A combination workplace intervention for neck pain to reduce the economic burden of health-related productivity loss among office workers: an employer’s perspective

Worker health-related productivity loss is a significant economic burden to employers. In this thesis, a series of studies investigated health-related productivity loss, associated factors, and the potential benefit of workplace health interventions for office workers. This thesis compares the efficacy and cost-effectiveness of two types of workplace health programs that target health-related productivity loss in office workers. In view of the necessity for employer support required for the implementation of workplace health interventions, the perspective considered in this thesis was that of the employer. This thesis consists of seven chapters of which four are based on a cluster-randomised trial. The second chapter is a systematic review of randomised controlled trials examining onsite workplace health-enhancing physical activity interventions on worker productivity. This review highlighted the evidence gap for a suitable worker health-related productivity measurement, a study design involving a primary productivity outcome that can lead to an appropriately powered trial, and a multi-dimensional workplace health program of adequate duration and attendance. The third chapter confirmed the inter-rater reliability of an observation-based ergonomic assessment that was used in the subsequent three studies. A cross-sectional study was undertaken in Chapter 4 to investigate self-reported health-related productivity loss in office workers and associations with individual and work-related factors using an employer's perspective. A combination of individual factors (presence of recent musculoskeletal pain and levels of psychological stress), and work-related factors (office worker occupational category and job satisfaction levels) were associated with levels of self-reported health-related productivity loss in office workers.  Chapter 5 and 6 report the efficacy and cost-effectiveness of two types of workplace health programs targeting the economic burden of health-related productivity loss in a large cohort of office workers, respectively. This was achieved with a 2-arm longitudinal cluster-randomised trial incorporating findings from the first three studies. Chapter 5 showed that a combined ergonomics and neck-specific exercise intervention showed benefits in the primary outcome of productivity, demonstrated with lower monetised health-related productivity loss and sickness presenteeism in a general population of office workers, and lower longer-term sickness absenteeism for office workers with neck pain, when compared to a combined ergonomics and health promotion information intervention. Lastly, it was found in Chapter 6 that the combination intervention with exercise might becost-effective relative to the combination with health promotion information for office workers when using a cost-utility analysis from an employer’s perspective.The evaluations of worker health-related productivity in this thesis encompassing tangible economic outcomes may influence decision-makers in industry and health policy makers when considering the implementation of similar workplace health interventions.