**6. Limitations of ergonomics education**

**5. Efficacy of ergonomics education**

56 Anatomy, Posture, Prevalence, Pain, Treatment and Interventions of Musculoskeletal Disorders

sic motivation to alter posture and behaviors [29].

increase in overall ergonomic knowledge [29].

Ergonomics education has been found to be an effective strategy. The literature supports the use of ergonomics education to improve computer workers' awareness of risk factor [13], reduce musculoskeletal injuries [30, 48], improve workers' posture and workstation layout [48], increase perceived control over the physical environment, and improve workers' intrin-

Ergonomics education enhances the knowledge about the risk factors associated with WMSDs. In a study conducted in a small nonprofit organization, the authors found that 89% of the participants were able to identify more risk factors and answer more questions correctly in a pre-/postknowledge test after a six-week on-site ergonomics education intervention [13]. Another large-scale field intervention study with more than 200 participants revealed that participants who received education and training to understand office ergonomic principles, perform self-evaluation of work places, and rearrange workstation demonstrated a significant

Ergonomics education intervention was reported to be an effective intervention in reducing musculoskeletal pain and discomfort. Bohr [30] stated that those who received ergonomics education reported less pain or discomfort. Ketola et al. [36], through a randomized controlled trial, investigated the efficacy of ergonomics education on workstation changes and musculoskeletal disorders among computer users. Results identified that computer workers who underwent intensive ergonomics and ergonomics education interventions showed less

Several studies found that ergonomics education had a positive influence on the work posture of computer workers. Greene et al. [49] evaluated the effectiveness of an ergonomics training program in computer workers and found that the risk factor exposure of the intervention group participants was significantly reduced. The authors asserted that participative training in workstation ergonomics can improve work postures and work practices. Mahmud et al. [50] used a cluster randomized controlled trial design to investigate the effect of ergonomics education in reducing musculoskeletal disorders among computer users. When the outcomes were evaluated post-intervention, experimental group participants who received the ergonomics education demonstrated improved workstation habits and work posture. Through a cross-over trial that investigated the effectiveness of a 2-week workstation ergonomic intervention (consultation and provision of ergonomic accessories), the authors found that individualized ergonomic interventions may improve work-related posture and reduce low back pain [51]. Esmaeilzadeh et al. [48] examined the effect of ergonomic intervention on work-related UE MSDs among computer workers and found that

musculoskeletal discomfort at the 2-month follow-up assessment post-intervention.

the ergonomic training significantly improved participants' posture over 6 months.

Ergonomics education was reported to positively influence worker's behavior. Mani et al. [13] stated that after 6 weeks of intervention, study participants demonstrated healthy work behaviors such as adjusting their workstation, taking rest breaks, and engaging in stretching exercises. Robertson et al. [29] found that increased ergonomics knowledge resulted in behavioral translation. In their study, the experimental group participants demonstrated appropriate behavioral changes to their workstations when compared to the control group participants. The experimental group participants also adjusted their workstation and ergonomic accessories One of the biggest limitations of any educational intervention is the retention of knowledge and ergonomics education intervention is not an exception. Studies that investigated the effectiveness of ergonomics education measured the outcome at different intervals that ranged from 1 week to as long as 30-month postintervention [13, 30, 36, 51]. Though the majority of the studies reported short-term improvements, evidence is scarce on long-term gains. One study reported improvements in work posture and reduction in pain during short- and long-term follow-ups [51]. However, another study that reported a short-term gain (2-month follow-up), failed to report a similar outcome at the 10-month follow-up. [36]. Ongoing ergonomics education sessions at specified intervals and provision of ergonomic resources to employees may overcome the problems with latency of knowledge. Showing pictures that highlight good versus bad postures during ergonomics education sessions and encouraging participants to identify what is wrong and why it is wrong may also help solidify their knowledge.

Another limitation of ergonomics education is the lack of application of the learning. Simply presenting the ergonomics information to employees does not solve the problem if they do not have the necessary ergonomic accessories. For instance, as a result of ergonomics education, an employee might become cognizant of the need to adjust his/her office chair to minimize the risk of WMSDs, but either does not have an office chair with adjustable components or has a chair with many adjustable features to the extent that he/she does not know how and what to adjust. Participatory ergonomics education, in which the participants are allowed to evaluate and modify their own workstation with the help of an ergonomic expert, may overcome this limitation to an extent.

Though ergonomics education reported to positively influence work behavior in a short term; in most instances, it fails to elicit the motivation required to induce permanent behavior change. Habits are powerful and difficult to overcome. Often, participants of ergonomics education were seen to resort to their old habits of work posture and behaviors. Ongoing participatory ergonomics education at specified intervals may overcome this limitation.
