van de Wijdeven et al.

BMC Musculoskeletal
BMC Musculoskeletal Disorders (2023) 24:87
https://doi.org/10.1186/s12891-023-06155-w Disorders

RESEARCH Open Access

A first step towards a framework

for interventions for individual working practice
to prevent work‑related musculoskeletal
disorders: a scoping review
Bert van de Wijdeven1* , Bart Visser2 , Joost Daams1   and Paul P.F.M. Kuijer1   

Abstract
Background Work-related musculoskeletal disorders (WMSDs) are a key topic in occupational health. In the primary
prevention of these disorders, interventions to minimize exposure to work-related physical risk factors are widely
advocated. Besides interventions aimed at the work organisation and the workplace, interventions are also aimed at
the behaviour of workers, the so-called individual working practice (IWP). At the moment, no conceptual framework
for interventions for IWP exists. This study is a first step towards such a framework.
Methods A scoping review was carried out starting with a systematic search in Ovid Medline, Ovid Embase, Ovid
APA PsycInfo, and Web of Science. Intervention studies aimed at reducing exposure to physical ergonomic risk factors
involving the worker were included. The content of these interventions for IWP was extracted and coded in order to
arrive at distinguishing and overarching categories of these interventions for IWP.
Results More than 12.000 papers were found and 110 intervention studies were included, describing 810 topics for
IWP. Eventually eight overarching categories of interventions for IWP were distinguished: (1) Workplace adjustment, (2)
Variation, (3) Exercising, (4) Use of aids, (5) Professional skills, (6) Professional manners, (7) Task content & task organisa-
tion and (8) Motoric skills.
Conclusion Eight categories of interventions for IWP are described in the literature. These categories are a starting
point for developing and evaluating effective interventions performed by workers to prevent WMSDs. In order to
reach consensus on these categories, an international expert consultation is a necessary next step.
Keywords Work related risk factors, Occupational training, Ergonomic interventions, Musculoskeletal diseases,
Prevention and control

Background
Musculoskeletal disorders (MSDs) are defined by the
World Health Organisation (WHO) as “health problems
*Correspondence:
Bert van de Wijdeven of the locomotor apparatus, i.e. muscles, tendons, the
l.c.vandewijdeven@amsterdamumc.nl skeleton, cartilage, ligaments and nerves. MSDs include
1
Public and Occupational Health, Amsterdam UMC location University all forms of ill-health ranging, from light, transitory dis-
of Amsterdam, Meibergdreef 9, K0‑116 1105 AZ Amsterdam, The
Netherlands orders to irreversible disabling injuries [1]. An overview
2
Centre of Expertise Urban Vitality, Amsterdam University of Applied in 2013 across 188 countries of the 25 most common
Sciences, Amsterdam, The Netherlands causes of “years lived with disability” showed that MSDs

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van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 2 of 14

are highly prevalent. Top of the list is low back pain, term individual behaviour that influences work-related
fourth is neck pain, and tenth in that list are “other MSD physical ergonomic risk factors, like posture and work-
complaints” [2]. In addition to personal suffering, MSDs ing speed, and skills acquired over time that influence
also cause direct and indirect economic cost, such as these risk factors, like motoric skills and professional
healthcare cost and lost productivity [3]. In Europe the competence.
total cost of work-related MSDs due to lost productiv- These different types of interventions can be combined
ity among people of working age is estimated as 2% of in an implementation project. Where possible, the hier-
the gross domestic product (GDP). In Europe MSDs are archy of risk management should be taken into account,
responsible for 50% of all absences from work lasting for i.e. organisational and technical measures are preferred
more than three days and about 60% of all reported cases over interventions aimed at behaviour [18].
of permanent incapacity [4]. Worldwide low back pain Although IWP takes last place in the hierarchy of risk
arising from ergonomic exposures at work was estimated management, in the context of preventing WMSDs it
to cause 21.7 million disability-adjusted life years in 2010. still is a key topic for various reasons. First, a technical or
These are the years of life lost as a result of premature organisational improvement may not be possible or not
death plus the years lived with a disability [5]. immediately available. A behavioural change, if effective,
MSDs induced or aggravated by work and the circum- is then a logical next step. Second, the success of a tech-
stances of its performance are called work-related MSDs nical or organisational improvement can depend on the
(WMSDs), according to WHO [2]. WMSDs are partly behaviour and compliance of the employee. For instance,
preventable given the association with work-related risk lifting equipment only has an effect if it is used in daily
factors. With regard to physical ergonomic risk factors practice, halving the weight of the cement bag is only an
such as force exertion, demanding posture or repetitive improvement if the mason lifts one bag instead of two.
movement, recent studies found that occupational expo- Third, improving personal behaviour is the only topic
sure is highly prevalent and there is evidence that the that can be intervened on during the course of a voca-
burden of MSDs attributed to that exposure is substantial tional training; an improvement in the later work organi-
[6, 7]. For several prevalent musculoskeletal disorders, sation or the work environment is obviously not part of
threshold limits are formulated for work-related risk fac- the curriculum. Fourth, when WMSDs are treated in
tors. Examples are carpal tunnel syndrome [8], lateral curative care, the health practitioner usually has no direct
epicondylitis [9, 10], specific shoulder disorders [11], hip control over the work environment or work organisation.
and knee osteoarthritis [12, 13] and lumbosacral radicu- However, behaviour in daily work practice can be influ-
lopathy syndrome [14]. enced and is therefore a feasible starting point for this
To eliminate or minimize the work-related risk fac- guidance.
tors for MSD, primary prevention is widely advocated. There are numerous articles in the medical literature
A framework of six steps was proposed in 2017 for set- describing interventions that include an aspect of IWP.
ting up such prevention [15]. The first three steps include For example, if the intervention comprises of advice on
identifying the incidence and severity of the condition, posture, working technique or work variation. It is strik-
determining the risk factors that may be involved and the ing to note that, as far as we are aware, in the context of
mechanisms that may cause a MSD. In the fourth step, prevention of WMSDs, no framework exists for the cat-
based on the knowledge of previous steps, an interven- egorisation of interventions for IWP. To take a first step
tion is developed. Steps five and six concern the evalu- towards the development of such a framework, this study
ation and implementation of the assumed effective answers the question: which categories of interventions
intervention. for Individual Working Practice (IWP) can be distin-
When developing an intervention, different interven- guished to reduce exposure to physical ergonomic risk
tions can be distinguished [16, 17]. There are interven- factors in order to prevent WMSDs?
tions to improve organisational aspects of work, aimed
for example at the task content, collaboration, support, Method
work pace and planning. There are also technical inter- To answer the research question, a scoping review as
ventions with the focus on for instance the work environ- designed by Arksey [19], later supplemented by Levac
ment, working height, tools and equipment. And there [20], and in line with the PRISMA-Scoping Reviews
are interventions regarding the behaviour of workers, extension [21] and the JBI reviewer’s manual [22], was
addressing working practice, education and training. performed. The prescribed steps, with the exception for
To emphasize the context of work, the term Individual ‘the consultation step’, have been completed. The subse-
Working Practice (IWP) is used to describe the behav- quent steps are: developing search strategy, identifying
iour of workers in this study. IWP covers both short relevant studies, data charting, collation and discussion.
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 3 of 14

Search strategy Thereafter, PK and BV jointly scanned 15 studies to

To develop a search strategy, a non-systematic search was evaluate whether the right papers had been included
first performed via PubMed. The aim was to find a select and to calibrate their assessment. Subsequently, PK and
group of about twenty papers with IWP as their subject. BV then independently reassessed each half of all stud-
In joint consultation, agreement was reached on twenty- ies that were included in the first global scan. The results
three papers (PK, BV, BW). By analysing these papers of this reassessment was discussed in mutual consulta-
in a mutual consultation (PK, BV, BW, JD), the clinical tion (PK,BV,BW) to identify papers eligible for full text
librarian JD distilled search terms for an extensive sys- reviewing and data charting. In case of doubt, the study
tematic search. The databases Ovid Medline and Ovid was included in the full-text screening.
Embase were chosen because these databases represent
the majority of the scientific literature on prevention of Data charting
work-related musculoskeletal disorders. To cover inter- A data extraction sheet was designed to collect informa-
ventions with a psychological component, APA PsycInfo tion from the selected studies. BW performed the data-
has been added and Web of Science to cover conference charting of five articles according to this chosen design
proceedings. There was no restriction regarding the years and this was discussed (BW, PK and BV). The following
of publication. data were extracted: 1st author – Title Year of publication
The set of preselected twenty-three papers was used to – Country – Study design – The aim of the intervention/
assess whether the developed search strategy has found measure– IWP intervention topics – IWP intervention
all these papers. If not, the search was modified using an outcome measured – Results of the IWP intervention on
iterative process. The final search strategy is outlined in the outcome –Number of people (workers) involved –
Additional file 1: Appendix B. Age – Sex - Kind of work – Remarks.
Data extraction of the selected studies was performed
by BW as described in the studies and these data were
Identify relevant studies and study selection checked by BV and PK.
Inclusion criteria were: 1. Abstract available (exclu-
sion label: ‘No abstract); 2. English language (exclusion Collation, summarising and reporting
label: ‘Foreign Language’); 3. Full text available and pri- All IWP intervention topics collected in data chart-
mary study, no review (exclusion label: ‘Wrong publica- ing were merged by BW into an overview in Excel. Next
tion type/Wrong study design‘); 4. Papers must relate the following steps were taken. First, similar topics were
to work, workers or working practice (exclusion label: combined. Then an inductive approach was used to code
‘No work’); 5. Papers must relate to physical ergonomic the extracted data by asking: what has the worker to do,
work-related risk factors or physical workload (exclusion change or develop to reduce the exposure to a physical
label: ‘No Physical load’); 6. Papers must relate to IWP, ergonomic risk factor? For example, the topic ‘correct
and should describe an intervention or measure aimed to monitor position’ leads to the code: ‘adjusting workplace’,
reduce exposure to one or more physical ergonomic risk because that is what the worker has to do. Other top-
factors that can be influenced by the worker (exclusion ics like ‘mouse position’, ‘right position of the bed’, ‘the
label: ‘No IWP’); 7. Papers should describe the effect of workstation lay-out’ also fit in this code. Another exam-
the intervention or measure in terms of exposure to the ple is ‘patient-handling techniques’ leading to the code:
physical ergonomic risk factors (exclusion label: ‘Wrong ‘motoric skill’, because the worker has to develop or to
outcome’). apply that skill. Topics like ‘the correct lifting posture’,
No quality assessment of the studies has purposefully ‘the correct hand position’ fit also in this code. If a topic
been performed. The aim was to trace as many types of did not fit into an existing code, a new code was named.
IWP interventions as possible. By performing a selection In the distinction between codes, the process to achieve
on the quality of the research, a selection bias could be the change was an important factor to base the decision
introduced, for example on more simply described IWP on. For example, it is a different process to make a change
interventions or IWP interventions that have only been within an activity, i.e. to change working from left to
described in non-randomised observational studies with- right hand, than to change a task schedule over a day; the
out a control group. first can be seen as an example of variation in working
BW performed the first inclusion of relevant papers technique and the latter as an example of task content &
by scanning title and abstract. In this phase there was task organisation. During mutual consultations between
a meeting every 2 weeks with PK and BW in which the BW, BV and PK, all topics were discussed and coded.
studies that potentially complied with the inclusion Coding discrepancies were discussed until 100% agree-
criteria were discussed until agreement was reached. ment was achieved. Finally these codes were defined as
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 4 of 14

Fig. 1 Flowchart of selection of papers

the categories of interventions for IWP according which and abstract involved 12,296 articles. After this screen-
exposure to physical ergonomic risk factors can be ing, 522 studies remained. Most studies were excluded
reduced in order to prevent WMSDs. because of the No Work or No IWP label. Of these, after
a second screening by PK (261) and BV (261), 314 studies
Results were eligible for full text review and data charting. In that
General process another 204 studies were excluded, most of them
The systematic search until July 2021 generated 17.455 because it turned out it wasn’t about IWP. Ultimately
articles. Most articles were found in Ovid Medline 110 studies fulfilled the inclusion criteria, 51 from PK
(> 6000) and Ovid Embase (> 9000). There was an over- and 59 from BV. The flowchart of the selection process is
lap of more than 5000 articles. The first screening on title depicted in Fig. 1.
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 5 of 14

Fig. 2 Overview of included studies by year of publication

The included articles described interventions or meas- described in the Additional file 1: Appendix C including
ures aimed at a wide variety of work activities. Office the references to the studies concerned.
work is the main part (44), nursing is second (32), and
other studies are performed in construction work (14), Categorisation
assembly work (14), manual material handling (6), work- The topics are coded according to the question: what has
ing in the meat industry (6), driving (3), dentistry (3), the worker to do, change or develop to reduce the expo-
teaching (3), kitchen work (3), cleaning (2), and more. In sure to a physical ergonomic risk factor? In total 160 top-
the distribution over the years, we see a gradual increase ics were coded as Workplace adjustments. For example
of included studies in the period from the start in 1980 topics like chair adjustments, correction of the mouse
up to and including 2021 (Fig. 2 ). With the exception of position or the position of the bed. In total 59 topics,
Africa, the studies are performed in the following conti- like varying work posture, alternate between both hands
nents: North America (46), Asia (31), Europe (25), Oce- and incorporate minibreaks are coded as Variation. This
ania (7) and South America. is variation within a work-related activity. Exercising is a
category in which 56 topics were included that have to do
Topics with a form of physical training aimed at fitness, strength
The 110 included studies described in total 819 inter- and relaxation exercises. Use of aids, including 58 top-
vention topics concerning IWP. For example, a study on ics, is about the use of supporting tools, like for example
prevention among healthcare workers yielded 15 inter- lifting equipment. Professional skills, with 53 topics, is
vention topics, such as lifting technique, patient assess- the category that contains specific skills strongly related
ment and using smooth controlled movements [23]. A to the job and where proper application of these skills
study about an intervention in computer workers yielded can reduce exposure to physical ergonomic risk fac-
two intervention topics, namely workplace adjustments tors. Examples are a specific cutting technique of the
and workplace exercises [24] and a study of an educa- deboner in the meat industry or the dexterity in the care
tional program among school teachers yielded twelve of patients. The category Professional manners, with 86
intervention topics, such as doing breaks, doing exer- topics in it, may appear similar to the previous category
cises and adjusting body joint angles. All these topics are of Professional skills. However, in contrast to Profes-
sional skills, Professional manners is about professional
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 6 of 14

behavior, such as working together, following rules and framework for interventions for IWP to prevent work-
making preparations. Task content and task organisation related musculoskeletal disorders.
(15 topics) is the category that contains topics related The coding of the 819 intervention topics resulted
to planning and coordination of activities or alternating eventually in eight categories of interventions for IWP.
between activities within the work. For example time- Table 1 gives an overview of these 8 categories, including
management, task modification or pacing during the some examples and the references to the related studies.
workday. The most frequently described intervention The table in Additional file 1: Appendix C shows all inter-
topics were coded as Motoric skills, namely with 323 vention topics per category including the references.
times. This category includes topics related to specifically In Fig. 3 a graphical representation of the categories of
trained movements to perform the work with less expo- interventions for IWP is displayed. In doing so, a sym-
sure to physical ergonomic factors, such as using less bolic representation of each category was sought that
extreme body joint postures while performing an activity fits the definition. These symbols can be of added value
or preventing a twisted back when picking up loads. in applying and communicating these IWP interventions
In summary, if a different IWP strategy is needed with workers.
to reduce exposure to a physical ergonomic risk fac-
tor, another category has been formulated based on the Discussion
described topics. Adjusting a workplace differs from Based on this scoping review, a first step towards a con-
training a motoric skill. Using a tool differs from adjust- ceptual framework for interventions for IWP is made
ing the order in which work activities are performed. The to prevent WMSDs due to physical ergonomic risk fac-
distinction of the eight categories provides the opportu- tors. Eight categories of interventions for IWP are dis-
nity to develop specific knowledge on the effectiveness of tinguished: Workplace adjustment, Variation, Exercising,
the categories on the prevention of work-related MSDS Use of aids, Professional skills, Professional manners,
or a targeted approach for implementation. The defini- Task content & task organisation and Motoric skills.
tion of these categories are thus a first step towards a

Fig. 3 Eight categories of interventions for Individual Working Practice (IWP)

Table 1 Categories of interventions for Individual Working Practice and some examples, included references
Categories Studies containing intervention topics belonging to this category

1. Workplace adjustments: the worker adjusts the working environment. (160 topics) [25]; [26]; [27]; [28]; [29]; [30]; [31]; [32]; [33]; [34]; [35]; [36]; [24]; [37];
Examples: [38]; [39]; [40]; [41]; [42]; [43]; [44]; [45]; [46]; [47]; [48]; [49]; [50]; [51];
   • Proper positioning chair- desk-monitor- keyboard-mouse-footstools-printer- scanner- telephone- frequently used [52]; [53]; [54]; [55]; [56]; [57]; [58]; [59]; [60]; [61]; [62]; [63]; [64]; [65];
objects- bed [66]; [67]; [68]; [69]; [70]; [71].
   • Adjustment work tool and office equipment
   • Lowering the storage position of heavy equipment
2. Variation: the worker varies in the execution of the work activities. (59 topics) [25]; [72]; [73]; [28]; [29]; [30]; [74] ; [75]; [76]; [36]; [77]; [39]; [41]; [78];
Examples: [79]; [80]; [45]; [46, 74]; [50]; [51]; [52]; [53]; [81]; [82]; [83]; [60]; [61]; [63];
   • Varying work posture, positioning in work [64]; [65]; [66]; [68]; [69]; [84]; [70]; [71].
   • Alternation between hands, pressing finger etc.
   • Taking (micro) rest-breaks, using work-rest schedules
3. Exercising: the worker executes a form of physical training to prepare for work or to recover from the effects of work. [26]; [27, 85]; [28]; [31]; [34]; [23]; [76]; [24]; [86]; [77]; [38]; [39]; [41]; [87];
van de Wijdeven et al. BMC Musculoskeletal Disorders

(56 topics). [46]; [47]; [52]; [53]; [62]; [64]; [88]; [65]; [66]; [68]; [69]; [70]; [89]; [90].
Examples:
   • Stretching, strengthening or relaxing exercises
  • Warm-up routines
   • Posture correction exercises
4. Use of aids: the worker chooses to use assistive tools. (58 topics) [91]; [92]; [73]; [31]; [93] ; [32]; [33]; [23]; [94]; [35]; [76]; [86]; [37] ; [38];
(2023) 24:87

Examples: [39]; [49]; [51]; [52]; [53]; [81]; [58]; [59]; [60]; [62]; [65]; [66]; [69]; [95];
   • Ceiling lift usage [96]; [70].
   • Using transfer equipment
   • Using of document holder, headset phone, optical tool
5. Professional skill: the worker applies specific job related know-how and dexterity that facilitates the execution of the work. [73]; [97]; [76]; [77]; [42]; [43]; [87]; [98]; [79]; [80]; [46]; [48]; [49]; [51];
(53 topics) [56]; [59]; [82]; [63]; [88]; [66]; [99]; [70]; [100].
Examples:
   • Specific professional technics for deboning: grip forces, cutting moments, position of the piece of meat etc.
   • Specific professional working technique in nursing (f.i. replace clothing).
   • Specific professional technics by drivers: route selection, driving style, driving speed
6. Professional manners: the worker applies specific job related behaviour that facilitates the execution of the work. (86 topics) [73]; [29]; [31]; [101]; [23]; [97]; [76]; [86]; [77]; [43]; [79]; [45]; [49]; [51];
Examples: [53]; [59]; [102]; [82]; [103]; [62]; [84]; [104] ; [95]; [70];
   • Ask help from colleagues
   • Patient assessment before handling
   • Compliance with recommendations (f.i. no lift policy)
7. Task content and task organisation: the worker changes the content of a specific part of the work or the way these parts are [28]; [74]; [39]; [41]; [42]; [51]; [53]; [57]; [82]; [67]; [68]; [70].
scheduled to get more variety in the execution of work. (15 topics)
Examples:
   • Improve work organisation
   • Managing the pace of one’s own work
  • Time-management
Page 7 of 14
 van de Wijdeven et al. BMC Musculoskeletal Disorders

Table 1 (continued)
Categories Studies containing intervention topics belonging to this category
(2023) 24:87

8. Motoric skill: the worker applies specific trained movements to perform the work with less physical strain. (323 topics) [25]; [92]; [105]; [73]; [27]; [28]; [106]; [29]; [107] ; [30]; [31] ; [93]; [101];
Examples: [108]; [34]; [23]; [94]; [35]; [75]; [76]; [86]; [77]; [109]; [110]; [37]; [111];
   • More relaxed (neutral) positions in joints [112]; [39]; [113]; [40]; [41]; [42]; [43]; [44]; [87]; [98]; [114]; [79]; [80];
   • Patient-handling techniques [45]; [115]; [116]; [46]; [47]; [48]; [49]; [117]; [50]; [51]; [52]; [53]; [54];
   • Accurate acceleration-velocity-timing in movement [55]; [56]; [58]; [118]; [102]; [82]; [103]; [119]; [83]; [60]; [120]; [121];
[62]; [122]; [123]; [64]; [124]; [88]; [65]; [66]; [67]; [68]; [125]; [69]; [104];
[95]; [126]; [96]; [127] ; [70]; [100]; [89]; [128] ; [129]; [130]; [90].; [71].
Page 8 of 14
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 9 of 14

Relevance the workers responsiveness. Eliminating, if possible, the

The categorisation of interventions can be help- source of exposure to physical ergonomic risk factors is
ful in designing and in evaluating the effectiveness of always the best course of action.
these interventions For example, the distinction made
between organisational, technical and behavioural Strength and limitations
interventions in prevention of WMSDs makes it pos- A strength of the present review is that the categorisa-
sible to prioritise one approach above the other. The tion of interventions for IWP is based on an extensive lit-
same kind of prioritisation seems also possible for the erature search in four databases using a validation set of
eight categories of interventions for IWP. For exam- preselected papers. A second strength is that because of
ple: the ratio between effort and effect of an interven- the inclusion criterion ‘Outcome measured must relate to
tion probably differs between stimulating a worker IWP intervention topics’, all topics were of relevance for
to change the workplace versus training a motor skill practice and therefore do justice to the P of IWP. How-
in order to prevent WMSDs. Besides prioritisation ever, an important limitation is that using only literature
of interventions the categorisations also offers the does not guarantee that all relevant topics and categories
opportunity to apply the right approach for successful have been identified. Moreover, the coding was done by
implementation. Regarding the former example, stimu- only three Dutch experts in the field of WMSD preven-
lating a worker to change the workplace versus training tion. It is therefore necessary to test the categorisation
motoric skills requires different expertise and training and the vocabulary used in a broad consultation of inter-
or teaching skills. Adding the right approaches for each national experts in this field. This international consulta-
category makes the framework probably even more tion is also the final step in the performance of a scoping
useful for theory and practice. review [19, 20] and therefore it will be our next step to
On an individual level, a framework might facilitate assess if the presented eight categories are seen as a valid
communication to prevent WMSDs among workers, representation of the current literature.
thereby increasing shared understanding, and sharing Another limitation might be that the first selection
power and responsibility – two of the four important of the more than 12.000 papers was only performed by
domains in consultations [131]. At a community level, the first author with a random calibration with the other
a framework is regarded as an essential prerequisite for two researchers. This might have resulted in selection
advancing the translation of science on prevention into bias. However, the ultimately included studies have been
practice [132]. approved by all three researchers. Moreover, we pre-
These developments can support occupational health sume that the selection bias is probably small due to the
professionals and workers alike in designing, evaluating broad search and the large number of papers that were
and implementing effective IWP interventions and thus included. If papers have been missed than the more than
reducing exposure to physical ergonomic risk factors for 800 extracted topics from the selected papers still appear
WMSDs. A framework could also encourage communi- a reliable source for the coding of the topics in the even-
cation between researchers, practitioners, employees and tual eight categories of interventions for IWP. At least
employers, strengthening the field of IWP. 15 studies were found per category, so that the chance is
considered small that an entire category was missed due
to this design of the selection procedure. In addition, the
Ranking international consultation of experts will further mini-
Interventions for IWP to reduce exposure to work- mize this effect.
related physical ergonomic risk factors might overlap We purposefully selected only papers describing inter-
with interventions based on technical and organisational ventions or measures aimed at reducing exposure to
measures. For example, a workplace adjustment can also physical ergonomic risk factors or physical workload.
be an assignment for the company and a strictly imposed This is a limitation because interventions exclusively
work pace might negatively influence the IWP. Above all, aimed at psychosocial risk factors are excluded. The
a focus on the IWP should not divert attention from the reason for this choice is that the psychosocial factors
other two types of ergonomic interventions that have a partly belong to the organisational domain, such as work
higher priority in the hierarchy of prevention. In addi- atmosphere and collegiality. Moreover, in the context of
tion IWP should of course not be a stepping stone to IWP to prevent WMSDs it is unlikely that only psychoso-
blame the worker for harmful exposure to physical ergo- cial risk factors are a direct cause for the development of
nomic risk factors. Moreover, improvements in the IWP WMSDs, without a physical ergonomic risk factor being
are often the result of a learning process and therefore involved. Nevertheless, this may be considered an omis-
dependent on the effectiveness of that process and on sion, which needs further study in the future.
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 10 of 14

Distinguishing between categories and assigning an adjustments, Variation, Use of aids, Task content and
intervention to a category might be arbitrary. Some- task organisation a tactical approach seems most
times the distinction is clear, like for example the differ- appropriate and for Professional manners a psychologi-
ence between a motor skill and a workplace adjustment. cal approach. Finally, a physiological approach seems
Sometimes the distinction is less clear, for example the most appropriate to address Exercising (Figure A1 in
difference between a professional skill and a profes- Additional file 1: Appendix A).
sional manner. Sharpening a knife was categorized as a
professional skill and compliance with rules was cat-
egorized as a professional manner. However, in case of Conclusion
verbally guiding a patient while transferring him or her A first step towards a conceptual framework for inter-
from chair to bed, this distinction might be more dif- ventions for IWP is made by defining eight categories
fuse. The choice to verbally guide the patient was even- of interventions, based on the scientific literature, like
tually seen as a professional manner, but the verbally workplace adjustment, motor skills and variation. These
guiding was seen as a professional skill. Taking a mini- categories can be used as a starting point for develop-
break during an activity was categorised as variation ing and evaluating the effectiveness of these worker-
and how long this mini-break should last as an exam- oriented interventions to prevent WMSDs.
ple of task content and organisation. Of course other
experts might think differently about these choices made.
Abbreviations
However the main contribution of the present paper is UMC University Medical Centre
the definition of these eight categories. Here too, an inter- WMSDs Work-related musculoskeletal disorders
national expert consultation might further improve and/ IWP Individual Working Practice
BW Bert van de Wijdeven
or strengthen the IWP intervention framework. BV Bart Visser
PK Paul Kuijer
JD Joost Daams
Improving IWP
This paper presents a first step into the development of Supplementary Information
an IWP framework. Once the eight categories are seen The online version contains supplementary material available at https://​doi.​
as describing distinct IWP interventions, meta-analyses org/​10.​1186/​s12891-​023-​06155-w.
can be performed to assess the effect of each category on
reduction of exposure to physical ergonomic risk factors Additional file 1: Appendix A. Frameworkof interventions for Individual
Working Practice (IWP) included 4 approaches for improvement. Figure
and on the actual prevention of work-related MSDs. A1. Eight categories of interventions for Individual Working Practice (IWP)
Furthermore, it is likely that in the practical imple- included 4 approaches for improvement as mentioned in the Discus-
mentation of the interventions, different categories also sion chapter. AppendixB. SEARCH-STRATEGY. Appendix C. Topic List Per
Category.
require different approaches. For example, encouraging
and guiding a worker in changing a motor skill requires
a different approach than supporting an improvement Acknowledgements
Not applicable.
in professional manners. A suitable strategy to teach or
train workers regarding the eight categories of interven- Authors’ contributions
tions in IWP, might be adapted from the approaches to BW is corresponding author: l.c.vandewijdeven@amsterdamumc.nl. PK, BV,
BW designed the study. JD took part in data collection and preparation of the
improve performance in sports. In sports four different datasets. BW analysed the data. PK and BV contributed to the interpretation
approaches are distinguished, because improve personal and categorisation of the data. BW drafted the manuscript, with all authors
behavior requires different learning processes [133– providing critical revision and approving the final manuscript.
135]. The technical approach concerns unconsciously, Funding
automated skills. The physiological approach concerns This research did not receive any specific grant from funding agencies in the
the physical capabilities of the person, such as agility, public, commercial, or not-for-profit sectors.
strength, endurance, general health. The psychological Availability of data and materials
approach addresses the psychological aspects of behav- The datasets generated and analysed during the current study are available
iour, like motivation, attention, and stress resistance. The from l.c.vandewijdeven@amsterdamumc.nl upon reasonable request.
tactical approach addresses consciously made choices or
decisions made for best performance. Declarations
Regarding the eight categories of interventions in Ethics approval and consent to participate
IWP, the technical approach seems relevant to address Not applicable.
Professional skills and Motoric skills. For Workplace
van de Wijdeven et al. BMC Musculoskeletal Disorders (2023) 24:87 Page 11 of 14

Consent for publication radiculopathy syndrome: review and dose-response meta-analysis.

Not applicable. Neurology. 2018;91(12):558–64.
15. van der Beek AJ, Dennerlein JT, Huysmans MA, Mathiassen SE, Burdorf
Competing interests A, van Mechelen W, van Dieën JH, Frings-Dresen MH, Holtermann A,
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implementation of interventions preventing work-related musculoskel-
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