Can home care work be organized to promote musculoskeletal health for workers? Study protocol for the Norwegian GoldiCare cluster randomized controlled trial

Abstract

Background Home care workers perform physically strenuous tasks, in particular when handling patients with high care demands. Thus, musculoskeletal pain and sick leave is greater in this group than in the general population. To ease these issues, we will implement a Goldilocks Work intervention (GoldiCare), redistributing schedules between workers to achieve a “just right” weekly structure of physical work that can promote health. This protocol paper describes the content, design, implementation and evaluation of the cluster randomized controlled trial of the GoldiCare intervention in home care. Methods The cluster randomized controlled trial is a 16-week workplace organizational intervention implemented through operations managers at the home care units. The operations managers will be introduced to the Goldilocks Work Principle and a GoldiCare tool, to assist the operations managers when composing a “just right” distribution of work schedules throughout the week. The GoldiCare tool provides an overview of the physical strain for each shift, based on the number of patients and their need for care. We expect to include 11 units, which will be randomized to either intervention or control at a 1:1 ratio. Home care workers assigned to the control group will continue to work as normal during the intervention period. Musculoskeletal pain in neck/shoulder and lower back will be the primary outcomes and we will also evaluate the composition of physical behaviors as well as fatigue after work as secondary outcomes. We will collect data using (1) daily questions regarding musculoskeletal pain and fatigue after work, (2) 7 days of objective measurements of physical behavior, (3) questionnaires about the participant’s characteristics, health, and workplace psychosocial stressors and (4) information on the implementation of the GoldiCare tool. In addition, a process evaluation will be conducted using focus group discussions and individual interviews. Discussion Due to the increasing aging population in need of care, measures that can improve the health of home care workers are paramount for the sustainability of this sector. This organizational intervention is based on information available nation-wide, and therefore has the potential to be scaled to all municipalities in Norway if proven effective. Trial registration This clinical trial was registered on 08/05/2022 under NCT05487027.

Is patients’ activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

“…Previous research has described an uneven distribution of physical work demands in home care in Norway [ 10 ]. To avoid the increased risk of sick leave that a high workload provides, a more balanced workload between employees could be the solution [ 41 , 42 ]. A possible way to balance the workload could be through a re-organization ensuring that when employees working shifts containing an above average number of high ADL assignments, they will subsequently work a shift with fewer than average high ADL assignments, thus balancing the total weekly workload more evenly [ 41 ].…”

“…To avoid the increased risk of sick leave that a high workload provides, a more balanced workload between employees could be the solution [ 41 , 42 ]. A possible way to balance the workload could be through a re-organization ensuring that when employees working shifts containing an above average number of high ADL assignments, they will subsequently work a shift with fewer than average high ADL assignments, thus balancing the total weekly workload more evenly [ 41 ]. Furthermore, the implications of the findings from the current study are very likely to be relevant for nursing homes, as patients in nursing homes, often unable to live at home, are more likely to have a high ADL self-care score.…”

Association between musculoskeletal pain and exposures to awkward postures during work: a compositional analysis approach

“…We, therefore, propose the development and implementation of interventions aimed at decreasing the inter-individual differences in exposure to awkward postures among home care workers. By addressing this variability and focusing on protecting the most highly exposed individuals, it is conceivable that such interventions could contribute to an overall reduction in the prevalence of musculoskeletal pain within this occupational group ( Lohne et al 2022 ).…”

“…The data were collected by questionnaires, anthropometric measurements, and accelerometer measurements from August to November 2022. The data collection also served as the baseline data for a cluster randomized controlled trial—aiming at improving workers’ health by reorganizing the distribution of work tasks ( Lohne et al 2022 ).…”

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders’ perspectives on organizational work redesign concepts based on the Goldilocks Work principles

“…No previous study has evaluated a more even distribution of work lists with different occupational physical activity demands between HCWs throughout a work week. However, a cluster-randomized controlled study redistributing work schedules between HCWs to achieve a balanced weekly structure of physical work load, is being conducted in the municipality where the present investigation took place [ 53 ]. The aim is to evaluate the impact of the redesign on variation in physical activity and musculoskeletal health among HCWs.…”