Beyond risk reduction of work-related musculoskeletal disorders: The CoWork musculoskeletal health model

Work-related musculoskeletal disorders (MSD) affect over 1.7 billion people globally with a huge economic burden. Despite decades with legislations, policies and risk-reduction interventions, we see no decreases in MSD prevalence. Current prevention models focus on eliminating workplace hazards, overlooking that physical and psychosocial work factors can also promote musculoskeletal health (MSH). We were commissioned through the Danish Working Environment Agreement to develop new approaches addressing this conceptual gap.

Through iterative stakeholder dialogue with Danish policymakers, social partners, and workplace practitioners, we developed and visualized the CoWork (Copenhagen work-related) MSH model to shift the focus from preventing MSD through risk reduction toward actively promoting work-related MSH. The model aims to bridge theory with workplace structure and implementation by addressing stakeholder requests for clear terminology, conceptual understanding in a workplace context, and actionable guidance.

The CoWork MSH model provides a new definition of work-related MSH as "a state of physical, mental, and social well-being of the locomotor system in relation to work" as well as five integrated elements; (i) a health-oriented approach, (ii) a just-right work factor conceptualization, (iii) the Organizational, Management, Group, !ndividual (OMG!) workplace framework, (iv) an intervention guidance, and (v) health economics perspective. This approach recognizes that work factors can benefit rather than harm health when properly designed and implemented.

The CoWork MSH model represents a paradigm shift, extending from risk reduction to MSH promotion, providing researchers, policymakers, and practitioners with a framework for understanding, researching, and practice to promote workplace MSH.