Modelling workplace stressors, emotional distress, and work engagement factors as predictors of work related musculoskeletal disorders among public hospital nurses in the Klang Valley, Malaysia’

Abstract

Introduction: Work-related musculoskeletal disorders (WRMSDs) are important occupational illnesses. Nurses are among the professionals at high risk of WRMSDs. WRMSDs have significant impact and repercussion not only on the workers involved, but also on the organization and society. To date, only a few studies have examined the prevalence and risk factors of WRMSDs among nursing professionals in Malaysia. Objectives: The aim of this study was to determine the (1) prevalence of WRMSDs; and (2) potential predictors [workplace stressors (psychosocial and physical), emotional distress (depression, anxiety and stress) and work engagement (vigour, dedication and absorption)] of WRMSDs among nurses working in public hospitals in the Klang Valley, Malaysia. Methods: A cross-sectional study was conducted among female nursing personnel from four public hospitals in the Klang Valley, Malaysia using a self-administered Malay translated and validated questionnaire survey. The validated Malay version of the Standardised Nordic Musculoskeletal Questionnaire (M-SNMQ) was used to determine the annual prevalence of WRMSDs while the workplace stressors (psychosocial and physical) was assessed using Karasek’s validated Malay version of the Job Content Questionnaire (M-JCQ). The emotional distress was assessed using the validated Malay version of the Depression, Anxiety and Stress Scale (M-DASS). Level of work engagement was evaluated using the validated Malay version of the Utrecht Work Engagement Scale (M-UWES). The socio-demographic and occupational information were also obtained from the nurses. Factors associated with WRMSDs were identified using univariate and multivariate logistic regressions. A structural equation modelling (SEM) analysis was applied to test the structural relationships of the model using AMOS version 22, with the maximum likelihood ratio as the method of estimation. Results: A total of 550 out of 660 nurses returned the questionnaire (response rate: 83.3%). Of this, only data from 376 nurses were included for overall analysis. The study indicated that the annual prevalence of WRMSDs was 73.1%. WRMSDs in the neck (48.9%) was the most prevalent followed by feet (47.2%), upper back (40.7%) and shoulders (36.9%). The least complaint was received for the arms/elbows (6.6%). In order to extend the statistical analysis further, the body regions were categorized into four anatomical regions. Similar trend was also documented with approximately half of the studied nursing population had WRMSDs in region 1(neck and shoulders), region 3 (upper and lower back) and region 4 (hips, knees, ankles, and feet), while only 26.1% of the nurses developed WRMSDs in region 2 (wrists, arms and hands). Less than 25% of the nurses agreed that WRMSDs affected their quality of life. After adjustment, the results of the multiple logistic regression analysis revealed that workplace stressors (high psychological job demand, low job control, poor social support, and high physical demand) were amongst significant workplace stressors of WRMSDs in different body regions. Also, nurses reporting significant emotional distress (stress, anxiety, and depression) were at risk of WRMSDs in various body regions. Meanwhile, work engagement (vigour, dedication, and absorption) significantly reduced the risk of WRMSDs in all body regions. When all significant factors (cut-off p<0.10) were examined in the final model for each body region, the results indicated that psychological job demand, physical demand, stress, and work engagement significantly predicted WRMSDs in different body regions. The findings also revealed mediating effects of work engagement on the relationship between job control and social support on WRMSDs, respectively. Interestingly, stress also showed mediating effects on the relationship between social support, psychological job demand and physical demands on WRMSDs. Conclusions: The present results suggest that WRMSDs are highly prevalent among public hospital nurses in Malaysia. However, only a minority of the nurses were aware that WRMSDs affected their quality of life. The results suggest that more attention should be given to work-related psychological job demand, physical demand, and stress while addressing the significant role of vigour (work engagement) in ameliorating these negative influences on the WRMSDs among these nurses. The findings have important implications for future longitudinal studies and also in determining interventional programs to be implemented for the prevention and control of WRMSDs in the hospital settings