Workplace interventions for chronic musculoskeletal disorders: a systematic review
Clinical Snapshot
PICO Framework
| P — Population | Working-age adults with chronic musculoskeletal disorders (CMSDs) in occupational settings |
| I — Intervention | Workplace interventions including physical exercise programmes, ergonomic modifications, and multicomponent approaches (combining exercise, ergonomics, and education) |
| C — Comparator | Usual care, waitlist control, alternative interventions, or no intervention |
| O — Outcomes | Primary: pain intensity and functional outcomes. Secondary: quality of life, work ability, productivity, presenteeism, and absenteeism |
Bottom Line
This systematic review of 23 RCTs (n=2,456) provides directional support for workplace interventions — particularly multicomponent approaches combining exercise, ergonomics, and education — in improving pain and functional outcomes for workers with chronic musculoskeletal disorders. Physical exercise interventions consistently demonstrated benefit, and digital delivery appears comparably effective to face-to-face approaches, which has important implications for scalable implementation. However, the review's clinical utility is substantially constrained by the absence of pooled effect sizes, confidence intervals, GRADE certainty ratings, and sensitivity analyses. Evidence for work-related outcomes — arguably the most occupationally relevant domain — remains limited and inconsistent. The small evidence base and high heterogeneity preclude definitive practice-changing recommendations. For Australian clinicians and occupational health practitioners, these findings support the integration of structured exercise and ergonomic strategies into workplace health programmes, consistent with existing RACGP and Safe Work Australia guidance. However, clinicians should interpret directional findings cautiously and await higher-certainty evidence before substantially altering current practice. Future research should prioritise standardised outcome measurement, longer follow-up periods, and condition-specific subgroup analyses to strengthen the evidence base.
Key Findings
P Value: Not reported at the review level
Effect Size: Not reported — narrative synthesis only; no pooled effect sizes calculated due to study heterogeneity
Primary Outcome: Physical exercise interventions consistently improved pain and functional outcomes. Multicomponent interventions (exercise + ergonomics + education) demonstrated the most consistent benefits across all outcome domains.
Nnt Or Sensitivity: Not calculable from available data. No NNT, standardised mean differences, or relative risk estimates provided. Digital delivery of exercise interventions reported as comparably effective to face-to-face approaches, but without quantitative comparison metrics.
Confidence Interval: Not reported
Clinical Application
Multicomponent interventions combining exercise, ergonomic modification, and education are feasible in workplace settings but require employer engagement, occupational health infrastructure, and trained facilitators. Digital delivery platforms may improve scalability and access, particularly for geographically dispersed workforces or small-to-medium enterprises without on-site health services. Implementation costs, staff release time, and sustained engagement remain practical barriers. Chronic musculoskeletal disorders represent a leading cause of work disability and workers' compensation claims in Australia, with significant burden documented by Safe Work Australia. Physiotherapy-led workplace exercise programmes and ergonomic assessments are broadly consistent with RACGP guidelines for chronic pain management and the principles of the National Strategic Framework for Chronic Conditions. Exercise physiology services are partially accessible via Medicare Chronic Disease Management (CDM) plans (up to 5 allied health visits per calendar year), though workplace-based delivery is not specifically funded under the MBS. Occupational rehabilitation services funded through state-based workers' compensation schemes (e.g., WorkCover Queensland, icare NSW, WorkSafe Victoria) may provide a funding pathway for multicomponent workplace interventions. The TGA does not regulate exercise or ergonomic interventions. Digital exercise delivery platforms are increasingly available in Australia but are not yet systematically integrated into occupational health frameworks. The findings support advocacy for expanded workplace health programmes within Australian occupational health policy. Working-age adults with established chronic musculoskeletal disorders across a range of occupational settings. Most applicable to those in sedentary or physically demanding roles where workplace-based intervention delivery is feasible. Generalisability across specific CMSD subtypes (e.g., chronic low back pain, neck-shoulder disorders, upper limb conditions) requires caution given the heterogeneous evidence base.
Abstract
OBJECTIVES: To provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted. ELIGIBILITY CRITERIA: Randomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism). DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted. RESULTS: 23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies. CONCLUSIONS: Workplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent. PROSPERO REGISTRATION NUMBER: CRD420261289218.
References
- 1.Skamagki, G., Greaves, C. J., Shrestha, R. M., & Stathi, A. (2026). Workplace interventions for chronic musculoskeletal disorders: a systematic review. BMJ Open. https://doi.org/10.1136/bmjopen-2025-115276
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