A systematic review of ergonomic interventions for reducing work-related musculoskeletal disorders among informal workers
Abstract
Work-related musculoskeletal disorders (WMSDs) impose a disproportionate burden on informal sector workers who lack occupational health protection. To identify and characterize ergonomic interventions applied to informal sector workers, to analyze their effectiveness in reducing WMSD outcomes by anatomical region, to evaluate the methodological quality of available evidence, and to provide evidence-based recommendations for ergonomic programs in resource-limited settings. A systematic search was conducted on 5 May 2026 across PubMed/MEDLINE, Scopus, and EBSCO using a Population, Intervention, Comparison, Outcome, and Study (PICOS) framework following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Six studies met all inclusion criteria from 29 unique articles. Due to substantial heterogeneity in study design, intervention characteristics, outcome measures, and incomplete statistical reporting, a narrative synthesis approach was adopted following Synthesis Without Meta-analysis (SWiM) guidelines. All six included studies involving informal agricultural and plantation workers in Thailand (n = 3), Malaysia (n = 1), Iran (n = 1), and Colombia (n = 1) reported statistically significant improvements in at least one work-related musculoskeletal disorders (WMSDs) outcome. Multicomponent interventions combining ergonomic training with workstation modification demonstrated the most favorable outcomes. Low back pain was the most frequently improved region (6/6 studies). Quality of evidence was Moderate according to the Effective Public Health Practice Project (EPHPP) framework in five studies and Strong in one. Ergonomic interventions were associated with reductions in WMSDs outcomes among the studied informal worker populations, although the evidence is limited by study heterogeneity. Participatory ergonomics and multicomponent interventions showed the most favorable findings. The evidence supports implementation of context-sensitive ergonomic programs within primary healthcare and community health infrastructure in low- and middle-income countries (LMICs).