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Evidence from this review suggests that interventions that increase staff control by providing worker-centred flexibility (including self-planning and partial/phased retirement) are likely linked to health improvements, including improvements in physical health (reduced systolic blood pressure and heart rate), mental health (e.g.B reduced psychological stress), and general health (e.g.B fatigue and sleep quality). It is important that interventions that increased workers` flexibility did not have negative effects on short-term health. Kandolin 1996 reported a significant reduction in fatigue during night work when comparing participants in the intervention and control group, although it was noted that this study reported the effects of several interventions. Smith showed in 1998 improvements in mental health, quality of sleep on day shifts, duration of night sleep, and alertness during night work in the intervention group compared to the comparison group. Viitasalo 2008 found statistically significant decreases in systolic blood pressure and heart rate for workers with flexible planning compared to those in the control group. Pryce 2006 did not find any significant change in primary health outcomes, although improvements were seen at some secondary breakpoints when comparing intervention and control groups. We included ten CBA studies, the six flexible work interventions (self-planning; flexible working hours; overtime; progressive/age part-time; involuntary part-time employment; fixed-term contracts) with regard to contractual and temporal flexibility. We did not identify any studies that met the criteria for inclusion in the design of studies on job sharing (contractual flexibility) or on spatial flexibility measures, in particular teleworking. While we are aware of the limitations of the audit in terms of the ability to combine our results and generalize, we observed that studies that examined the impact of interventions on temporal flexibility tended to report at least some improvements in health and wellness outcomes (Kandolin 1996); Pryce 2006; Smith 1998; Viitasalo 2008), while contractual flexibility interventions (with the exception of phased/partial retirement) reported ambiguous or negative health effects when comparing intervention and control groups before and after implementation of interventions (Dooley 2000; Rodriguez 2002). No studies were found that met our containment criteria for telework interventions.

Four controlled before and after studies investigated the impact of self-planning on shiftworkers (kandolin, 1996); Pryce 2006; Smith 1998; Viitasalo 2008). Three of these studies reported significant improvements in a subset of primary health outcomes, while the fourth study did not report statistically significant differences between the control and intervention groups in the primary health outcomes studied (Pryce 2006). Only one controlled study before and after our closing study investigated the impact of flexible working hours on workers (Dunham, 1987). This flexible schedule intervention included a rush hour between 1:30 p.m. and 3:30 p.m., but with flexibility in terms of departure and arrival times, as well as the time and duration of lunch breaks. . . .