TITLE:
Alignment between Intervention Design and Multidimensional Risk in Educator WMSDs: A Systematic Review
AUTHORS:
Nedonya Abreek-Sarhan, Bilal Sarhan, Leonid Kalichman, Deborah Alperovitch-Najenson
KEYWORDS:
Work-Related Musculoskeletal Disorders, Educators, Occupational Health, Workplace Interventions, Ergonomics
JOURNAL NAME:
Occupational Diseases and Environmental Medicine,
Vol.14 No.4,
September
4,
2026
ABSTRACT: Background: Work-related musculoskeletal disorders (WMSDs) are common among preschool and school educators and arise from interacting ergonomic, physical, and psychosocial workplace factors. Despite this multidimensional etiology, workplace interventions typically address only a limited range of these risk factors. Purpose: To systematically review workplace interventions targeting WMSDs among educators, classify intervention approaches, examine the breadth of reported outcomes, and identify gaps to inform future intervention development. Methods: PubMed/MEDLINE, Scopus, Web of Science, and ProQuest were searched from inception through December 2025. Eligible studies evaluated workplace-based ergonomic, physical/exercise, psychosocial, or multicomponent interventions among preschool and school educators. Owing to substantial heterogeneity in study design, intervention characteristics, and outcome measures, findings were synthesized narratively. Results: Thirty studies met the inclusion criteria. Interventions were classified as ergonomic (n = 6), physical/exercise-based (n = 7), psychosocial (n = 11), and multicomponent (n = 6). Single-domain interventions generally improved outcomes within their primary target domain, whereas multicomponent interventions demonstrated broader benefits across musculoskeletal, psychosocial, and work-related outcomes. However, all multicomponent interventions combined only two intervention domains. No study implemented a workplace-based intervention integrating ergonomic, physical, and psychosocial components within a single program. Conclusions: Current evidence is dominated by single-domain and dual-domain interventions that do not fully address the multidimensional nature of WMSDs among educators. The absence of integrated tri-domain interventions highlights an important evidence gap. Based on the identified patterns, the Education-Oriented Tri-Domain Intervention Model (ETDIM) is proposed as a conceptual framework to guide the design and evaluation of future workplace interventions in educational settings.