A Systematic Review of the Impact of Remote Working Referenced to the Concept of Work–Life Flow on Physical and Psychological Health

COVID-19 has had major impacts on population and individual health (Solmi et al., 2022) and a transformational impact on the widespread adoption of remote working by both employers and employees (Ng et al., 2021; Vyas & Butakhieo, 2021). Remote working includes what is known as telework and working from home (WFH). The European Framework Agreement on Telework (2006) defines telework as a “form of organizing and/or performing work, using information technology, in the context of an employment contract/relationship, where work, which could also be performed at the employer’s premises, is carried out away from those premises on a regular basis” (Gabaglio et al., 2002). WFH may be defined as a situation in which an employee works mainly from home and usually communicates with their employer and co-workers by digital means (e.g., email, video conferencing, mobile phone).

WFH is predicted to accelerate over the coming years as employees become more focused on the interface of quality of life with that of work–life (Pheng & Chua, 2019; Philips, 2020) and employers see the cost-efficiency benefits of locating employees at home (Parker, 2020). Governments from a number of European countries agreed on the adoption of the EU framework on telework (European Social Partners ETUC (2006). Consequently, countries such as Ireland are enshrining into employment law a right to work from home if an employee can demonstrate that doing so would have no material negative impact on the employer (Department of Enterprise, Trade and Employment, 2021).

Such a significant shift in the locus of employment may change the nature of health and well-being issues for many workers (Oakman et al., 2020); the obligations of employers to support worker well-being within the home (Philips, 2020) and, by implication, the future practice of occupational health nurses as this relates to both positive and negative health impacts on workers (Gleason, 2021). Remote work may affect both physical and psychological health ranging from musculoskeletal disorders, fatigue, and stress (Collins et al., 2016; Oakman et al., 2020). Alternatively, there is evidence that it can have positive social and psychological benefits by improving personal mood (Anderson et al., 2015).

Literature indicates gendered differences in reported negative health impacts on women compared with men when forced to work from home (Anderson & Kelliher, 2020). Such findings suggest a need for consideration of gendered differentials as to the nature of health interventions where the home is the employee’s working environment.

Linked to these impacts is the adoption of the concept of decent work in the workplace (dos Santos, 2019; Ferraro et al., 2018). The 8th Sustainable Development Goal of the 2030 United Nations Agenda includes the adoption of decent work principles to reinforce employer commitment to health and safety at work (Ferraro et al., 2015, 2018; International Labour Organization (ILO), 2012; dos Santos, 2019).

Such international pronouncements combined with rapid changes to the workspace suggest that both current and future adoption of remote working, combined with the personal aspirations of workers for better quality of life (Sull et al., 2022), will require employers to demonstrate commitment to worker well-being. In many organizations, occupational health nurses as the operational arm of such commitment will need to master and engage with an interactive complexity of health promotion, personal workspace safety, and quality life issues that previously, it could be argued, were not in their purview.

This systematic review reports on health impacts of remote working within the context of WFH as happened in many countries during the height of the COVID-19 pandemic between 2020 and 2021. The review is referenced to trends in remote work, the concept of work–life flow (WLF) rather than work/life balance, and how trends and new concepts may change the practice paradigm of occupational health nursing in the future.

The question posed for this review was “What is the impact of remote work on individuals’ physical and psychological health?” The review protocol was registered with PROSPERO (CRD42021258517) and followed the PRISMA guidelines.

Studies exploring physical and psychological impacts of WFH that result from sustained exposure to remote working and mediating factors were included in this review. Physical impacts included musculoskeletal disorders, back pain, neck pain, repetitive strain injury, eye strain, vision, fatigue, and sleep. Psychological impacts included substance use, online behavior, depression, anxiety, stress, mental health, mental illness, sense of well-being, and fatigue.

A systematic search of the literature was conducted utilizing a series of search terms generated through initial reading of relevant literature (see Table 1). Articles were reviewed from ClNAHL, MEDLINE, APA PsycINFO, and APA PsycArticles. Search terms related to remote working (a) and mental impacts (b) or physical impacts (c) or COVID-19 (d). A timeframe between 2020 and 2021 was selected in recognition of the dramatic change in work practices wrought by COVID-19 and the resulting policy responses.

All included studies were in the English language. Reviews, commentaries, single-case reflections and studies not focussing on the working population were excluded. The strength of evidence was evaluated using the GRADE approach.

Eight hundred and thirty articles were identified through the literature search. Two hundred and fifty duplicates were removed, leaving 579 articles for screening. Four hundred and eighty-five articles were removed due to non-relevance, leaving 94 records sought for retrieval (of which two could not be retrieved). Ninety-two were screened for eligibility leading to the exclusion of 58 articles for the following reasons: wrong study design (n = 19); wrong condition (n = 6); wrong outcomes (n = 19), and wrong population (n = 13). This left 34 articles for inclusion in the review (see Figure 1). The retrieved studies are described in more detail in Table 2: Study Description.

Most studies originated in Europe (n = 14) followed by North America (n = 9); Asia (n = 6); South America (n = 2); Africa (n = 1); Australia (n = 1) and one inter-continental study (n = 1). In studies where population size was reported the size ranged from 4 (Edwards et al., 2021) to 270,000 (Kawashima et al., 2021). Studied populations included remote workers (n = 8); the general population—this included a subset of remote working people (n = 7); general employees—this included a subset of remote working people (n = 5); remote working healthcare workers (n = 4); remote working academic and education staff (n = 4); remote working parents and/or carers (n = 3); remote working embassy staff (n = 1); pet and non-pet owning workers (n = 1); and social media users (n = 1).

Most of the studies used a cross-sectional research design (n = 26) while a minority of studies used a longitudinal design (n = 8). A majority of cross-sectional studies utilized a survey approach (n = 18) while other approaches included interviews (n = 2); interviews and surveys (n = 2); social media data (n = 2) and the use of an air monitor to test exposure to air pollutants in the home compared with the outside environment (n = 1). Longitudinal studies included those that adopted a quasi-experimental design (n = 1); social media data (n = 1); emails and survey (n = 1); accelerometer and diary (n = 1); survey (n = 1), and diary (n = 1).

This systematic review aimed to answer the question what is the impact of remote work on individuals’ physical and psychological health? A secondary aim was to consider the relevance of these findings to the future practice of occupational health nursing. Overall, the quality of the literature was mixed in terms of design and sample size and this needs to be considered when forming a general view in relation to both questions (see “Appraisal” section and Table 3 in relation to the quality of the literature). Consequently, the quality of the literature would suggest that more robust research is warranted. It may also be suggested that such research should be led by occupational health nurses since they will have a pivotal role in any successful support of workers in a WFH setting. With these caveats in mind, the review identified a complex relationship between negative impacts of remote working on specific areas of physical and psychological health, while also highlighting some positive benefits to overall well-being. The implications of these findings for the practice of occupational health nursing are two-fold—first, that practice will need to extend beyond the traditional scope of the working space and, second, training for occupational health nurses will need to encompass a more comprehensive yet nuanced consideration of the iterative nature of workers’ lives with their personal space and concerns when formulating advice and interventions.

It is apparent that negative impacts of remote working are distributed unequally related to age, gender, job role, and whether choice was a determinant in WFH (Estrada-Muñoz et al., 2021; Larrea-Araujo et al., 2021; Oksanen et al., 2021; Shockley et al., 2021; Tusl et al., 2020; van Niekerk and van Gent, 2021). This suggests that health interventions, as designed and implemented by occupational health nurses, need to consider targeted interventions with specific groups.

Ergonomic design and adaptation is a key issue in such intervention planning (Larrea-Araujo et al., 2021). The findings of the review highlight the importance of designing ergonomic work environments to mitigate the negative effects of WFH (Larrea-Araujo et al., 2021). In this regard, occupational health nurses will best serve employees by expanding their skill set in relation to ergonomic design and mitigations (with greater understanding of the inter-relationship of home furnishing, lighting and ventilation with optimal health promoting at home workspace design) and how to encourage workers to adapt their homes in relation to these factors.

Similarly, there is a range of negative impacts associated with using online tools, which include “zoom fatigue” and vocal tract discomfort (Kenny, 2020; Shockley et al., 2021). To address these impacts, occupational health nurses will want to promote a range of harm reduction practices such as switching off the camera and microphone when possible (Bennett et al., 2021; Shockley et al., 2021). Several studies suggested benefits in terms of overall well-being linked to WFH (Björndell & Premberg, 2021; Dhont et al., 2020). Associated with these results were perceived job autonomy, job crafting, and a positive work schedule (Ingusci et al., 2021; Reizer et al., 2021; Wang et al., 2021)—all of which are associated with the concept “flow.” These results would suggest, therefore, that occupational health nurses are in a position to help remote workers identify and utilize these factors to improve their WLF—indeed we would argue WLF should be incorporated into occupational health nurses’ education, training, and professional philosophy.

Closely related to a sense of well-being is the positive effect WFH can have on sleep (Hallman et al., 2021) though perceived stress can reduce sleep quality and may be dependent on the ability of workers to psychologically detach from work (Rhower et al., 2020). The relationship of sleep to well-being is closely related to employee work performance and job satisfaction and needs special consideration from a practice viewpoint (Deng et al., 2022; Kun & Gadanecz, 2022).

Quality of sleep is also related to physical activity. Access to green and blue spaces and having pets are mediating factors related to physical activity among remote workers. Occupational health nurses are able to encourage remote workers to engage in physical activity and consider the resources available to them, such as access to outdoor spaces and pets, which are thought to promote a healthy lifestyle (Astell-Burt & Feng, 2021; Fukushima et al., 2021 Hoffman, 2021).

Overall, these results suggest that occupational health nurses’ roles should extend to promoting workers’ quality of life through a holistic approach to occupational health assessment and planning that goes beyond recommendations about how often remote workers need to be physically active. This would mean that occupational health nurses would need to address remote workers’ ability to detach from work psychologically and physically to improve well-being and thereby increase work satisfaction that supports a positive work engagement. These are the most significant elements to be identified through this review as areas that need to be addressed by occupational health nurses.

The expansion of the occupational health nurse’s role to the home is not without controversy as this relates to the employee’s right to privacy and autonomy. However, this can be negotiated if employers adopt policies informed by decent work and WLF in which there is an emphasis on the promotion of well-being within remote working and the rights of individual workers to be supported through consultation and collaboration.

There are several limitations to this review. These include the heterogeneity of the studies, and that most studies were cross-sectional surveys. Furthermore, the short timeframe considered makes the main findings also limited in its scope. The low evaluation of the retrieved studies implies the conclusions should be cautious.

The rise of remote working means that occupational health nurses need to engage with a broader span of practice that should include the provision of advice in restructuring the home as a workspace and addressing specific physical and psychological challenges associated with home-based work and, within the precepts of WLF, engaging with the promotion of employee quality of life. This would include providing guidelines for employees on their personal work practices and their relationship to their well-being practices, such as when to take physical exercise and when to disengage with technology.

Adopting a holistic approach to manage challenges that did not exist within the boundaries of the traditional workspace means that occupational health nurses may also need to work collaboratively with other healthcare professionals, such as mental health practitioners, and general practitioners. By doing so, they will contribute to a more sustainable and productive remote work environment.