinicalTrials.gov and the World Health Organization trials portal up to January 2018.
Selection criteria
We included randomised controlled trials (RCTs), and non‐randomised controlled before‐after trials (CBAs) that employed a cross‐over or parallel‐group design, focusing on any type of lighting interventions applied for daytime workers.
Data collection and analysis
Two review authors independently screened references in two stages, extracted outcome data and assessed risk of bias. We used standardised mean differences (SMDs) and 95% confidence intervals (CI) to pool data from different questionnaires and scales assessing the same outcome across different studies. We combined clinically homogeneous studies in a meta‐analysis. We used the GRADE system to rate quality of evidence.
Main results
The search yielded 2844 references. After screening titles and s, we considered 34 full text articles for inclusion. We scrutinised reports against the eligibility criteria, resulting in the inclusion of five studies (three RCTs and two CBAs) with 282 participants altogether. These studies evaluated four types of comparisons: cool‐white light, technically known as high correlated colour temperature (CCT) light versus standard illumination; different proportions of indirect and direct light; individually applied blue‐enriched light versus no treatment; and individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder.
We found no studies comparing one level of illuminance versus another.
We found two CBA studies (163 participants) comparing high CCT light with standard illumination. By pooling their results via meta‐analysis we found that high CCT light may improve alertness (SMD −0.69, 95% CI −1.28 to −0.10; Columbia Jet Lag Scale and the Karolinska Sleepiness Scale) when compared to standard illumination. In one of the two CBA studies with 94 participants there was no difference in positive mood (mean difference (MD) 2.08, 95% CI −0.1 to 4.26) or negative mood (MD −0.45, 95% CI −1.84 to 0.94) assessed using the Positive and Negative Affect Schedule (PANAS) scale. High CCT light may have fewer adverse events than standard lighting (one CBA; 94 participants). Both studies were sponsored by the industry. We graded the quality of evidence as very low.
We found no studies comparing light of a particular illuminance and light spectrum or CCT versus another combination of illuminance and light spectrum or CCT.
We found no studies comparing daylight versus artificial light.
We found one RCT (64 participants) comparing the effects of different proportions of direct and indirect light: 100% direct lighting, 70% direct lighting plus 30% indirect lighting, 30% direct lighting plus 70% indirect lighting and 100% indirect lighting. There was no substantial difference in mood, as assessed by the Beck Depression Inventory, or in adverse events, such as ocular, reading or concentration problems, in the short or medium term. We graded the quality of evidence as low.
We found two RCTs comparing individually administered light versus no treatment. According to one RCT with 25 participants, blue‐enriched light individually applied for 30 minutes a day may enhance alertness (MD −3.30, 95% CI −6.28 to −0.32; Epworth Sleepiness Scale) and may improve mood (MD −4.8, 95% CI −9.46 to −0.14; Beck Depression Inventory). We graded the quality of evidence as very low. One RCT with 30 participants compared individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder. There was no substantial difference in alertness levels (MD 7.00, 95% CI −10.18 to 24.18), seasonal affective disorder symptoms (RR 1.60, 95% CI 0.81, 3.20; number of participants presenting with a decrease of at least 50% in SIGH‐SAD scores) or frequency of adverse events (RR 0.53, 95% CI 0.26 to 1.07). Among all participants, 57% had a reduction of at least 50% in their SIGH‐SAD score. We graded the quality of evidence as low.
Publication bias could not be assessed for any of these comparisons.
Authors' conclusions
There is very low‐quality evidence based on two CBA studies that high CCT light may improve alertness, but not mood, in daytime workers. There is very low‐quality evidence based on one CBA study that high CCT light may also cause less irritability, eye discomfort and headache than standard illumination. There is low‐quality evidence based on one RCT that different proportions of direct and indirect light in the workplace do not affect alertness or mood. There is very low‐quality evidence based on one RCT that individually applied blue‐enriched light improves both alertness and mood. There is low‐quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder.
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