Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb

Objectives: To investigate potential interactions between physical and psychosocial risk factors in the workplace that may be associated with symptoms of musculoskeletal disorder of the neck and upper limb. Methods: 891 of 1514 manual handlers, delivery drivers, technicians, customer services computer operators, and general office staff reported on physical and psychosocial working conditions and symptoms of neck and upper limb disorders using a self administered questionnaire (59% return rate). Of the 869 valid questionnaire respondents, 564 workers were classified in to one of four exposure groups: high physical and high psychosocial, high physical and low psychosocial, low physical and high psychosocial, and low physical and low psychosocial. Low physical and low psychosocial was used as an internal reference group. The exposure criteria were derived from the existing epidemiological literature and models for physical and psychosocial work factors. The frequency and amplitude of lifting and the duration spent sitting while experiencing vibration were used as physical exposure criteria. Ordinal values of mental demands, job control, and social support with managers and coworkers were used as psychosocial exposure criteria. Results: In the multivariate analyses, the highest and significant increase in risk was found in the high physical and high psychosocial exposure group for symptoms of hand or wrist and upper limb disorders after adjusting for years at the job, age, and sex. A potential interaction effect was found for the symptoms of the hand or wrist and upper limb disorders but not for the neck symptoms. Conclusion: This study showed that workers highly exposed to both physical and psychosocial workplace risk factors were more likely to report symptoms of musculoskeletal disorders than workers highly exposed to one or the other. The results suggest an interaction between physical and psychosocial risk factors in the workplace that increased the risk of reporting symptoms in the upper limbs. Psychosocial risk factors at work were more important when exposure to physical risk factors at work were high than when physical exposure was low. Ergonomic intervention strategies that aim to minimise the risks of work related musculoskeletal disorders of the upper limb should not only focus on physical work factors but also psychosocial work factors.     

A cross-sectional study of risk factors for musculoskeletal symptoms in the workplace using data from the General Social Survey (GSS)

OBJECTIVE: Assessments of potential risk factors for musculoskeletal disorders (MSDs) from large, national study populations using personal interviews are critical to our understanding of exposure-response relationships. To address this need, we analyzed two outcome measures--self-reported back pain and upper extremity pain--from the quality of work life (QWL) module of the General Social Survey (GSS). We investigated several individual, psychosocial, and physical factors for their relationship to these outcome measures. METHODS: The study population included US adults, noninstitutionalized, English-speaking, aged 18 years or older, and employed at least part time (>or=20 hr/wk). Final sample size was 1484 workers. RESULTS: Variables of physical exposure significantly increased the risk of both low back pain and upper extremity pain. Multiple injuries and some psychosocial factors were associated with MSDs, and there was an additive effect on risk of MSDs with exposure to both physical exposure and work stress. CONCLUSIONS: A relationship between physical loads and musculoskeletal disorders was indicated by the results, which will enable creating a database for tracking reports of MSDs in the US working population.     

Musculoskeletal complaints among Italian X-ray technologists

The aim of this study was to determine the prevalence of musculoskeletal complaints among X-ray technologists and to examine their relationship with physical and psychosocial factors. A cross-sectional study was performed in 2006 among 203 X-ray technologists working in 13 hospitals in the Apulia region of southern Italy. A questionnaire was used to collect data on personal characteristics, physical workload, psychosocial aspects, and the presence of musculoskeletal symptoms in the neck, shoulders, low back, hand/wrist and legs. Univariate analyses and multiple logistic regression analyses were then performed. The prevalence of complaints at any body site in the previous 12 months was 67%. Low back pain was the most commonly reported symptom (59.6%), followed by shoulder (21.2%), neck (19.7%), leg (13.8%) and hand/wrist pain (12.3%). Age was associated with low back pain, while high physical workload was associated with symptoms in the neck, low back and hand/wrist. High job demands were associated with neck and shoulder pain. Overall, our study suggests high prevalence rates of musculoskeletal complaints may exist among Italian X-ray technologists. Physical workload, psychosocial and individual factors appear to be important risk factors for musculoskeletal disorders within this occupational group.     

Work characteristics and upper extremity disorders in female dental health workers

Many dental health workers suffer from musculoskeletal disorders in the upper extremities. In addition to ergonomic factors, psychosocial work characteristics have been linked to musculoskeletal disorders. The present cross-sectional study aimed at investigating how musculoskeletal disorders in the upper extremities (UED) and occupational position are related to work characteristics and general health problems in female dental health workers. Questionnaire data from dentists, dental hygienists and dental nurses (N=945) showed that 81% reported UED. Multivariate analysis of variance showed that dentists reported the highest levels of physical load and fatigue whereas dental nurses reported the lowest levels of influence at work. Irrespective of position, those with UED considered their physical and psychosocial work environment and their own health to be significantly poorer than did those without UED. A hierarchical multiple regression showed that the physical load of dentistry was most strongly related to UED. Despite improvements to the ergonomics and physical work environment of dentistry, it is concluded that female dental health workers are still at high risk of developing UED.     

Fish processing work: the impact of two sex dependent exposure profiles on musculoskeletal health

OBJECTIVES: To evaluate the impact of work tasks, physical exposure, and psychosocial factors on the risk of musculoskeletal disorders in men and women, in a defined industrial setting. METHODS: 116 male and 206 female fish industry workers were compared with 129 men and 208 women with more varied work. Physical and psychosocial work load as well as musculoskeletal complaints were recorded by a questionnaire. A physical examination was performed and an observation method was used for work evaluation. 196 male and 322 female former fish processing workers received a postal questionnaire. RESULTS: The women workers in the fish industry had worse working conditions than the men for repetitiveness, constrained neck postures, and psychosocial work environment. They also had higher prevalences of complaints of the neck and shoulder (prevalence odds ratio (POR) 1.9; 95% confidence interval (95% CI) 1.1 to 3.2), neck and shoulder and elbow and hand complaints (POR 2.9; 95% CI 1.8 to 4.7 and POR 2.8; 95% CI 1.6 to 4.7, respectively). The women more often than the men left the industry because of neck and upper limb complaints. Also, women in other work had a higher prevalence of complaints of the neck and shoulder (POR 2.3; 95% CI 1.1 to 5.1) than the men. The men in the fish processing industry had a higher prevalence of complaints of the neck and shoulder than the men in other work (POR 3.6; 95% CI 1.6 to 8.0). This difference was not shown up by the questionnaire. CONCLUSIONS: Despite superficially similar work, there were clear sex differences in physical exposure and psychosocial work environment. Work in the fish processing industry was associated with a high risk of neck and upper limb disorders in women, which was probably mainly due to their extremely repetitive work tasks; the corresponding men had less repetitive work and less disorders. Also, a healthy worker effect on neck and upper limb disorders was found. The advantage of a physical examination compared with a questionnaire is clearly shown.

 

     

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.     

心理因素及物理负荷对职业性肌肉骨骼疾患的影响分析

目的 探讨心理因素与物理负荷的交互作用及其对职业性肌肉骨骼疾患(WMSDs)的影响.方法 选取653名来源于电子行业流水线作业、缝纫行业、制造行业的工人及行政管理人员作为调查对象.采用改良的北欧国家肌肉骨骼疾患标准调查表调查肌肉骨骼疾患情况,心理社会状况调查采用工作内容量表(JCQ),进行流行病学横断面调查,并应用快速暴露检查法(QEC)问卷对其进行工效学的物理负荷评价.结果 不同暴露等级下,肩部、上背、下背、手/腕的肌肉骨骼疾患的年患病率的差异有统计学意义(P＜0.05或P＜0.01),同时暴露在高的物理和心理负荷时,工作人员各部位的年患病率明显高于暴露在其他等级时的肌肉骨骼疾患的患病率.调整工龄、年龄、性别后,用logistics回归分析结果表明,在肩部、上背、下背和手/腕部的WMSDs影响中可能存在物理负荷和心理负荷的交互作用(P＜0.05).结论 高物理负荷下,不良心理因素对工人WMSDs的发生造成的影响远大于工人处于低物理负荷工作时,实施工效学干预不仅要从过度负荷,不良姿势,静态负荷等物理因素方面进行干预来降低WMSD的发生,也要关注心理因素方面的干预.

Abstract：

Objective To investigate the interactive effect of job task and psychosocial factors on the outcomes of musculoskeletal disorders. Methods 653 workers from different type of manufacturing industries and administration office recruited in a cross-sectional epidemiological survey. The Quick Exposure Check (QEC) was applied to assess the ergonomic load of job task, Job Content Questionnaire (JCQ) for identifying psychological characteristics, and Nordic Standardized Questionnaire for investigating outcomes of WMSDs.Results The prevalence of WMSD in shoulder, upper back, lower back and hand/wrist were significantly different under a variety of combined job task and psychosocial characteristics (P＜0.05 or P＜0.01 ). The more physical and psychological loads, the higher prevalence of WMSDs were revealed. By using multivariate analyses, a potential interactive effect was found in terms of the WMSDs symptoms in hand/wrist shoulder,upper back and lower back after adjusted by work year, age, and gender. Conclusions Higher physical load and greater psychosocial risk are more frequent self-reported symptoms of WMSDs than those of lower exposures. Ergonomic intervention strategies aimed at reducing the incidence of WMSDs should not only be focused on control of physical work factors but also psychosocial risks of relevance.     

Musculoskeletal complaints, functional capacity, personality and psychosocial factors

OBJECTIVES: The aim of the research was to study the association between psychosocial and personality factors, and neck and wrist-hand musculoskeletal complaints, taking account of the occupational factors of force, posture and repetitiveness, and non-occupational risk factors such as sport, hobbies, medical history. METHODS: During personal interviews 133 women from seven different companies, working at constraining workplaces (very repetitive work), answered several questionnaires. These concerned: personal characteristics and history; work characteristics; psychosocial factors (perception and appreciation of the work situation, satisfaction at work, stress symptoms, Karasek questionnaire) and personality factors (neuroticism, conscientiousness, type-A behavior). They also undertook functional and psychomotor tests (wrist angles, grip strength and a dexterity test). Logistic regression models were calculated. RESULTS: Wrist-hand complaints appear to be associated with some personal characteristics (smoking habits, fewer hobbies), work constraints (fewer breaks, heavy lifting efforts) and some personality (introversion) and psychosocial factors (worse appreciation of work). Neck complaints are also associated with some personal characteristics (young people, small, bad health, hormonal problems, fewer hobbies), some personality (urgency of time) and psychosocial factors (constraints as seen by the supervisor). CONCLUSION: The study confirms the multifactorial character of the musculoskeletal disorders and underlines the need for a global ergonomic approach to work situations, taking into account all their physical, psychological and social components.     

Prevalence of musculoskeletal pain and associated factors in the Quebec working population

Background: While the determinants of musculoskeletal pain are numerous, few studies conducted among workers have taken into account, altogether, physical factors, psychosocial factors (personal and work-related) and individual characteristics. Objectives: To estimate the 1-year prevalence of musculoskeletal pain in the Quebec working population by gender and anatomical site, and to determine which factors are associated with these prevalence figures. Methods: Data came from the 1998 Quebec Health Survey and included 9,496 individuals. One-year period prevalences for neck pain, back pain and pain in the upper and lower extremities were calculated for men and women. Logistic regression analyses were conducted to estimate the associations between individual, physical and psychosocial work factors, on one hand, and musculoskeletal pain in the four body regions, on the other hand. Results: For both genders back pain was the most frequent musculoskeletal symptom that had disturbed their activities during the past year. The largest difference between genders was observed for neck pain (women: 18%; men: 11%). Multivariate analyses indicated that physical and psychosocial work factors, as well as psychological variables, were associated with musculoskeletal pain in different body regions. Body mass index was associated only with pain in lower extremities for both genders. Conclusions: The results of this study suggest that interventions aimed at reducing musculoskeletal pain should take into account personal and work-related psychosocial variables, in addition to physical workload.     

Ergonomics, musculoskeletal disorders and computer work

This review summarizes the knowledge regarding ergonomics and musculoskeletal disorders and the association with computer work. A model of musculoskeletal disorders and computer work is proposed and the evidence and implications of the model together with issues for future research is discussed. The model emphasizes the associations between work organization, psychosocial factors and mental stress on the one hand and physical demands and physical load on the other. It is hypothesized that perceived muscular tension is an early sign of musculoskeletal disorder, which arises as a result of work organizational and psychosocial factors as well as from physical load and individual factors. It is further hypothesized that perceptions of exertion and comfort are other possible early signs of musculoskeletal disorders in computer work. Interventions aimed at reducing musculoskeletal disorders due to computer work should be directed at both physical/ergonomic factors and work organizational and psychosocial factors. Interventions should be carried out with management support and active involvement of the individual workers.     

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study

Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain.

Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for musculoskeletal disorders. Workers from 21 companies located throughout The Netherlands participated in the part of this study on sickness absence due to low back pain. The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period. The mean (range) period of follow up in this group was 37 (7–44) months. Physical load at work was assessed by analyses of video recordings. Baseline information on psychosocial work characteristics was obtained by a questionnaire. Data on sickness absence were collected from company records. The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period.

Results: After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants, significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion, trunk rotation, lifting, and low job satisfaction. A dose-response relation was found for trunk flexion, but not for trunk rotation or lifting. Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support. Quantitative job demands, conflicting demands, decision authority, and skill discretion showed no relation with sickness absence due to low back pain.

Conclusions: Flexion and rotation of the trunk, lifting, and low job satisfaction are risk factors for sickness absence due to low back pain. Some indications of a relation between low social support, either from supervisors or coworkers, and sickness absence due to low back pain are also present.

     

Interactions between physical and psychosocial risk factors at work increase the risk of back disorders: an epidemiological approach

OBJECTIVES: To investigate the possible interactions between physical and psychosocial risk factors at work that may be associated with self reported back disorders. METHODS: 891 of 1514 manual workers, delivery drivers, technicians, customer services computer operators, and general office staff reported risk factors at work and back disorders with a self administered questionnaire (59% return rate). Of the 869 respondents with a valid questionnaire, 638 workers were classified in to one of four exposure groups: high physical and high psychosocial; high physical and low psychosocial; low physical and high psychosocial; and low physical and low psychosocial. Low physical and low psychosocial was used as an internal reference group. The exposure criteria were derived from existing epidemiological publications and models for physical and psychosocial work factors. The frequency and amplitude of lifting and the duration spent sitting while experiencing vibration were used as physical exposure criteria. Ordinal values of mental demands, job control, and social support from managers and coworkers were used as psychosocial exposure criteria. RESULTS: The highest increase in risk was found in the high physical and high psychosocial exposure group for symptoms of back disorders. In the crude and multivariate analyses, a departure from an additive risk model was found for the 7 day prevalence of symptoms of a low back disorder and also for a recurrent back disorder not present before the current job but also experienced in the past 7 days. CONCLUSION: This study suggests that an interaction between physical and psychosocial risk factors at work may exist to increase the risk of self reported back disorders. Ergonomic prevention strategies that aim to minimise the risks of symptoms of work related back disorders should not only focus on physical but also on psychosocial risk factors at work. The greatest benefits are likely to be realised when both physical and psychosocial factors are put right.       

不良工效学因素对缝纫女工的健康效应调查

目的 探讨缝纫女工不良工效学因素与肌肉骨骼效应的关系。方法 采用作业场所工效学分析、劳动姿势评价系统和问卷调查方法对某服装厂缝纫车间进行了不良工效学暴露因素评价和肌肉骨骼症状调查。结果 缝纫女工不良工效学因素包括体力劳动高、工作姿势和动作不良、劳动受限程度大、劳动重复性高、噪声强等。其不良复合姿势达84．2％,有害和非常有害的复合姿势达3．2％;女工肩部、手臂和腰背的疼痛患病率分别是48．0％、30．7％、72．0％,且91．8％的腰背痛发生于工作时间,均明显高于对照组。结论 不良工效学因素与肌肉骨骼疾患高发有一定关系。     

Differences in physical workload,psychosocial factors and musculoskeletal disorders between two groups of female hospital cleaners with two diverse organizational models

Objectives To clarify if differences in the physical workload, the psychosocial factors and in musculoskeletal disorders can be attributed to work organizational factors. Methods The physical workload (muscular activity of m. trapezius, positions and movements of the head, upper arms and wrists and heart rate) was assessed in 24 female hospital cleaners working in a traditional work organization (TO) and in 22 working in an extended one (i.e. with an enlarged work content and more responsibilities; EO). The psychosocial work environment was assessed as job demand, decision latitude and social support in 135 (TO) and 111 (EO) cleaners, and disorders of the neck and upper extremity by a physical examination. Results The EO group was associated with lower physical workload, in terms of heart rate ratio (23 vs 32; P < 0.001), head and upper arm positions and movements (right upper arm, 50th percentile, 35°/s vs 71°/s; P < 0.001) and wrist movements (20°/s vs 27°/s; P = 0.001), than the TO group. The EO group reported higher decision latitude and lower work demand than the TO one, while we found no difference in social support. The prevalence of complaints and diagnoses in neck/shoulders were lower in the EO group (diagnoses 35% vs 48%; P = 0.04). Moreover, the prevalence of subjects with at least ten physical finding in elbows/hands was lower in the EO group (10 vs 29; P < 0.001). Conclusion Hospital cleaners have a high prevalence of neck and upper limb disorders and a high physical workload. Comparing two groups of cleaners, with differences in the way of organizing the work, lower physical workload, more beneficial psychosocial factors and a better musculoskeletal health was found in the group with an extended organization. Hence, the differences found can be attributed to the organizational factors.     

A prospective study of psychosocial risk factors and absence due to musculoskeletal disorders--implications for occupational screening

OBJECTIVES: There is considerable evidence documenting the association between psychosocial risk factors and work disability due to musculoskeletal disorders, and this has prompted suggestions that psychosocial screening should be administered in the workplace in order to identify individuals at risk of prolonged absence. However, the predictive value of psychosocial risk factors on return-to-work is largely unknown. The present study aimed to explore the predictive relationship between psychosocial risk factors and absence due to musculoskeletal disorders of the lower back and upper limbs. METHODS: A prospective study of 4637 workers from a large, multi-site company in the UK was conducted in which a wide range of established questionnaires were used to collect baseline psychosocial data. Respondents were then followed over the ensuing 15 months, and absence due to musculoskeletal disorders was recorded. RESULTS: 219 workers took absence due to musculoskeletal disorders. Detrimental cut-off scores (risks) on the psychosocial instruments were established, and it was found that work-related psychosocial risk factors predicted the likelihood of a future spell of absence (odds ratios ranging between 1.6 and 3.2), but not the duration of that absence. CONCLUSIONS: Although work-related psychosocial factors were associated with the occurrence of absence due to musculoskeletal disorders, these findings do not lend support to the use of routine occupational psychosocial screening in order to predict prolonged absence.     

Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople.

OBJECTIVES: To analyse the association between symptoms from the musculoskeletal system and many psychosocial and other physical stressors in the job demand-control-support model. Also to analyse the influence of personality characteristics. METHODS: 1306 salespeople answered a self administered questionnaire on job characteristics, exposures, personality characteristics, social network, smoking and drinking habits, and symptoms of the neck, shoulders, and low back. RESULTS: In multivariate analyses, high job demands were related to neck and shoulder symptoms (ORs 1.43-1.47 in the highest exposure groups compared with the lowest), and tendency to become overworked and lack of social support from colleagues were related to back pain (OR 1.81-2.04 in the highest exposure groups compared with the lowest). Lack of variation in the job, low control over time, and high competition were related to neck symptoms, but there was an interaction so that both low control over time and high competition had to be present to increase the OR. Also, driving long distances and sedentary work were related to neck and low back pain, and time spent in the car to shoulder pain (ORs 1.64-2.80 in the three highest groups v the lowest exposure groups). CONCLUSION: Both psychosocial and physical factors were associated with musculoskeletal symptoms. Many dimensions of the demand-control-support model were associated with symptoms. Only one personality characteristic, tendency to feel overworked, significantly influenced the prevalence of musculoskeletal symptoms.     

Work-related Musculoskeletal Symptoms in Surgeons

Introduction Surgeons are a unique group of healthcare professionals who are at risk for developing work-related musculoskeletal symptoms (WMS). The diversity of operating skills for laparoscopic and endovascular procedures impose different physical demands on surgeons, who also work under time pressure. The present study aims to examine the physical and psychosocial factors and their association with WMS among general surgeons in Hong Kong. Method A survey was conducted among surgeons working in the General Surgery departments in public hospitals of Hong Kong. Over 500 questionnaires were mailed and 135 surgeons completed the survey successfully (response rate 27%). Questions included demographics, workload, ergonomic and psychosocial factors. The relationship of these factors with WMS symptoms in the past 12 months was examined. Results Results indicated a high prevalence rate of WMS symptoms in surgeons, mainly in the neck (82.9%), low back (68.1%), shoulder (57.8%) and upper back (52.6%) regions. Sustained static and/or awkward posture was perceived as the factor most commonly associated with neck symptoms by 88.9% of respondents. Logistic regression showed the total score for physical ergonomic factors was the most significant predictor for all 4 body regions of musculoskeletal symptoms, with OR of 2.028 (95%CI 1.29–3.19) for the neck, 1.809 (1.34–2.43) for shoulder and 1.716 (1.24–2.37) for the lower back. Workstyle score was significantly associated with the symptom severity in the low back region (P = .003) but not with the other regions. Conclusion These results confirmed a strong association of physical and psychosocial factors with the musculoskeletal symptoms in surgeons. There is a potential for such musculoskeletal symptoms to escalate in the future, with rapid advances and increasing application of minimally invasive surgery.     

Work-schedule characteristics and reported musculoskeletal disorders of registered nurses

OBJECTIVES: The relationship between a combination of demanding work-schedule characteristics and reported musculoskeletal disorders of the neck, shoulders, and back was examined. METHODS: A probability sample of 1163 nurses, randomly selected from the list of actively licensed nurses in two states of the United States, served as the sample for this cross-sectional study. Data were collected via an anonymous survey mailed to the participants' homes from October 1999 through February 2000. RESULTS: Four of the nine work-schedule characteristics (working full-time, >8 hours/day, 2-4 weekends/month, and other than day shift) were significantly related to musculoskeletal disorders in one or more body sites. When a work-schedule index was created by summing the nine characteristics, a demanding schedule was significantly associated with musculoskeletal disorders in the neck [odds ratio (OR) 1.10, 95% confidence interval (95% CI) 1.00-1.21], shoulder (OR 1.12, 95% CI 1.01-1.23), and back (OR 1.16, 95% CI 1.06-1.27). Adjustment for psychological and physical job demands reduced the odds ratios slightly and therefore suggested that some of the association between musculoskeletal disorders and schedule was due to increased exposure to these job demands. Working "long hours" (>12 hours/day, >40 hours/week) and "off hours" (weekends and "other than day shifts") were associated with a 50-170% increase in the age-adjusted odds ratio for musculoskeletal disorders in the three body sites. CONCLUSIONS: The findings of this study suggest that preventing musculoskeletal disorders requires system-level approaches to scheduling that reduce the time of exposure to demanding work conditions and promote healthful work-rest patterns.     

Identifying Work Organization Targets for a Work-Related Musculoskeletal Symptom Prevention Program

While research linking work organization factors to work-related musculoskeletal disorders has been increasing, there is still a need to delineate specific dimensions to be targeted by intervention programs. The present cross-sectional investigation identified work organization risk factors for low back (LB) and upper extremity (UE) symptoms and determined the magnitudes of such associations. Questionnaires containing items on ergonomic, individual psychosocial, and occupational psychosocial factors were administered to a sample of workers (n = 248 U.S. Marines) in previously identified high-risk job categories for musculoskeletal disorders. Study participants were categorized into groups of either having LB symptoms only, UE symptoms only, concurrent LB and UE symptoms, or being asymptomatic on the basis of self-report. Additionally, measures of pain intensity, physical function, and mental health were obtained. Linear regression analyses adjusting for demographics, ergonomic factors, and individual psychosocial factors indicated that decision authority and experienced responsibility for work were significant correlates for pain intensity during the week. Logistic regression analyses indicated that ergonomic stressors were a risk factor for all symptomatic groups (OR = 1.02 per point increase; 95% CI: 1.0-1.1). Time pressure (OR = 1.2 per point increase; 95% CI: 1.0-1.4) was also a significant risk factor for all symptomatic groups, while cognitive processing placed workers at higher risks for concurrent LB and UE symptoms (OR = 1.2; 95% CI: 1.0-1.4). Interpersonal demands placed individuals at a lower risk for LB symptoms (OR = 0.8; 95% CI: 0.5-1.0). Findings highlight the importance of intervention approaches that address time pressure, cognitive processing factors, and interpersonal demands at work. In light of past biobehavioral studies, these results also suggest that job redesign and interventions that address a worker's workstyle when faced with increased work demands may help reduce the likelihood of musculoskeletal symptoms and/or their intensity.     

Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals

OBJECTIVES: To investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of the lower back, neck and shoulders. METHODS: In this cross-sectional study a questionnaire survey was carried out among 351 nursing personnel (response 84%) in six general hospitals in Athens, Greece. A questionnaire was used on physical and psychosocial workload, need for recovery, perceived general health and (1) the occurrence of musculoskeletal complaints in the past 12 months, (2) chronic complaints during at least 3 months, and (3) complaints which led to sickness absence. In logistic regression analysis odds ratios (ORs) were estimated for all relevant risk factors. RESULTS: Self-reported factors of physical load were associated with the occurrence of back pain (OR=1.85), neck pain (OR=1.88), and shoulder pain (OR=1.87) but these factors were not associated with chronic complaints and musculoskeletal sickness absence. Physical load showed a trend with the number of musculoskeletal complaints with ORs of 2.47 and 4.13 for two and three musculoskeletal complaints, respectively. No consistent influence of psychosocial factors on complaints, chronicity, or sickness absence was observed. A perceived moderate general health was also a risk factor, and strongest associations were observed for sickness absence due to back pain (OR=2.03), neck pain (OR=8.31), and shoulder pain (OR=6.84). CONCLUSIONS: The handling of physical loads among nurses seems to put them at risk for the occurrence of musculoskeletal disorders. The development of these complaints into chronic complaints and associated sickness absence is strongly determined by perceived general health and almost not associated with work-related physical and psychosocial risk factors. When the influence of work-related risk factors on musculoskeletal health is being investigated, the general health status of individual workers should be taken into account.