Combating Fatigue in the Office: Findings of a Participatory Ergonomics Intervention
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Abstract
Background: The nature of unstandardized office work exposes call center agents not only to work-related musculoskeletal disorders (WRMSDs) but also to other mental and physical adversities. Despite this, the occupational health literature presents a surprising paucity of research on fatigue management interventions among call center agents. Accordingly, a participatory ergonomics intervention was designed to examine its effects on workers’ mental and physical fatigue.
Methods: A quasi-experimental participatory interventional study using a single-arm pretest-posttest design was conducted among 84 call center agents at a private telecommunications company in Tehran, Iran. Prior to the intervention, data on mental and physical fatigue were collected via SOFI questionnaires. Participants then took part in a multifaceted intervention program comprising comprehensive office ergonomics training, work layout improvement, supervised on-site face-to-face visits, and provision of quality break time that included a regular exercise program. A follow-up evaluation was conducted after a six-month period. The Wilcoxon signed-rank test was applied to compare participants’ perceived mental and physical fatigue before and after the intervention.
Results: The intervention had a significant effect on reducing the overall fatigue scale score (P < 0.01). However, the results for the subscales were mixed. “Lack of energy” was reported to decrease meaningfully (P < 0.01), while “lack of motivation” and “sleepiness” did not change significantly. Regarding physical fatigue, “physical discomfort” was perceived to be alleviated by the intervention (P < 0.001), although the condition of “physical exertion” did not improve significantly.
Conclusion: The findings indicated that the intervention had mixed effects on different aspects of employees’ fatigue. Customizing interventions to target specific facets of occupational fatigue could be an effective strategy. Moreover, this study contributes to the growing body of literature suggesting that participatory ergonomic interventions can help improve work systems, particularly in managing occupational fatigue.
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13. Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kinesiol. 2004 Feb 1;14(1):13–23.
14. Danesh MK, Garosi E, Mazloumi A, Abedi Z. Identifying factors influencing cardiac care nurses’ work ability within the framework of system engineering initiative for patient safety. Work. 2020;(In Press).
15. Azmoon H, Salmani Nodooshan H, Jalilian H, Choobineh A, Kargar Shouroki F. The relationship between fatigue and job burnout dimensions in hospital nurses. Health Scope. 2018;7(2).
16. Abbasi M, Araban M, Aalipour K. The relationship between job stressors and fatigue in nurses: the role of organizational support as a moderator. J Clin Nurs Midwifery. 2018;6(4):42–52.
17. Kalantari R, Mazloumi A, Garussi E, Ahmadi Zirabi M. Risk assessment of the manual handling of patients in remedial wards of Qazvin hospitals and its relationship with incidence of musculoskeletal disorders. J Occup Hyg Eng. 2014 Dec 10;1(3):29–36.
18. Aghilinejad M, Azar NS, Ghasemi MS, Dehghan N, Mokamelkhah EK. An ergonomic intervention to reduce musculoskeletal discomfort among semiconductor assembly workers. Work [Internet]. 2016 Jul 5 [cited 2019 Sep 13];54(2):445–50. Available from: http://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/WOR-162325
19. Lacaze DH de C, Sacco I de CN, Rocha LE, Pereira CA de B, Casarotto RA. Stretching and joint mobilization exercises reduce call-center operators’ musculoskeletal discomfort and fatigue. Clinics. 2010;65(7):657–62.
20. Nino V, Marchak F, Claudio D. Association between perceived workload and adverse body posture. Proc Int Symp Hum Factors Ergon Health Care [Internet]. 2019 Sep 15 [cited 2020 Mar 20];8(1):182–6. Available from: http://journals.sagepub.com/doi/10.1177/2327857919081046
21. Nino L, Marchak F, Claudio D. Physical and mental workload interactions in a sterile processing department. Int J Ind Ergon. 2020 Mar 1;76:102902.
22. Bazazan A, Dianat I, Feizollahi N, Mombeini Z, Shirazi AM, Castellucci HI. Effect of a posture correction–based intervention on musculoskeletal symptoms and fatigue among control room operators. Appl Ergon. 2019 Apr 1;76:12–9.
23. Schwartz B, Kapellusch JM, Schrempf A, Probst K, Haller M, Baca A. Effect of alternating postures on cognitive performance for healthy people performing sedentary work. Ergonomics. 2018 Jun 3;61(6):778–95.
24. Esmaeilzadeh S, Ozcan E, Capan N. Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial. Int Arch Occup Environ Health [Internet]. 2014 Jan 23 [cited 2019 Sep 16];87(1):73–83. Available from: http://link.springer.com/10.1007/s00420-012-0838-5
25. Hoe VCW, Urquhart DM, Kelsall HL, Zamri EN, Sim MR. Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database Syst Rev. 2018.
26. Bongers PM, Ijmker S, Van Den Heuvel S, Blatter BM. Epidemiology of work-related neck and upper limb problems: psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II). J Occup Rehabil. 2006;16:279–302.
27. Karsh BT, Moro FBP, Smith MJ. The efficacy of workplace ergonomic interventions to control musculoskeletal disorders: a critical analysis of the peer-reviewed literature. Theor Issues Ergon Sci. 2001;2(1):23–96.
28. Rasmussen CDN, Sørensen OH, Allard J, Holtermann A. The effect of training for a participatory ergonomic intervention on physical exertion and musculoskeletal pain among childcare workers (the TOY project) – a wait-list cluster-randomized controlled trial. Scand J Work Environ Health [Internet]. 2020 Jan 16 [cited 2020 Mar 23]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/31945165
29. Choobineh A, Motamedzade M, Kazemi M, Moghimbeigi A, Heidari Pahlavian A. The impact of ergonomics intervention on psychosocial factors and musculoskeletal symptoms among office workers. Int J Ind Ergon [Internet]. 2011 Nov [cited 2020 Mar 23];41(6):671–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0169814111001053
30. Juhanson K, Merisalu E. Ergonomic intervention programs in different economic sectors: a review article. Agron Res. 2017;15.
31. Sharifi AS, Danesh MK, Gholamnia R. Improvements in musculoskeletal symptoms, mental workload and mental fatigue: effects of a multicomponent ergonomic intervention among call center workers. Work. 2022;72(2):765–74.
32. Burgess-Limerick R. Participatory ergonomics: evidence and implementation lessons. Appl Ergon. 2018;68:289–93.
33. Wilson JR. Ergonomics and participation. Eval Hum Work. 1995;2:1071–96.
34. Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction. 2001;96(12):1725–42.
35. Javadpour F, Keshavarzi S, Choobineh A, Aghabaigi M. Validity and reliability of the Swedish Occupational Fatigue Inventory (SOFI-20) among Iranian working population. Iran J Ergon. 2015;3(1):50–8.
36. Mahmud N, Kenny DT, Zein RM, Hassan SN. Ergonomic training reduces musculoskeletal disorders among office workers: results from the 6-month follow-up. Malays J Med Sci. 2011 Apr;18(2):16–26.
37. Fenety A, Walker JM. Short-term effects of workstation exercises on musculoskeletal discomfort and postural changes in seated video display unit workers. Phys Ther [Internet]. 2002 [cited 2020 Mar 23];82(6):578–89. Available from: https://academic.oup.com/ptj/article/82/6/578/2836987
38. Sjögren T, Nissinen KJ, Järvenpää SK, Ojanen MT, Vanharanta H, Mälkiä EA. Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial. Pain. 2005 Jul 1;116(1–2):119–28.
39. Kamalikhah T, Safarian MH, Rahmati-Najarkolaei F, Yaghoubi M. A comparison of the effects of ergonomic, organization, and education interventions on reducing musculoskeletal disorders in office workers. Health Scope. 2018 Sep 9;In Press.
40. Van Rhenen W, Blonk RWB, van der Klink JJ, van Dijk FJ, Schaufeli WB. The effect of a cognitive and a physical stress-reducing programme on psychological complaints. Int Arch Occup Environ Health. 2005;78(2):139–48.
41. Dahlman AS, Matsangas P, Shattuck NL. The effect of habitual exercise on daytime sleepiness and mood of US navy sailors. Proc Hum Factors Ergon Soc. 2017;2017-Octob:522–6.
42. Dunstan DW, Wiesner G, Eakin EG, Neuhaus M, Owen N, LaMontagne AD, et al. Reducing office workers’ sitting time: rationale and study design for the Stand Up Victoria cluster randomized trial. BMC Public Health [Internet]. 2013 Dec 9 [cited 2019 Nov 26];13(1):1057. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1057
43. Sanaeinasab H, Saffari M, Valipour F, Alipour HR, Sepandi M, Al Zaben F, et al. The effectiveness of a model-based health education intervention to improve ergonomic posture in office computer workers: a randomized controlled trial. Int Arch Occup Environ Health. 2018 Nov 1;91(8):951–62.
2. Norman K, Nilsson T, Hagberg M, Tornqvist EW, Toomingas A. Working conditions and health among female and male employees at a call center in Sweden. Am J Ind Med [Internet]. 2004 Jul 1 [cited 2020 Mar 24];46(1):55–62. Available from: http://doi.wiley.com/10.1002/ajim.20039
3. Poochada W, Chaiklieng S. Ergonomic risk assessment among call center workers. Procedia Manuf. 2015 Jan 1;3:4613–20.
4. Cabrera AP, John C, Campang C, Plaza JP. Occupational, physical and mental hazards and cognitive weariness of call center agents in selected business process outsourcing companies in Cavite. Cavite State University-Main; 2019.
5. Suroedova E, Li T. Structural organization of emotional burnout in call-center operators with different communicative tolerance. SHS Web Conf. 2019;70:07005.
6. Sharara ESA, Tsuji A, Terada K. Burnout recognition for call center agents by using skin color detection with hand poses. Int J Comput Electr Autom Control Inf Eng [Internet]. 2017 [cited 2020 Mar 24];11(9):1016–9. Available from: https://publications.waset.org/10007970/burnout-recognition-for-call-center-agents-by-using-skin-color-detection-with-hand-poses
7. Åhsberg E, Gamberale F, Kjellberg A. Perceived quality of fatigue during different occupational tasks: development of a questionnaire. Int J Ind Ergon. 1997 Aug;20(2):121–35.
8. Åhsberg E, Kecklund G, Åkerstedt T, Gamberale F. Shiftwork and different dimensions of fatigue. Int J Ind Ergon. 2000;26(4):457–65.
9. Ma L, Chablat D, Bennis F, Zhang W, Guillaume F. A new muscle fatigue and recovery model and its ergonomics application in human simulation. Virtual Phys Prototyp. 2010;5(3):123–37.
10. Gantois P, Caputo Ferreira ME, Lima-Junior D de, Nakamura FY, Batista GR, Fonseca FS, et al. Effects of mental fatigue on passing decision-making performance in professional soccer athletes. Eur J Sport Sci. 2020;20(4):534–43.
11. Alshmemri M, Shahwan-Akl L, Maude P. Herzberg’s two-factor theory. Life Sci J. 2017;14(5):12–6.
12. Shen J, Barbera J, Shapiro CM. Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev. 2006;10:63–76.
13. Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kinesiol. 2004 Feb 1;14(1):13–23.
14. Danesh MK, Garosi E, Mazloumi A, Abedi Z. Identifying factors influencing cardiac care nurses’ work ability within the framework of system engineering initiative for patient safety. Work. 2020;(In Press).
15. Azmoon H, Salmani Nodooshan H, Jalilian H, Choobineh A, Kargar Shouroki F. The relationship between fatigue and job burnout dimensions in hospital nurses. Health Scope. 2018;7(2).
16. Abbasi M, Araban M, Aalipour K. The relationship between job stressors and fatigue in nurses: the role of organizational support as a moderator. J Clin Nurs Midwifery. 2018;6(4):42–52.
17. Kalantari R, Mazloumi A, Garussi E, Ahmadi Zirabi M. Risk assessment of the manual handling of patients in remedial wards of Qazvin hospitals and its relationship with incidence of musculoskeletal disorders. J Occup Hyg Eng. 2014 Dec 10;1(3):29–36.
18. Aghilinejad M, Azar NS, Ghasemi MS, Dehghan N, Mokamelkhah EK. An ergonomic intervention to reduce musculoskeletal discomfort among semiconductor assembly workers. Work [Internet]. 2016 Jul 5 [cited 2019 Sep 13];54(2):445–50. Available from: http://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/WOR-162325
19. Lacaze DH de C, Sacco I de CN, Rocha LE, Pereira CA de B, Casarotto RA. Stretching and joint mobilization exercises reduce call-center operators’ musculoskeletal discomfort and fatigue. Clinics. 2010;65(7):657–62.
20. Nino V, Marchak F, Claudio D. Association between perceived workload and adverse body posture. Proc Int Symp Hum Factors Ergon Health Care [Internet]. 2019 Sep 15 [cited 2020 Mar 20];8(1):182–6. Available from: http://journals.sagepub.com/doi/10.1177/2327857919081046
21. Nino L, Marchak F, Claudio D. Physical and mental workload interactions in a sterile processing department. Int J Ind Ergon. 2020 Mar 1;76:102902.
22. Bazazan A, Dianat I, Feizollahi N, Mombeini Z, Shirazi AM, Castellucci HI. Effect of a posture correction–based intervention on musculoskeletal symptoms and fatigue among control room operators. Appl Ergon. 2019 Apr 1;76:12–9.
23. Schwartz B, Kapellusch JM, Schrempf A, Probst K, Haller M, Baca A. Effect of alternating postures on cognitive performance for healthy people performing sedentary work. Ergonomics. 2018 Jun 3;61(6):778–95.
24. Esmaeilzadeh S, Ozcan E, Capan N. Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial. Int Arch Occup Environ Health [Internet]. 2014 Jan 23 [cited 2019 Sep 16];87(1):73–83. Available from: http://link.springer.com/10.1007/s00420-012-0838-5
25. Hoe VCW, Urquhart DM, Kelsall HL, Zamri EN, Sim MR. Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database Syst Rev. 2018.
26. Bongers PM, Ijmker S, Van Den Heuvel S, Blatter BM. Epidemiology of work-related neck and upper limb problems: psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II). J Occup Rehabil. 2006;16:279–302.
27. Karsh BT, Moro FBP, Smith MJ. The efficacy of workplace ergonomic interventions to control musculoskeletal disorders: a critical analysis of the peer-reviewed literature. Theor Issues Ergon Sci. 2001;2(1):23–96.
28. Rasmussen CDN, Sørensen OH, Allard J, Holtermann A. The effect of training for a participatory ergonomic intervention on physical exertion and musculoskeletal pain among childcare workers (the TOY project) – a wait-list cluster-randomized controlled trial. Scand J Work Environ Health [Internet]. 2020 Jan 16 [cited 2020 Mar 23]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/31945165
29. Choobineh A, Motamedzade M, Kazemi M, Moghimbeigi A, Heidari Pahlavian A. The impact of ergonomics intervention on psychosocial factors and musculoskeletal symptoms among office workers. Int J Ind Ergon [Internet]. 2011 Nov [cited 2020 Mar 23];41(6):671–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0169814111001053
30. Juhanson K, Merisalu E. Ergonomic intervention programs in different economic sectors: a review article. Agron Res. 2017;15.
31. Sharifi AS, Danesh MK, Gholamnia R. Improvements in musculoskeletal symptoms, mental workload and mental fatigue: effects of a multicomponent ergonomic intervention among call center workers. Work. 2022;72(2):765–74.
32. Burgess-Limerick R. Participatory ergonomics: evidence and implementation lessons. Appl Ergon. 2018;68:289–93.
33. Wilson JR. Ergonomics and participation. Eval Hum Work. 1995;2:1071–96.
34. Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction. 2001;96(12):1725–42.
35. Javadpour F, Keshavarzi S, Choobineh A, Aghabaigi M. Validity and reliability of the Swedish Occupational Fatigue Inventory (SOFI-20) among Iranian working population. Iran J Ergon. 2015;3(1):50–8.
36. Mahmud N, Kenny DT, Zein RM, Hassan SN. Ergonomic training reduces musculoskeletal disorders among office workers: results from the 6-month follow-up. Malays J Med Sci. 2011 Apr;18(2):16–26.
37. Fenety A, Walker JM. Short-term effects of workstation exercises on musculoskeletal discomfort and postural changes in seated video display unit workers. Phys Ther [Internet]. 2002 [cited 2020 Mar 23];82(6):578–89. Available from: https://academic.oup.com/ptj/article/82/6/578/2836987
38. Sjögren T, Nissinen KJ, Järvenpää SK, Ojanen MT, Vanharanta H, Mälkiä EA. Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial. Pain. 2005 Jul 1;116(1–2):119–28.
39. Kamalikhah T, Safarian MH, Rahmati-Najarkolaei F, Yaghoubi M. A comparison of the effects of ergonomic, organization, and education interventions on reducing musculoskeletal disorders in office workers. Health Scope. 2018 Sep 9;In Press.
40. Van Rhenen W, Blonk RWB, van der Klink JJ, van Dijk FJ, Schaufeli WB. The effect of a cognitive and a physical stress-reducing programme on psychological complaints. Int Arch Occup Environ Health. 2005;78(2):139–48.
41. Dahlman AS, Matsangas P, Shattuck NL. The effect of habitual exercise on daytime sleepiness and mood of US navy sailors. Proc Hum Factors Ergon Soc. 2017;2017-Octob:522–6.
42. Dunstan DW, Wiesner G, Eakin EG, Neuhaus M, Owen N, LaMontagne AD, et al. Reducing office workers’ sitting time: rationale and study design for the Stand Up Victoria cluster randomized trial. BMC Public Health [Internet]. 2013 Dec 9 [cited 2019 Nov 26];13(1):1057. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1057
43. Sanaeinasab H, Saffari M, Valipour F, Alipour HR, Sepandi M, Al Zaben F, et al. The effectiveness of a model-based health education intervention to improve ergonomic posture in office computer workers: a randomized controlled trial. Int Arch Occup Environ Health. 2018 Nov 1;91(8):951–62.
| Files | ||
| Issue | Vol 14 No 4 (2022) | |
| Section | Original Article(s) | |
| Published | 2025-08-30 | |
| Keywords | ||
| Keywords: Macroergonomics physical fatigue Mental fatigue office workers occupational fatigue | ||
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How to Cite
1.
Seyed Sharifi A, K. Danesh M, Gholamnia R. Combating Fatigue in the Office: Findings of a Participatory Ergonomics Intervention. Int J Occup Hyg. 2025;14(4):180-188.
