This document summarizes a systematic review on the effect of cushioning materials on discomfort during prolonged standing at work. The review examined research on interventions like mats and insoles and their ability to reduce musculoskeletal discomfort in the lower body for workers standing for over three hours. The systematic review sought to determine if cushioned surfaces are more effective than shoe inserts at reducing discomfort, and if age and gender influence cushioning material effectiveness. Ten studies were included in the review. The results showed that cushioning materials can help reduce subjective discomfort, local muscle fatigue, and changes to center of pressure during standing. However, most studies had unclear or high risk of bias. Future research is still needed, especially randomized controlled trials in real workplaces that examine

1. The effect of cushioning materials on
discomfort during prolonged standing at work
A Systematic Review
Main author & presenter: Ms Gosia Speed (M.ESH Latrobe University)
Co-authors: Dr Tessa Keegel (Latrobe University)
Dr Kate Harris

2. Objectives
• Background:
➢ Prevalence of standing work
➢ Health effects of standing
➢ Proposed physiological processes involved
• Interventions: mats, insoles, soft flooring
• Research question
• Method
• Results
• Conclusions

4. Health effects of prolonged standing
Cardiovascular:
venous disease
orthostatic symptoms
Pregnancy:
pre-term births
spontaneous abortions
Musculoskeletal:
pain in legs & low back
general & local fatigue

5. MSK effects
US factory workers:
•  risk plantar fascitis
Werner, Gell, Hartigan, Wiggerman, & Keyserling (2010)
Australian hairdressers:
• 77.5% LBP
• 51.4% ankle/foot pain
Best et al. (2002)
Sales & Kitchen workers:
•  foot sensitivity
Messing & Kilbom (2001)
Canadian standing workers:
• 30.4% LBP
Tissot et al. (2009)
Dutch poultry inspectors:
• 70% reported discomfort
Van Dieen & Oude Vrielink (1998)

6. Physiological processes involved in standing
Static Muscle
Activity
 Metabolites
Hypersensitivity
Tissue compression
 Joint movement
Cartilage degeneration
Arthritic disease
 Circulation
Blood pooling
Leaking valves
Varicose veins
Fatigue &
discomfort

7. Barriers to elimination
Procedural
Infrastructure
Task demands
Cultural norms

8. Interventions
✓ Provide support
✓ Optimise body weight
distribution
✓ Provide biomechanical
re-alignment
✓ Reduce shearing forces
✓ Facilitate sensori-motor
control

9. The Research Questions:
Does a cushioning material, compared to a hard floor,
reduce lower body musculoskeletal discomfort in workers
who work in a constrained standing position for longer
than three hours?
Are cushioned surfaces more effective than shoe inserts in
reducing musculoskeletal discomfort of the lower body?
Does age influence the effectiveness of cushioning
materials on musculoskeletal discomfort?
Is there a gender difference in the effectiveness of
cushioning materials on musculoskeletal discomfort?

10. Method
Inclusion Criteria:
✓ Healthy participants
✓ Standing min. 3 hrs
✓ Using cushioning interface
✓ Real & simulated workplaces
✓ English language
✓ Jan 2000 – April 2016
Exclusion Criteria:
✗ Children, adolescents, elderly
✗ Pre-existing conditions
✗ Standing < 3 hrs
✗ Walking / Running
✗ Sloped surfaces / magnetic inserts /
instability shoes / high heels
Risk of bias assessment
Quality assessment
Measurement outcomes:
1. Subjective discomfort / fatigue
2. Local muscle fatigue
3. Centre of Pressure (COP) / weight shifts
4. Leg volume
10 studies

11. Results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Appropriate
cross-over
design
Randomised
treatment
order
Carry-over
effect
Unbiased data Allocation
concealment
Blinding Incomplete
outcome data
Selective
outcome
reporting
Other bias
%ofstudies
Risk of bias category
High
Unclear
Low

12. Results

13. Conclusion
Future
Research
RCTs
Real
workplaces
Psychosocial
factors Organisational
factors

14. Thank you
Gosia.speed@me.com