Underreporting Work Absences for Nontraumatic Work-Related Musculoskeletal Disorders to Workers’ Compensation: Results of a 2007–2008 Survey of the Québec Working Population

Objectives. We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers’ compensation (WC).Methods. In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression.Results. Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized.Conclusions. The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.Musculoskeletal disorders (MSDs) are the main cause of disability in most industrialized countries and represent a considerable human and economic burden.1–4 Workers perceive a high proportion of their MSDs to be work related: nearly three quarters of workers in the province of Québec who had experienced musculoskeletal pain in 2007 to 2008 attributed it to work.5 The term work-related musculoskeletal disorders (WMSDs) refers to nontraumatic inflammatory or degenerative disorders of the musculoskeletal structures of the neck, back, or upper or lower extremities that usually develop over time as a result of cumulative microtrauma, arising from biomechanical and other work exposures, that surpasses the adaptive and repair capacities of affected structures.6,7 Nontraumatic WMSDs are distinguished in etiology and prevention from MSDs caused by acute accidental traumatic injuries. Although one of the most common sources of data used to measure the incidence of work-related disorders is workers’ compensation (WC) data, several studies have suggested that such data underestimate the prevalence of occupational disorders, including MSDs.8–12 Few of these studies have specifically looked at nontraumatic WMSDs.We estimated, among nonmanagement salaried employees (NMSEs), (1) the 1-year prevalence of nontraumatic WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who lacked replacement income during their work absence.     

Prevalence and impact of musculoskeletal disorders in New Zealand nurses, postal workers and office workers

Objectives: To describe the prevalence, characteristics and impact of musculoskeletal disorders (MSDs) in New Zealand nurses, postal workers and office workers.
Methods: A postal survey asked participants about MSDs, (low back, neck, shoulder, elbow, wrist/hand or knee pain lasting longer than one day), and demographic, physical and psychosocial factors. Nurses were randomly selected from the Nursing Council database, postal workers from their employer's database and office workers from the 2005 electoral roll.
Results: The response rate of potentially eligible participants was 58% (n=443). Participants were aged 20–59 years; 86% were female. Over the 12 months prior to the survey 88% of respondents had at least one MSD lasting longer than a day and 72% reported an MSD present for at least seven days. Of the 1,003 MSDs reported, 18% required time off work and 24% required modified work duties. In the month prior to the survey 17% of MSDs made functional tasks difficult or impossible. Low back, neck and shoulder pain prevalence did not differ by occupation. Postal workers had the highest prevalence of elbow and wrist/hand pain; nurses of knee pain.
Conclusions: The high prevalence of MSDs among these workers indicates that they are indeed in 'at risk' occupations. In each occupational group MSDs encompass a range of anatomical sites, however the overall pattern of MSDs differs by occupation. MSDs have a significant impact on activities at work and home.
Implications: Primary and secondary prevention strategies should encompass a range of anatomical sites and specifically target different occupational groups.     

The effect of ergonomic interventions in healthcare facilities on musculoskeletal disorders

BACKGROUND: The high incidence of musculoskeletal disorders (MSDs) among healthcare workers suggests that the introduction of ergonomic interventions could be beneficial. While laboratory studies have clearly documented the efficacy of ergonomic devices, few studies have examined their effectiveness in the healthcare workplace. METHODS: This study evaluated a statewide program that provided ergonomic consultation and financial support for purchasing ergonomic devices, which aid in patient handling and lifting. Changes in MSD rates between baseline (1 year pre-intervention) and post-intervention (up to 2 years) periods were examined in 100 work units in 86 healthcare facilities. RESULTS: The median MSD rate decreased from 12.32 to 6.64 per 200,000 employee-hours, a decrease greater than the secular trend for the study period (1999-2003). CONCLUSIONS: This study suggests that ergonomic consultation and financial support for purchasing ergonomic equipment can be an effective intervention to reduce MSDs among healthcare workers.     

The relationship of unions to prevalence and claim filing for work-related upper-extremity musculoskeletal disorders

BACKGROUND: Unionization has been found to be related to higher filing of workers' compensation (WC) claims, but the extent of the relationship and the relationships to other variables have not been previously reported. METHODS: Telephone interviews were conducted with both a population-based and WC-based samples of musculoskeletal disorder (MSD) cases. RESULTS: Workers at unionized facilities were 5.7 times (95% CI 2.5-13.1) more likely to file a claim for WC, despite a comparable rate of MSD cases. Higher filing was also associated with several measures of MSD severity (1.8-14.1 odds ratios), economic sector (OR = 10.1 for manufacturing), hourly (vs. salary) wages (OR = 2.6), and for having a personal physician (OR = 2.5). Unions appeared to have a protective effect on social effects of work-related MSD. CONCLUSIONS: Unions appear to improve filing of work-related MSD, particularly for less severe conditions. The higher filing does not appear to be a case of "moral hazard," but rather improved and earlier reporting, as is advocated by early intervention approaches to reducing MSD.     

Examination of postures and frequency of musculoskeletal disorders among manual workers in Calcutta,India

Background: Manual material handling (MMH) activities require workers to adopt various awkward postures leading to the development of musculoskeletal disorders (MSD).

Objectives: To investigate the postures adopted during heavy load handling and the frequency of MSDs among MMH workers in Calcutta, India.

Methods: We conducted a cross-sectional study with 100 MMH workers. MSD frequency was assessed via the Standardized Nordic Questionnaire. The Ovako Working Posture Assessment System (OWAS) was used to analyze working posture. We used logistic regression to predict MSD risk factors.

Results: Ninety five percent of workers reported a MSD in at least one body part in the past 12 months. According to OWAS results, 83% of the analysed work postures require immediate corrective measures for worker safety. The most harmful posture was carrying a heavy load overhead. Carrying more than 120 kg increased the odds of low back and neck pain by 4.527 and 4.555, respectively.

Conclusions: This sample had a high frequency of reported MSDs, likely attributed to physiologically strenuous occupational activities repeated on average of 30–40 times daily. Ergonomic interventions, such as the use of handcarts, and occupational training are urgently needed.     

Musculoskeletal problems among workers of an Iranian rubber factory

Musculoskeletal disorders (MSDs) are a common health problem throughout the world and a major cause of disability among the work force. Assessment of exposure level to MSD risk factors can be an appropriate base for planning and implementing interventional ergonomic programs in the workplace. This study was conducted among workers of an Iranian rubber factory with the objectives of (a) determination of the prevalence of MSDs among production line workers, and (b) assessment of the level of exposure to MSD risks. In this study, all 16 production units of the factory were studied. In each unit, 50% of the workers were randomly selected and included in the study. A total of 454 workers participated. The Nordic Musculoskeletal Questionnaire was used to study the prevalence of MSDs and the Quick Exposure Check (QEC) technique was applied to assess physical exposure to the risks. The videotaping technique was used to collect the required data for each worker. The vast majority of the workers (73.6%) had suffered from some kind of musculoskeletal symptoms during the last 12 months. The highest prevalence was reported in the lower back (50.2%), knees (48.5%) and upper back (38.1%). In 85.5% of the workers studied, the QEC score was high or very high. Statistical analysis showed a significant association between the QEC level of risk and MSDs symptoms (p<0.001). The most common ergonomics problems were found to be awkward postures and manual material handling. MSDs had occurred with a high rate among workers of this rubber factory. Corrective measures for reducing risk level seemed essential. Elimination of awkward postures and manual material handling in the workplace were recommended.     

Accuracy of a Disability Instrument to Identify Workers Likely to Develop Upper Extremity Musculoskeletal Disorders

Background Work related upper extremity musculoskeletal disorders (MSD) result in substantial disability, and expense. Identifying workers or jobs with high risk can trigger intervention before workers are injured or the condition worsens. Methods We investigated a disability instrument, the QuickDASH, as a workplace screening tool to identify workers at high risk of developing upper extremity MSDs. Subjects included workers reporting recurring upper extremity MSD symptoms in the past 7 days (n = 559). Results The QuickDASH was reasonably accurate at baseline with sensitivity of 73% for MSD diagnosis, and 96% for symptom severity. Specificity was 56% for diagnosis, and 53% for symptom severity. At 1-year follow-up sensitivity and specificity for MSD diagnosis was 72% and 54%, respectively, as predicted by the baseline QuickDASH score. For symptom severity, sensitivity and specificity were 86% and 52%. An a priori target sensitivity of 70% and specificity of 50% was met by symptom severity, work pace and quality, and MSD diagnosis. Conclusion The QuickDASH may be useful for identifying jobs or workers with increased risk for upper extremity MSDs. It may provide an efficient health surveillance screening tool useful for targeting early workplace intervention for prevention of upper extremity MSD problems.     

Musculoskeletal Disorders and Agricultural Risk Factors Among Korean Farmers

Farming is a strenuous occupation with various health risks, with musculoskeletal disorders (MSDs) being some of the most common. The risk factors for MSDs among Korean farmers are not well understood. Data were obtained from the Korean Farmers’ Occupational Disease and Injury Survey (2012), which interviewed 16,113 participants regarding their demographic profiles, self-reported MSDs, and agricultural characteristics. Multiple logistic regression analysis was used to identify the risk factors for MSDs. Subjects reported MSDs in the neck or upper extremities (5.89%), lower extremities (19.62%), and back (26.9%). Working in animal husbandry significantly increased the risk of MSDs in the neck/upper extremities, compared with irrigation farming (odds ratio: 1.837, 95% confidence interval: 1.130–2.987). The risk of MSDs increased significantly with number of years of farming, after adjusting for age and sex (neck/upper extremities, P for trend = .0002; lower extremities, <.001; back, <.001). Agriculture type, years of farming, and ergonomic factors increased the risk of MSDs among Korean farmers.     

Musculoskeletal disorder costs and medical claim filing in the US retail trade sector

The average costs of Musculoskeletal Disorder (MSD) and odds ratios for filing medical claims related to MSD were examined. The medical claims were identified by ICD 9 codes for four US Census regions within retail trade. Large private firms' medical claims data from Thomson Reuters Inc. MarketScan databases for the years 2003 through 2006 were used. Average costs were highest for claims related to lumbar region (ICD 9 Code: 724.02) and number of claims were largest for low back syndrome (ICD 9 Code: 724.2). Whereas the odds of filing an MSD claim did not vary greatly over time, average costs declined over time. The odds of filing claims rose with age and were higher for females and southerners than men and non-southerners. Total estimated national medical costs for MSDs within retail trade were $389 million (2007 USD).     

Gender Differences in Demographic and Clinical Correlates among Veterans with Musculoskeletal Disorders

BackgroundStudies suggest that women may be at greater risk for developing chronic pain and pain-related disability.MethodsBecause musculoskeletal disorders (MSD) are the most frequently endorsed painful conditions among veterans, we sought to characterize gender differences in sociodemographic and clinical correlates among veterans upon entry into Veterans Health Administration's Musculoskeletal Disorders Cohort (n = 4,128,008).ResultsWomen were more likely to be younger, Black, unmarried, and veterans of recent conflicts. In analyses adjusted for gender differences in sociodemographics, women were more likely to have diagnoses of fibromyalgia, temporomandibular disorders, and neck pain. Almost one in five women (19.4%) had more than one MSD diagnosis, compared with 15.7% of men; this higher risk of MSD multimorbidity remained in adjusted analyses. Adjusting for sociodemographics, women with MSD were more likely to have migraine headache and depressive, anxiety, and bipolar disorders. Women had lower odds of cardiovascular diseases, substance use disorders, and several MSDs, including back pain conditions. Men were more likely to report “no pain” on the pain intensity Numeric Rating Scale, whereas more women (41%) than men (34%) reported moderate to severe pain (Numeric Rating Scale 4+).ConclusionsBecause women veterans are more likely to have conditions such as fibromyalgia and mental health conditions, along with greater pain intensity in the setting of MSD, women-specific pain services may be needed.     

Prevalence and risk factors of musculoskeletal disorders among Sri Lankan rubber tappers

Background: Rubber tapping exposes workers to risk factors for musculoskeletal disorders (MSDs).

Objectives: This cross-sectional study assessed the prevalence and factors associated with MSDs among Sri Lankan rubber tappers.

Methods: Questionnaires were administered to 300 rubber tappers to measure MSDs and potential associated factors. Ergonomic exposure levels were measured for 90 tappers using the Quick Exposure Check instrument. MSD prevalence and prevalence ratios were calculated using log-binomial regression.

Results: In the past 12 months, 66% of rubber tappers in our sample experienced an MSD. Ergonomic exposure levels were high or very high in the back (94.4%), shoulders (96.7%), and neck (83.3%). Being female, older, Tamil, working two jobs, alternating tapping hands, and depression were significantly associated with increased risk of MSDs.

Conclusions: MSDs are common among rubber tappers in Sri Lanka. These results suggest a need for work process modifications to prevent MSDs.     

Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses

BACKGROUND: Though musculoskeletal disorders (MSDs) are highly prevalent among registered nurses (RNs), little is known about functional consequences of MSDs in nurses. METHODS: Data on neck, shoulder, and back MSD problems were analyzed in 1,163 working nurses (response rate = 74%). Cases had relevant symptoms lasting at least 1 week or occurring at least monthly in the past year, with at least moderate pain intensity, on average. MSD problems with a frequency, duration, or pain intensity below the level needed to meet the case definition were defined as MSD symptoms. Those who did not meet symptom or case criteria at any body site were defined as asymptomatic. Odds of consequences (e.g., saw a doctor/provider, missed work, reduced/modified work, non-work activities, or recreation, medication use, inadequate sleep) were estimated for cases versus those with symptoms. RESULTS: We found 45.8, 35.1, and 47.0% of nurses had neck, shoulder, or back MSD problems (either at the case or symptom level), respectively, within the past year. Cases were far more likely to have seen a provider versus those with symptoms (adjusted odds ratio, aOR Neck: 4.33, 95% CI: 2.85-6.56; aOR Shoulder: 4.83, 95% CI: 3.00-7.77; aOR Back: 3.69, 95% CI: 2.47-5.49). Cases also were more likely to experience all other functional consequences. CONCLUSIONS: MSD consequences are substantial and suggest opportunities for intervention. Future research will examine the impact of work organization and physical demands on MSDs.     

Physically demanding workloads and the risks of musculoskeletal disorders in homecare workers in the USA

Although musculoskeletal disorders (MSDs) are prevalent among homecare workers, little is known about the MSD risk factors. This study investigated whether physically demanding workloads among homecare workers are related to MSDs, especially in neck, shoulder and back pain. Data were taken from two waves of a random sample (June to December 2003 and December 2003 to February 2004). The sample included 1643 homecare workers at Wave 1 and 1198 homecare workers at Wave 2, respectively. A basic telephone interview and 30 minutes computer‐assisted interview were performed for homecare workers in Wave 1 and Wave 2. The prevalence of neck, shoulder and back MSDs was assessed at Wave 1 and Wave 2 using the Nordic questionnaire of musculoskeletal symptoms. The incidence of MSDs at 6 months was estimated at Wave 2 using only those who were in the asymptomatic reference group at Wave 1 as the denominator. At Wave 1, back MSDs were the most prevalent (10.2%), followed by neck (9.6%) and shoulder (7.1%) MSDs. After 6 months, the incidence of neck MSDs was the highest (7.0%), followed by back (6.4%) and shoulder (4.8%) MSDs. Physical demands of work were assessed using items developed from focus groups of workers. When compared with asymptomatic workers, those with MSDs showed a dose–response effect for physical job demands. After controlling for age, psychosocial demands and social support on‐the‐job, physical demands among homecare workers were significantly associated with an excessive odds of neck, shoulder and back MSDs incident at 6 months (odds ratios of 1.14–1.17 for each unit increase on a physical demand scale). Our study shows that the physical demands of work are a significant risk factor for MSDs among homecare workers. Considering the high physical demands among homecare workers, the finding in this study clearly indicates that practical intervention strategies should be implemented to protect homecare workers from exposure to MSD risk factors.     

A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders

BACKGROUND: A prospective study of computer users was performed to determine the occurrence of and evaluate risk factors for neck or shoulder (N/S) and hand or arm (H/A) musculoskeletal symptoms (MSS) and disorders (MSD). METHODS: Individuals (n = 632) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years. At study entry, workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed. Daily diaries were used to document work practices and incident MSS. Those reporting MSS were examined for specific MSD. Incidence rates of MSS and MSD were estimated with survival analysis. Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD. RESULTS: The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years. The most common N/S MSD was somatic pain syndrome. The annual incidence of H/A MSS was 39 cases/100 person-years and of H/A MSD was 21 cases/100 person-years. The most common H/A disorder was deQuervain's tendonitis. Forty-six percent of N/S and 32% of H/A MSS occurred during the first month of follow-up. Gender, age, ethnicity, and prior history of N/S pain were associated with N/S MSS and MSD. Gender, prior history of H/A pain, prior computer use, and children at home were associated with either H/A MSS or MSD. CONCLUSIONS: H/A and N/S MSS and MSD were common among computer users. More than 50% of computer users reported MSS during the first year after starting a new job.     

Underreporting of work-related injury or illness to workers' compensation: individual and industry factors

OBJECTIVE: We quantified the underreporting of work-related injury or illness to workers' compensation (WC). METHODS: Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. RESULTS: The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52% filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing varies considerably across industry and occupation groups holding all other measured factors constant. CONCLUSIONS: Individual and industry/occupation factors are related to underreporting of work-related injury or illness to the WC system.     

Work status after workers' compensation claims for upper limb musculoskeletal disorders

Methods: Two-year follow up of the workers who filed a WC claim for MSDs in 1996 in the Pays de la Loire region. Of the 701 eligible workers, 514 workers (70%) participated. Information was requested by means of a mailed questionnaire about the characteristics of the MSDs and job status at the time of the WC claim and two years later.

Results: Two years after the WC claim, 65% of the claimants had returned to work in the same company, often without any ergonomic improvement, 12% had retired or had left employment voluntarily, and 18% had been dismissed. The risk of dismissal was associated with three factors: being older than 45 years, having two or more MSDs at claim, and working in the cleaning services sector.

     

Musculoskeletal disorders among construction apprentices in Hungary.

The purpose of this study was to determine the prevalence of occupationally related musculoskeletal disorder (MSD) symptoms and carpal tunnel syndrome (CTS) among construction apprentices in Hungary. Symptoms of occupational MSDs and the job factors contributing to the symptoms were determined through an administered symptom and job factors survey. The prevalence of CTS was based on a case definition that included hand symptoms and nerve conduction studies of the median nerve across the carpal tunnel. The participation rate was 96% among the 201 eligible construction apprentices. More than 50% of the apprentices reported occupationally related musculoskeletal symptoms in the previous 12 months. Job tasks that required awkward postures and working in a static position were the two factors that contributed most to MSD symptoms. No cases of CTS were found in this sample of apprentices. Although disorders of the musculoskeletal system are more prevalent among experienced construction workers, this study indicated that symptoms of MSDs are present among young construction workers. Assessing the magnitude and nature of occupational related MSDs is the first step in promoting a healthier, safer, and more efficient workforce.     

What is known about temperature and complaints in the upper extremity? A systematic review in the VDU work environment

Upper extremity musculoskeletal complaints and disorders are frequently reported among visual display units (VDU) workers. These complaints include cold forearms, hands or fingers. Objective: The aim of this systematic review was to gain an insight into the relationship between objective and subjective temperature decrease and musculoskeletal disorders (MSDs) in the upper extremity in a VDU work environment by (internal or external) cooling of the arm and hand. Two questions were formulated: (1) Is a VDU work environment (temperature between 15 and 25°C) associated with temperature decrease of the arm, hand or fingers in healthy subjects? (2) Is there a difference in arm, hand and finger temperature between patients with upper extremity MSDs and healthy subjects in a VDU work environment? Methods: Through a systematic literature search in six databases between 1989 and October 2005, 327 articles were retrieved and 17 included. Results: Forearm, hand and finger temperature significantly decreases when the ambient temperature (between 15 and 25°C) decreases. The skin temperature in the hand that uses a computer mouse is lower than the other hand in the same ambient temperature. At baseline, no objective temperature differences are found between patient groups and controls, whereas in patients with cold hand complaints, lower skin temperatures are found compared to controls. The association between temperature (changes) in the forearm, hand or fingers during VDU work, and MSDs in the upper extremity is not clear. Conclusion: There is no consistent evidence available for the association between upper extremity MSDs and temperature changes in forearm, hand or fingers in an office work environment.     

Prevalence of musculoskeletal symptoms and carpal tunnel syndrome among dental hygienists

BACKGROUND: Carpal tunnel syndrome (CTS) and other work-related musculoskeletal disorders (MSDs) are common problems in general industry as well as dental hygiene. The purpose of this study is to determine the prevalence of CTS and other MSDs among dental hygienists. No previous studies involving dental hygienists have combined nerve conduction studies (NCS) and symptoms in their CTS case definitions. METHODS: Dental hygienists (N = 95) completed a symptom and job factors survey, hand symptom diagram, and underwent NCS across the wrist. RESULTS: At least one MSD was reported by 93%. Prevalence of CTS was 8.4% utilizing a case definition of symptoms and NCS, but 42% if defined by symptoms alone. Age, BMI, and the number of patients treated per day were significant factors associated with CTS. CONCLUSIONS: Dental hygienists are exposed to occupational factors that increase the risk of CTS. A case definition that does not include NCS overestimates CTS prevalence.     

Perceived physical demands and reported musculoskeletal problems in registered nurses

BACKGROUND: Nursing is physically demanding, and nurses have higher rates of musculoskeletal disorders (MSDs) than most other occupational groups. The physical demands of nursing may lead some nurses to leave the profession, contributing to the shortage of registered nurses in many workplaces that is a major concern today. As a first step toward reducing MSDs and their consequences, this study was designed to examine the relationship between perceived physical demands and reported neck, shoulder, and back MSDs in nurses. METHODS: Data were collected anonymously from 1163 randomly selected working nurses (74% response rate) using a cross-sectional survey. The 12-item survey scale (internal reliability coefficient=0.89), rated perceived physical demands such as force, awkward postures, and heavy lifting. Nurses with a presumed MSD case reported relevant past-year symptoms in the neck, shoulder, and/or back lasting >or=1 weeks, or at least monthly, with moderate or more pain, on average. RESULTS: Moderate and high perceived physical demands were significantly associated with reported neck, shoulder, and back MSD cases, even after adjustments for demographic and lifestyle-related covariates. Adjusted odds ratios for highly demanding work (vs low) ranged from 4.98 to 6.13 depending on body site. When analyses were restricted to staff nurses only, the odds ranged from 9.05 to 11.99. CONCLUSIONS: Perceived physical demands are associated with reported MSD in registered nurses, and the association is stronger in staff nurses.