Work-related Psychosocial Factors Research Articles

Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals.

To investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of the lower back, neck and shoulders. 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. 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). 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.

Risk factors for new-onset low back pain amongst cohorts of newly employed workers.

To test the hypothesis that work-related mechanical, psychosocial and physical environment factors would predict new-onset low back pain (LBP) in newly employed workers. A total of 1186 newly employed workers were recruited from a variety of occupational settings. Those who were free from LBP at baseline were identified. Subjects were followed up at 12 and 24 months. Work-related mechanical, psychosocial and physical environment exposures were measured. Generalized estimating equations were used to assess predictors of new-onset LBP. New-onset LBP was reported by 119 (19%) and 81 (19%) subjects at 12 and 24 months, respectively. Several work-related mechanical exposures predicted new-onset LBP including lifting heavy weights with one or two hands, lifting heavy weights at or above shoulder level, pulling heavy weights, kneeling or squatting for 15 min or longer. Of the psychosocial factors examined, stressful and monotonous work significantly predicted symptom onset. In addition, hot working conditions and pain at other sites also predicted new-onset LBP. On multivariate analysis these risks were only moderately attenuated but the 95% confidence intervals excluded unity only for the latter, non-mechanical, exposures. In this cohort of newly employed workers, from a range of occupations, several aspects of the work-place environment, other than mechanical factors, were important in predicting new-onset LBP. These results emphasize that interventions aimed at reducing the occurrence of LBP are likely to be most successful if they intervene across these domains.

Physical and Psychosocial Work-related Risk Factors Associated with Neck–Shoulder Discomfort in Male and Female Music Teachers

The aim of this cross-sectional study was to investigate the relationship between individual, physical, and psychosocial aspects of the work environment and musculoskeletal discomfort in the neck-shoulder region, in male and female music teachers. A questionnaire was distributed by mail that was based on the Standardised Nordic Questionnaire on work-related musculoskeletal disorders (WMSD) and the demand-control-support questionnaire on psychosocial work factors. The questionnaire included additional items on playing habits, weekly amount of performing and practice time, physical exercise during leisure time, perceived general health, and physical workload. The study population consisted of all music teachers employed at all 23 municipality music schools in the northern region of Sweden. Out of 287 music teachers, 208 (72.5%) agreed to participate, 88 women and 120 men. Multiple logistic regression analyses were used to examine the role of exposure factors in relation to the risk of discomfort in the neck-shoulder area. All analyses were performed separately for women and men, adjusting for age. Of the total number of participants, 82% reported that they had experienced discomfort during the preceding 12 months. The female teachers reported significantly more symptoms in the neck (p = 0.02), the shoulders (p = 0.02), and the upper back (p = 0.00) compared with the male teachers. In the multiple logistic regression analyses, neck-shoulder discomfort during the previous 7-day period was associated with both physical and psychosocial work factors. The risk association patterns were different between the female and male music teachers. The strongest risk factors for women were high psychological demands (OR 6.0, CI 1.1-32.4) and teaching at many schools (OR 4.8, CI 1.0-24.4). For men, lifting (OR 8.7, CI 2.1-34.8), playing the guitar (OR 6.0, CI 1.5-23.6), and low social support (OR 3.1, CI 1.0-9.7) were the strongest risk factors.

The work environment and workers' health in four large office buildings.

We conducted a 1-year epidemiologic study in Boston, Massachusetts, beginning May 1997, to examine the associations between environmental factors and office workers' health. We recruited 98 subjects (81 females and 17 males) in 21 offices in four office buildings. We conducted environmental sampling every 6 weeks and concurrently administered detailed questionnaires to collect information on work-related symptoms, psychosocial factors, and perceptions of the office environments. In multivariate analyses, eye irritation was positively correlated with floor dust [odds ratio (OR) = 1.46; 95% confidence intervals (CI), 1.14-1.86] and reported lack of office cleanliness (OR = 1.52; 95% CI, 1.11-2.08). Nonspecific symptoms were positively associated with unidentified chair fungi (OR = 1.87; 95% CI, 1.11-3.15) and several self-reported conditions, including a history of asthma (OR = 3.15; 95% CI, 1.26-7.87), more people in offices (OR = 1.71; 95% CI, 1.16-2.51), lack of office cleanliness (OR = 2.85; 95% CI, 1.72-4.73), and low job satisfaction (OR = 1.72; 95% CI, 1.06-2.81). Upper respiratory symptoms were positively associated with total fungal concentrations recovered from chair dust (OR = 1.35; 95% CI, 1.07-1.70) and the following self-reported conditions: more people in offices (OR = 1.45; 95% CI, 1.01-2.08), lack of office cleanliness (OR = 1.62; 95% CI, 1.15-2.30), and jobs frequently requiring hard work (OR = 1.43; 95% CI, 1.05-1.95). This study emphasizes the importance of maintaining a clean, uncrowded workspace and the importance of chair fungi as a correlate for health effects.

Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patients

The aims of this study were to assess the prevalence of temporomandibular joint related (TMJ) painless symptoms, orofacial pain, neck pain, and headache in a Finnish working population and to evaluate the association of the symptoms with psychosocial factors. A self-administered postal questionnaire concerning items on demographic background, employment details, perceived general state of health, medication, psychosocial status, and use of health-care services, was mailed to all employees with at least 5 years at their current job. The questionnaire was completed by 1339 subjects (75%). Frequent (often or continual) TMJ-related painless symptoms were found in 10%, orofacial pain in 7%, neck pain in 39%, and headache in 15% of subjects. Females reported all pain symptoms significantly more often than men (P < 0.001). Frequent pain and TMJ-related symptoms were significantly associated with self-reported stress, depression, and somatization (P < 0.001). Perceived poor general state of health (P < 0.001), health care visits (P < 0.001), overload at work (P < 0.001), life satisfaction (P < 0.05), and work satisfaction (P < 0.05) were also significantly associated with pain symptoms, but the work duty was not (P > 0.05). Our findings are in accordance with earlier studies and confirm the strong relationship between neck pain, headache, orofacial pain, TMJ-related painless symptoms, and psychosocial factors. Furthermore, TMJ-related symptoms and painful conditions seem to be more associated with work-related psychosocial factors than with type of work itself.

Work-related psychosocial factors and carotid atherosclerosis.

In order to better understand the role of work environment in the earlier stages of the cardiovascular disease process, we wanted to investigate the influence of work-related psychosocial factors on preclinical atherosclerosis. Cross-sectional data was used to examine the association between psychological job demands, job decision latitude, and carotid atherosclerosis in 2658 vocationally-active Swedish men and women, ages 46-65, from the general population. Odds ratios of carotid plaque prevalence and carotid artery intima-media thickness (IMT), determined by B-mode ultrasound, were estimated across combinations of job demands and decision latitude. Women in job situations with high demands and low decision latitude ('job strain') showed a high plaque prevalence odds (odds ratio [OR] = 1.68, 95% CI: 1.14, 2.48), and a thicker IMT in the carotid bifurcation area (mean difference: 0.15 mm, 95% CI: 0.07, 0.23) compared with women in job situations with low demands and high decision latitude ('relaxed'). Adjustment for covariates only slightly reduced the magnitude of these associations. No such associations were seen in men. However, women in job situations with high demands and high decision latitude ('active') also showed high odds for carotid plaque, and a thicker IMT in the carotid bifurcation, compared with women in 'relaxed' job situations. In men, those in 'active' job situations had a low carotid plaque prevalence odds, while IMT in the carotid bifurcation did not differ from those in 'relaxed' job situations. Results showed only weak associations with IMT in the common carotid artery (CCA) in both men and women. The specific hypothesis that high job demands interact synergistically with low decision latitude in the development of carotid atherosclerosis could not be supported in this study, neither in men nor in women. Instead a more complex pattern of interaction between job demands and decision latitude was shown.

Pushing and pulling in association with low back and shoulder complaints

Aims: To examine the association between exposure to pushing/pulling at work and low back and shoulder complaints. Methods: A cross sectional questionnaire survey was carried out among 434 workers from...

Work-related psychosocial, physical and individual factors associated with musculoskeletal symptoms in computer users

The aim of this study was to study associations between psychosocial, physical and individual factors, and musculoskeletal symptoms in the neck, shoulder and hand/wrist regions of computer users. Questionnaires were distributed to 5033 employees in 11 Danish companies; these employees all used computers for at least some of their work time. The response rate was 69% ( n = 3475). The analyses were based on employees working 32-41 h/week ( n = 2579). Symptomatic respondents reported symptoms for at least 8 days within the previous year. Multiple logistic regression analyses were used. Gender (female), age and duration of employment in the same job were associated with an increased prevalence of symptoms. High quantitative job demands and low possibilities for development at work were predictors of neck and hand/wrist symptoms. A high degree of repetitiveness and disturbing reflections on the computer screen were associated with symptoms in all three body regions. Repetitive movements were defined as the same finger, hand or arm movements performed many times per minute for at least 75% of their work time. Repetitiveness was the only factor that could partly explain associations between symptoms and duration of computer use, i.e. respondents who used the computer almost all the time at work reported more repetitive movements than those who used it less. Thus, long hours of computer use may be associated with musculoskeletal symptoms, due to physical factors such as repetitive movements, whereas psychosocial factors appeared to be associated with the symptoms independently of the duration of computer use.

High quantitative job demands and low coworker support as risk factors for neck pain: results of a prospective cohort study.

A 3-year prospective cohort study among 1334 workers was conducted. To determine whether the work-related psychosocial factors of quantitative job demands, conflicting job demands, skill discretion, decision authority, supervisor support, coworker support, and job security are risk factors for neck pain. Among the various risk factors for neck pain, work-related psychosocial factors play a major role. Previous studies on risk factors for neck pain often had a cross-sectional design, and did not take both physical and psychosocial factors into account. At baseline, data on work-related psychosocial factors were collected by means of a questionnaire. During the 3-year follow-up period, data on the occurrence of neck pain were collected by means of postal questionnaires. Individuals without neck pain at baseline were selected for the analyses. Cox regression analysis was applied to examine the relation between the work-related psychosocial factors and the cumulative incidence of neck pain. Adjustments were made for various physical factors and individual characteristics. The analysis included 977 patients. Altogether, 141 workers (14.4%) reported that they had experienced neck pain at least once during the 3-year follow-up period. The relation of neck pain to high quantitative job demands (relative risk [RR], 2.14; 95% confidence interval [CI], 1.28-3.58) and low coworker support (RR, 2.43; 95% CI, 1.11-5.29) was statistically significant. An increased risk was found for low decision authority in relation to neck pain (RR, 1.60; 95% CI, 0.74-3.45), but this relation was not statistically significant. High quantitative job demands and low coworker support are independent risk factors for neck pain. There are indications that another risk factor for neck pain is low decision authority.

The influence on seeking care because of neck and shoulder disorders from work-related exposures.

The aim of this study was to assess the influence of work-related physical and psychosocial factors on seeking care for neck or shoulder disorders among men and women in a general working population. The study population comprised gainfully employed (>17 hours per week) men and women in the municipality of Norrtälje, altogether 392 cases and 1,511 controls. Cases were defined as persons seeking care because of neck or shoulder disorders by any caregiver in the region. The study began in 1994 and continued to 1997. We assessed physical and psychosocial exposures by questionnaires and interviews. The pattern of seeking care for neck or shoulder disorders differed between men and women. Among men, work with vibrating tools [relative risk (RR) = 1.6], not having a fixed salary (RR = 1.9), and low demands in relation to competence (RR = 1.5) were the strongest risk indicators obtained in analyses stratified for age and previous symptoms. Among women, repetitive hand or finger movements (RR = 1.6), constrained sitting (RR = 1.6), not having a fixed salary (RR = 2.0), and solitary work (RR = 1.8) were the strongest risk indicators. A large proportion of the general population was exposed to several of these moderately harmful conditions, and their concomitant effect may explain the high incidence of neck and shoulder disorders in the general working population.

NO SIGNIFICANT DIFFERENCES BETWEEN INTERVENTION PROGRAMMES ON NECK, SHOULDER AND LOW BACK PAIN: A PROSPECTIVE RANDOMIZED STUDY AMONG HOME-CARE PERSONNEL

The effects of two different prevention programmes on: (1) reported neck, shoulder and back pain, (2) perceived physical exertion at work and perceived work-related psychosocial factors, were evaluated by questionnaires after 12 and 18 months. Female nursing aides and assistant nurses (n = 282) working in the home-care services, were randomly assigned to one of three groups for: (1) individually designed physical training programme, (2) work-place stress management, (3) control group. Results revealed no significant differences between the three groups. However, improvements in low back pain were registered within both intervention groups for up to 18 months. Perceived physical exertion at work was reduced in the physical training group. Improvements in neck and shoulder pain did not differ within the three groups. Dissatisfaction with work-related, psychosocial factors was generally increased in all groups. As the aetiology of neck, shoulder and back disorders is multifactorial, a combination of the two intervention programmes might be preferable and should be further studied.

Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study

Objective: To determine the aetiology of forearm pain. In particular to determine the relative contribution of (a) psychological factors, features of somatisation, and health anxiety and behaviour, (b) work related...

Systematic review of psychosocial factors at work and private life as risk factors for back pain.

A systematic review of observational studies. To assess whether psychosocial factors at work and in private life are risk factors for the occurrence of back pain. Several reviews on risk factors for back pain have paid attention to psychosocial factors. However, in none of the published reviews was a strict systematic approach used to identify and summarize the available evidence. A computerized bibliographical search of several databases was performed, restricted to studies with a cohort or case-control design. A rating system was used to assess the strength of the evidence for various factors, based on the methodologic quality of the studies and the consistency of the findings. Eleven cohort and two case-control studies were included in this review. Strong evidence was found for low social support in the workplace and low job satisfaction as risk factors for back pain. Insufficient evidence was found for an effect of a high work pace, high qualitative demands, low job content, low job control, and psychosocial factors in private life. Evidence was found for an effect of low workplace social support and low job satisfaction. However, the result for workplace social support was sensitive to slight changes in the rating system, and the effect found for low job satisfaction may be a result of insufficient adjustment for psychosocial work characteristics and physical load at work. In addition, the combined evaluation of job content and job control, both aspects of decision latitude, led to strong evidence of a role for low job decision latitude. Thus, based on this review, there is evidence for an effect of work-related psychosocial factors, but the evidence for the role of specific factors has not been established yet.

Multicomponent Intervention for Work-Related Upper Extremity Disorders

Although several multidimensional models have emerged to explain the development, exacerbation and maintenance of work-related upper extremity disorders and disability, there is a paucity of data on the application of these models for the development of worksite-based prevention and management programs. Sign language interpreting is an occupation associated with increased risk for upper extremity symptoms. Ergonomic, work organization, work style, and work-related and individual psychosocial factors have been demonstrated to play a role in the exacerbation of symptoms and lost time in this group. Therefore, it was hypothesized that an intervention directed at reducing the impact of these factors would be associated with reductions in the number of upper extremity cases/year and associated lost time and health care costs in a group of full-time sign language interpreters. Subjects included 53 symptomatic and asymptomatic interpreters working at the National Technical Institute for the Deaf. The intervention (eleven 1.5-hr group sessions) was designed to 1) reduce musculoskeletal overexertion by reducing workload and biomechanical strain, while increasing flexibility and endurance through tailored exercise and preinterpreting “warm ups,” 2) improve the ability of workers to manage job stress and musculoskeletal pain, 3) reduce biomechanical exposure through work organization and work style changes, 4) alter organizational sources of stress by improving supervisor's managerial skills to address work related upper extremity problems and provide increased supervisor support, and 5) educate workers and supervisors regarding the optimal utilization of health care resources, given the present state of the art in terms of clinical evaluation and management. Results indicated a 69% reduction in the number of cases reporting upper extremity problems in the 3 years following the intervention. Indemnity costs were reduced by 64% and were maintained over the next 2 years. Health care costs followed a similar, although smaller magnitude, change. Despite this reduction, a partial rebound in all outcome measures was observed in Year 3 postintervention. This rebound followed a progressive increase in workload over the 3-year follow-up period.

Method for retrospective collection of work-related psychosocial risk factors for musculoskeletal disorders: Reliability and aggregation.

Information on psychosocial work conditions during a 24-year period for 484 participants was collected retrospectively. Analyses were made of the interrater reliability, stability, specificity, and aggregation of data. The main finding was that it is possible to collect reliable information about psychosocial work conditions retrospectively for a long period of years when using a time ruler in a structured interview when earlier conditions are compared with the present. Interrater agreement was satisfactory for the larger part of the studied retrospective psychosocial risk factors and excellent for some of them. For most of the studied risk factors, the risk of overreporting exposure was low. The aggregation of data resulted in 2 indexes: poor social relations at work and low influence over work conditions. In conclusion, an individual time ruler works satisfactorily as a method of collecting retrospective information about psychosocial risk factors.

Dyspepsia in relation to Helicobacter pylori infection and psychosocial work stress in white collar employees

Objective: We undertook an investigation of the relationship between psychosocial work stress and Helicobacter pylori ( H. pylori) infection with dyspepsia. Methods: We conducted a cross-sectional study among 189 employees of a health insurance company in the city of Ulm, Germany. Results: A clear association between work-related psychosocial factors and the occurrence of dyspeptic symptoms during the past 3 months was evident. Persons who were considered to have a critical style of coping with work demands suffered more often from dyspeptic symptoms. Current infection with H. pylori was not associated with prevalence of dyspeptic symptoms. These results were also confirmed by adjustment for age, gender, smoking status, education, and use of antiinflammatory drugs within the past 3 months, by means of multivariate analysis. The odds ratio (OR) for having a dyspepsia symptom score in the upper tertile versus the 1st or 2nd was 3.22 (95% confidence interval [CI], 1.56–6.65), given that the employee was considered to have a critical style of coping with work demands. The OR for having a dyspepsia symptom score in the upper tertile given H. pylori infection was 1.23 (95% CI, 0.44–3.46), indicating no association of current H. pylori infection with dyspeptic symptoms. Conclusions: A critical style of coping with work demands may be an important determinant for dyspepsia-like symptoms. Therefore, in the absence of an underlying disease, specific intervention programs should be targeted at the behavior of the affected individual ( e.g., stress-reduction programs) rather than on the treatment of specific symptoms or infection with H. pylori.

Physical and Psychosocial Work-related Risk Factors Associated with Musculoskeletal Symptoms among Home Care Personnel

Physical and Psychosocial Work-related Risk Factors Associated with Musculoskeletal Symptoms among Home Care Personnel

Determinants of self-reported neck-shoulder and low back symptoms in a general population.

A combined cross-sectional and longitudinal design. To investigate relation between, on one hand, self-reported neck-shoulder symptoms and, on the other hand, low back symptoms and self-reported work-related physical load, psychosocial factors, and individual characteristics and to study the influence of physical capacity in adolescence on neck-shoulder and low back symptoms in adulthood. Heavy physical work and exposure to vibration constitute risk factors for low back problems, and repetitive and static work are risk factors for neck-shoulder symptoms in many jobs. The interplay between individual factors and work-related psychosocial and physical exposure, however, is not well documented. This study addresses effects of adolescent capacity on this interplay in a general population. A random sample of 425 Swedish students was investigated when the students were 16 years and 34 years of age. Sixty-five percent participated in both examinations; only those who worked > or = 16 hours/week at the follow-up period, 148 men and 90 women, were included in these analyses. Data about musculoskeletal symptoms, work, and sociodemographic and individual characteristics were collected at the age of 34 years; physical performance data were collected at the ages of 16 years and 34 years. Among the men, self-employment and worry were associated with neck-shoulder symptoms; among the women, monotonous work and high decision latitude were associated with neck-shoulder symptoms. Low back problems were related to monotonous work among men and women and to exposure to vibration among men. Performance in certain fitness tests at the ages of 16 years and 34 years was negatively associated with musculoskeletal symptoms. The inverse relationships between performance at the age of 16 years and adult musculoskeletal symptoms may imply benefits of early fitness training.

Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study.

A prospective, population-based cohort study of working adults. To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior. Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based. An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought. The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status. People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.

Psychosocial factors at work in relation to back and limb disorders

This study was a 10-year follow-up of the associations between work content, work control, social relationships at work, mental overstrain, physical work load, and musculoskeletal morbidity in the neck, shoulder and upper limb region, the low back, and the lower limbs among workers in the metal industry. A sample of 902 blue- and white-collar employees were studied. Measurements were made twice at the a 10-year interval by questionnaire and clinical examination. At the beginning of the study, mental overstrain showed several associations with both the symptoms and the findings. The other psychosocial factors were the most consistently associated with the symptoms in the region of the neck, shoulder, and upper limbs and also in the lower-limb region among the middle-aged men. Prospectively, the social relations and the work content scores predicted the change in several morbidity scores. The associations were independent of physical work load. Work-related psychosocial factors were associated with, and predicted, the change in the occurrence of musculoskeletal disorders when age, gender, social class, and physical work load were controlled for.