Journal of Occupational Rehabilitation

, Volume 16, Issue 3, pp 351–366 | Cite as

Integrative interventions for MSDs: Nature, evidence, challenges & directions

  • Donald C. Cole
  • Dwayne Van Eerd
  • Philip Bigelow
  • Irina Rivilis
Original Paper


Background: When applied to workplace interventions, integrative may be seen in various ways, requiring elucidation. Methods: Identification of primary studies through systematic reviews, limited bibliographic literature searches, the Cochrane Occupational Health Field database on intervention studies, and authors’ files. Focus was 2000 on. Categorization according to the Cochrane classes and lenses on integrative. Synthesis as narrative review. Results: Examples of each lens on integrative were uncovered: biomechanical and psychosocial, multiple component, primary and secondary prevention, organizational, and system. Each contributed different understanding to the potential impacts on different knowledge, exposure, behavior, health and administrative outcomes. Conclusions: Considerable opportunities exist to expand the range of integrative interventions, particularly at the organizational and system levels, and incorporate a combination of knowledge transfer and exchange with intervention evaluation.


Repetitive strain injury/cumulative trauma disorders Prevention Disability management Health promotion Program evaluation Review 



The authors would like to acknowledge contributions by other members of the Workplace Health Intervention Research team (Sue Ferrier, Nancy Theberge, Emile Tompa, Richard Wells, Alysha Williams); members of workplaces and health and safety system partners with whom we have developed these ideas as part of a Canadian Institute of Health Research Development press. The Institute for Work & Health, an independent not-for-profit research organization, sponsored the work and in turn receives support from the Ontario Workplace Safety & Insurance Board. Specific funding for the integrative newspaper evaluation cited was provided by the RSI Committee and the U.S. National Institute for Occupational Safety and Health/National Institutes of Health under Research Grant #5 R01 OH003708-03.


  1. 1.
    Amick BC 3rd, Robertson MM, DeRango K, Bazzani L, Moore A, Rooney T, et al. Effect of office ergonomics intervention on reducing musculoskeletal symptoms. Spine 2003;28(24):2706–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Armenakis A, Harris S, Mossholdern K. Creating readiness for organizational change. Hum Relat 1993;46:681–703.CrossRefGoogle Scholar
  3. 3.
    Arnetz BB, Sjogren B, Rydehn B, Meisel R. Early workplace intervention for employees with musculoskeletal-related absenteeism: a prospective controlled intervention study. J Occup Environ Med 2003;45(5):499–506.PubMedCrossRefGoogle Scholar
  4. 4.
    Baril R, Clarke J, Friesen M, Stock S, Cole D, Bombardier C, et al. Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces. Soc Sci Med 2003;57(11):2101–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Barling J, Loughlin C, Kelloway EK. Development and test of a model linking safety-specific transformational leadership and occupational safety. J Appl Psych 2002;87(3):488–96.CrossRefGoogle Scholar
  6. 6.
    Bernacki EJ, Guidera JA, Schaefer JA, Tsai S. A facilitated early return to work program at a large urban medical center. J Occup Environ Med 2000;42(12):1172–7; Bernacki EJ, et al. An ergonomics program designed to reduce the incidence of upper extremity work related musculoskeletal disorders. J Occup Environ Med 1999;41(12):1032–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Bohr PC. Efficacy of office ergonomics education. J Occup Rehabil 2000;10(4):243–55.CrossRefGoogle Scholar
  8. 8.
    Bongers P, et al. Synthetic review of psychosocial risk factors and interventions [this volume].Google Scholar
  9. 9.
    Bradshaw LM, Curran AD, Eskin F, Fishwick D. Provision & perception of occupational health in small & medium enterprises in Sheffield, UK. Occup Med 2001;51(1):39–44.CrossRefGoogle Scholar
  10. 10.
    Brewer S, Rempel D, et al. Systematic review on office ergonomics [this volume].Google Scholar
  11. 11.
    Chu C, Dwyer S. Employer role in integrative workplace health management: a new model in progress. Dis Manage Health Outcomes 2002;10(3):175–86.CrossRefGoogle Scholar
  12. 12.
    Cole DC, Wells RP, & the Worksite Upper Extremity Research Group. Interventions for musculoskeletal disorders in computer intense office work: a framework for evaluation. Work & Stress 2002;16(2):95– 106.CrossRefGoogle Scholar
  13. 13.
    Cole DC, Ferrier S, Hogg-Johnson S, Kennedy C, Lee H, Van Eerd D, et al. WMSD: evaluating interventions among office workers. NIOSH Final Performance/Progress Report; NIOSH Research Grant #5 R01 OH003708-03; December 23, 2003a.Google Scholar
  14. 14.
    Cole DC, Wells RP, Frazer MB, Kerr MS, Neumann WP, Laing AC, & the Ergonomic Intervention Evaluation Research Group. Methodological issues in evaluating workplace interventions to reduce work-related musculoskeletal disorders through mechanical exposure reduction. Scan J Work Environ Health 2003b;29(5):396–405.Google Scholar
  15. 15.
    Cole DC, Hogg-Johnson S, Manno M, Ibrahim S, Wells RP, Ferrier SE, and the Worksite Upper Extremity Research Group. Reducing musculoskeletal burden through ergonomic program implementation in a large newspaper. Int J Occup Environ Health; submitted.Google Scholar
  16. 16.
    Fowler HW, Fowler FG, editors. The concise Oxford dictionary of current English, 5th edn. revised by McIntosh E. Oxford, England, UK: Oxford University Press; 1964. p. 633.Google Scholar
  17. 17.
    The Consolidated-Webster Encyclopedic Dictionary. A library of essential knowledge. Meine FJ, Editor-in-Chief. Chicago, Ill., USA: consolidated Book Publishers, Division of Book Production Industries; 1954. p. 383.Google Scholar
  18. 18.
    Cunningham CA, Woodward HS, Shannon J, MacIntosh B, Lendrum D, Rosenbloom, et al. Readiness for organizational change: a longitudinal study of workplace, psychological and behavioural correlates. J Occup Organ Psychol 2002;75:377–92.CrossRefGoogle Scholar
  19. 19.
    DeJoy D. Behavior change versus culture change: divergent approaches to managing workplace safety. Safety Sci 2005;43(2):105–29.CrossRefGoogle Scholar
  20. 20.
    Denis D, St-Vincent M, Jetté C, Nastasia I, Imbeau D. Les pratiques d’intervention portant sur la prévention des troubles musculosquelettiques :un bilan critique de la littérature. IRSSTB-066. Montréal, Québec, Canada: institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST); Avril 2005.Google Scholar
  21. 21.
    Dixon SM, Theberge N, Cole DC, et al. They have the connections: the influence of bureaucratic processes on a participatory ergonomic intervention. Proceedings of the 35th Annual Conference of the Association of Canadian Ergonomists, October. 19–21 London, Ontario; 2003.Google Scholar
  22. 22.
    Eklof M, Hagberg M, Toomingas A, Tornqvist EW. Feedback of workplace data to individual workers, workgroups or supervisors as a way to stimulate working environment activity: a cluster randomized controlled study. Int Arch Occup Environ Health 2004;77(7):505–14. Epub 2004; Sep 28.PubMedCrossRefGoogle Scholar
  23. 23.
    Elovainio M, Kivimäki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health 2002;92(1):105–8.PubMedGoogle Scholar
  24. 24.
    Feuerstein M, Nicholas RA, Huang GD, Dimberg L, Ali D, Rogers H. Job stress management and ergonomic intervention for work-related upper extremity symptoms. Appl Ergon 2004;35(6):565–74.PubMedCrossRefGoogle Scholar
  25. 25.
    Franche R-L, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J, the IWH workplace-based RTW intervention literature review research team. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil; December, 2005. (in press).Google Scholar
  26. 26.
    Frank J, Sullivan T. Disability at work: ministering solutions for a wicked problem. In: Sullivan T, Frank J, editors. Preventing and managing disabling injury at work. London, New York: Taylor & Francis; 2003. pp. 1–11.Google Scholar
  27. 27.
    Frank JW, Cullen K. IWH Ad Hoc Working Group.* Preventing Injury, Illness and Disability at Work: the View from Canada. A Discussion Paper for the Occupational Health and Safety Community. IWH Occasional Paper 2004, Scan J Work Environ Health (submitted).Google Scholar
  28. 29.
    Fullan M. Change forces: the sequel. Philadelphia, PA: Falmer Press; 1999.Google Scholar
  29. 30.
    Gage Canadian Dictionary. Avis WS, Drysdale PD, Gregg RJ, Neufeldt VE, Scargill MH, editors. Toronto, ON, Canada: Gage Educational Publishing Company; 1983. p. 606.Google Scholar
  30. 31.
    Goodman RM, McLeroy KR, Steckler AB, Hoyle RH. Development of level of institutionalization scales for health promotion programs. Health Educ Q Summer 2003;20(2):161–78.Google Scholar
  31. 32.
    Griffiths A. Organizational interventions. Facing the limits of the natural science paradigm. Scan J Work Environ Health 1999;25(6, special issue):589–96.Google Scholar
  32. 33.
    Haimes MC, Carayon P. Theory and practice for the implementation of in-house continuous improvement participatory ergonomic programs. Appl Ergon 1998;29(6):461–72.CrossRefGoogle Scholar
  33. 34.
    Haslam RA. Targeting ergonomic interventions—learning from health promotion. Appl Ergon 2002;33:241–9.PubMedCrossRefGoogle Scholar
  34. 35.
    Heaney CA, Goetzel RZ. A review of health-related outcomes of multi-component worksite health promotion programs. Am J Health Promot 1997;11(4):290–308.PubMedGoogle Scholar
  35. 36.
    Hager MA, Wilson S, Pollak TH, Rooney PM. Response rates for mail surveys of nonprofit organizations: a review & empirical test. Nonprofit Volunt Sect Q; 2004.Google Scholar
  36. 37.
    Houtman ILD, Goodswaard A, Dhondt S, van der Grinet MP, Hildebrandt VH, van der Poel EGT. Dutch monitor on stress and physical load: risk factors, consequences, and preventive action. Occup Environ Med 1998;55:73–83.PubMedGoogle Scholar
  37. 38.
    Huberman M. Steps toward an integrated model of research utilization. Knowledge: creation, Diffusion, Utilization 1987;8(4):586–611.Google Scholar
  38. 39.
    Huberman M. Linkage between researchers and practitioners: a qualitative study. Am Educ Res J 1990;27(2):363–91.Google Scholar
  39. 40.
    Keller S, et al. Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention. Patient Educ Counsel 2001;42(2):175–84.CrossRefGoogle Scholar
  40. 41.
    Ketola R, Hakkanen M, Luukkonen R, Takala EP, Viikari-Juntura E. Effects of ergonomics intervention in work with video display units. Scand J Work, Environ Health 2002;28(1):18–24.Google Scholar
  41. 42.
    Kompier MAJ, Geurts SAE, Grundemann RWM, Vink P, Smulders PGW. Cases in stress prevention: the success of a participative and stepwise approach. Stress Med 1998;13:155–68.CrossRefGoogle Scholar
  42. 43.
    Kotter JP, Heskett JL. Corporate culture and performance. New York: the Free Press; 1992.Google Scholar
  43. 44.
    Kramer D, Cole DC. Sustained, intensive engagement to promote health and safety knowledge transfer to and utilization by workplaces. Sci Commun 2003;25(1):56–82.CrossRefGoogle Scholar
  44. 45.
    Kramer D, Cole DC, Hepburn G, Theberge N, VanEerd D, and the Workplace Health Intervention Research group. Walking a mile in each others’ shoes: the evolution of a research design with workplace health and safety partners as part of the process. Submitted to: Sci Commun.Google Scholar
  45. 46.
    Linnan LA, Sorensen G, Colditz G, Klar N, Emmons KM. Using theory to understand the multiple determinants of low participation in worksite health promotion programs. Health Educ Behav 2001;28(5):591–607.PubMedCrossRefGoogle Scholar
  46. 47.
    Loisel P, Cote P, Durand MJ, Franche RL, Sullivan MJL, Cole DC, and all other mentors of the program. Training the next generation of researchers in work disability prevention: the Canadian Work Disability Prevention CIHR Strategic Training Program. J Occup Rehabil 2005;15(3):273–84.PubMedCrossRefGoogle Scholar
  47. 48.
    Martin SA, Irvine JL, Fluharty K, Gatty CM. A comprehensive work injury prevention program with clerical and office workers: Phase I. Work 2003;21:185–96.PubMedGoogle Scholar
  48. 49.
    National Research Council (NRC) and Institute of Medicine Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education. Musculoskeletal disorders and the workplace: low back and upper extremities. Washington DC, USA: National Academy Press. Ch 11 on Interventions in the workplace; 2001. pp. 301–29. Available at Scholar
  49. 50.
    Nieuwenhuijsen ER. Health behavior change among office workers: an exploratory study to prevent repetitive strain injuries. Work 2004;23:215–24.PubMedGoogle Scholar
  50. 51.
    Polanyi M, Cole DC, Ferrier S, Facey M, and the Worksite Upper Extremity Research Group. Paddling Upstream: a contextual analysis of a worksite intervention to reduce upper limb musculoskeletal disorders. Appl Ergon 2005;36(2):231–9.PubMedCrossRefGoogle Scholar
  51. 52.
    Pluye P, Potvin L, Denis J-L. Making public health programs last; conceptualizing sustainability. Eval Program Plann 2004;27:121–33.CrossRefGoogle Scholar
  52. 53.
    Rivilis I, Cole DC, Frazer MB, Kerr MS, Ibrahim S, Wells RP. Evaluating the impacts of a participatory ergonomic intervention aimed at improving musculoskeletal health. Accepted: Am J Ind Med.Google Scholar
  53. 54.
    Rivilis I, Van Eerd D, Cullen K, Cole D, Irvin E, Tyson J, Mahood Q. Effectiveness of participatory ergonomic interventions: a systematic review. Submitted to: Ergonomics (July 2005b).Google Scholar
  54. 55.
    Robertson MM, Amick BC 3rd, Hupert N, Pellerin-Dionne M, Cha E, Katz JN. Effects of a participatory ergonomics intervention computer workshop for university students: a pilot intervention to prevent disability in tomorrow's workers. Work 2002;18(3):305–14.PubMedGoogle Scholar
  55. 56.
    Shain M. Returning to work after illness or injury: the role of fairness. Bull Sci, Technol Soc 2001;21(5):361–8.CrossRefGoogle Scholar
  56. 57.
    Shannon H. Firm-level organizational practices and work injury. Ch 7. In: Sullivan T, editor. Injury and the New World of Work. Vancouver: University of British Columbia Press; 2000. pp. 140–161.Google Scholar
  57. 58.
    Shannon HS, Cole DC. Making workplaces healthier: generating better evidence on work organization intervention research. Soz Praventivmed 2004;49:92–4.PubMedGoogle Scholar
  58. 59.
    Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks & future directions for research, practice and policy. Health Educ Res 1998;13(1):87–108.PubMedCrossRefGoogle Scholar
  59. 60.
    Tomaskovic-Devey D, Leiter J, Thompson S. Organizational survey non-response. Adm Sci Q 1994;39:439–57.CrossRefGoogle Scholar
  60. 61.
    Tyson J & the Pulp and Paper Health and Safety Association. Tackling work-related musculoskeletal disorders: a strategy for Ontario. A proposal to Occupational Health & Safety Council of Ontario. North Bay, ON: Pulp and Paper Health and Safety Association; 2004.Google Scholar
  61. 62.
    Verbeek J. A classification framework for occupational health interventions. Accessed August 20, 2005. On line at Scholar
  62. 63.
    Verbeek J, Husman K, van Dijk F, Jauhiainen M, Pasternak I, Vainio H. Building an evidence base for occupational health interventions. Scand J Work Environ Health 2004;30(2):164–8.PubMedGoogle Scholar
  63. 64.
    Vink P, Urlings IJM, Van der Molen HF. A Participatory Ergonomics Approach to Redesign Work of Scaffolders. Safety Sci 1997;26(12):75–85.CrossRefGoogle Scholar
  64. 65.
    Vink P, Kompier MAJ. Improving office work: a participatory ergonomic experiment in a naturalistic sitting. Ergonomics 1997;40:435–49.PubMedCrossRefGoogle Scholar
  65. 66.
    Wellman H, Davis L, Punnett L, Dewey R. Work-related carpal tunnel syndrome (WR-CTS) in Massachusetts, 1992–1997: source of WR-CTS, outcomes, and employer intervention practices. Am J Ind Med 2004;45:139–52.PubMedCrossRefGoogle Scholar
  66. 67.
    Workplace Safety and Insurance Board of Ontario (WSIB). The Safety Groups Program. Accessed October, 2005.Google Scholar
  67. 68.
    Yassi AL, Ostry A, Speigel J. Injury prevention and return to work: breaking down the solitudes. Ch 4. In: Sullivan T, Frank J, editors. Preventing and managing disabling injury at work. London, New York: Taylor & Francis; 2003. pp. 75–86.Google Scholar
  68. 69.
    Zohar D. A group-level model of safety climate: testing the effect of group climate on micro-accidents in manufacturing jobs. J Appl Psychol 2000;85:587–96.PubMedCrossRefGoogle Scholar
  69. 70.
    Zohar D. Modifying supervisory practices to improve sub-unit safety: a leadership-based intervention model. J Appl Psychol 2002;87:156–63.PubMedCrossRefGoogle Scholar
  70. 71.
    Zohar D, Luria G. The use of supervisory practices as leverage to improve safety behavior: a cross-level intervention model. J Safety Res 2003;34:567–77.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Donald C. Cole
    • 1
    • 2
  • Dwayne Van Eerd
    • 1
  • Philip Bigelow
    • 1
    • 2
  • Irina Rivilis
    • 1
    • 2
  1. 1.Institute for Work & HealthTorontoCanada
  2. 2.Department of Public Health SciencesFaculty of Medicine, University of TorontoTorontoCanada

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