The combined effect of physical, psychosocial/organisational and/or environmental risk factors on the presence of work-related musculoskeletal symptoms and its consequences
Introduction
Musculoskeletal symptoms (MSS) are common among general and working populations. They are most prevalent in the low back, followed by the neck or shoulder (Holmström and Engholm, 2003, Lei et al., 2005, Palliser et al., 2005, Scuffham et al., 2010, Widanarko et al., 2011, Wijnhoven et al., 2006), or upper extremities (Choobineh et al., 2007, Leroux et al., 2005).
Physical work factors have a major role in the development of MSS, such as awkward posture (Ariëns et al., 2000, Bernard, 1997, Heneweer et al., 2011, Lotters et al., 2003, NRC and IOM, 2001), repetitive movements (Bernard, 1997, Devereux et al., 2004), manual material handling (Bernard, 1997, Lotters et al., 2003, NRC and IOM, 2001) and vibration (Bernard, 1997, Lotters et al., 2003, NRC and IOM, 2001). However, during the last two decades, a number of studies and systematic reviews have shown that psychosocial risk factors also play a role in the development of MSS. These include high job strain (Ijzelenberg et al., 2004), high psychological demands (Ariëns et al., 2001, Hooftman et al., 2009, Ijzelenberg et al., 2004), low decision latitude (Bernard, 1997, Bongers et al., 1993), low social support (Ariëns et al., 2001, Bernard, 1997, Bongers et al., 1993, Hoogendoorn et al., 2000), job dissatisfaction (Bernard, 1997, Hoogendoorn et al., 2000, Linton, 2001, Lotters et al., 2003), effort-reward imbalance (Rugulies and Krause, 2008) and high work stress (Linton, 2000, Linton, 2001). As a result, some recent studies (Andersen et al., 2003, Engholm and Holmström, 2005, Hooftman et al., 2009, Jensen et al., 2012, Krause et al., 2010, Widanarko et al., 2012a) have included both physical and psychosocial factors as candidate exposure variables in multivariate models developed to estimate risk factors for MSS.
Theoretical models by Davis and Heaney, 2000, Karsh, 2006 and Widanarko et al. (2013) indicate that both physical and psychosocial factors may independently influence MSS and that both factors may interact. While this is a biologically plausible hypothesis, few studies have quantified the combined effect of these factors on MSS risk (Huang et al., 2003, Lapointe et al., 2009, Linton, 2005, Waters et al., 2007, Waters et al., 2011). To date, most studies have shown that the risk of MSS due to combination of physical and psychosocial factors is greater than the risk of MSS when a single factor is present (Devereux et al., 2004, Devereux et al., 1999, Devereux et al., 2002, Huang et al., 2003, Lapointe et al., 2009, Östergren et al., 2005, Vandergrift et al., 2012, Wahlstrom et al., 2004, Waters et al., 2007, Waters et al., 2011, Widanarko, 2013). For example, Huang et al. (2003) found that the combination of high biomechanical pressure and time pressure significantly increased the risk of low back symptoms (LBS) (odds ratio (OR) 2.61, 95% confidence interval (CI) 1.39–4.91) and upper extremities symptoms (OR 2.90, 95% CI 1.49–5.66), whereas the risk of LBS or upper extremities symptoms due to exposed to single exposure (either biomechanical pressure or time pressure) was between 0.46 and 1.05. Similarly, Devereux et al. (2004), in a 15-month cohort study of the general working population in the UK showed that those exposed to both high physical and psychosocial risk factors had the highest risk of LBS (OR 2.83, 95% CI 1.30–6.18), neck symptoms (OR 2.19, 95% CI 1.33–3.61), elbow/forearms symptoms (OR 1.87, 95% CI 1.02–3.46), and wrist symptoms (WS) (OR 3.14, 95% CI 1.76–5.61) compared with those exposed to a single exposure.
Whilst MSS per se may seriously impact the health and productivity of employees and employers, its consequences (reduced activities and absenteeism) reflect the real/practical impact of the problem. The 12-month period prevalence of reduced activities due to MSS has been estimated to be anywhere between 4% and 42% (Chen et al., 2005, Scuffham et al., 2010, Widanarko et al., 2012b). It is around 1–36% for absenteeism due to MSS (Alexopoulos et al., 2008, Bovenzi and Betta, 1994, Bovenzi et al., 2002, Cunningham et al., 2006, Ghaffari et al., 2006, Ijzelenberg et al., 2004, Matsudaira et al., 2011, Scuffham et al., 2010, Widanarko et al., 2012b). To the best of the authors' knowledge, very few studies (Fernandes et al., 2009, Lapointe et al., 2009, Thorbjörnsson et al., 2000) have examined the combined effect of risk factors at work for MSS consequences. The few studies that have attempted to do so have specifically examined the combined effect on MSS consequences and found that the combination of poor posture and job strain significantly increased the risk of reduced activities due to LBS (OR 5.51, 95% CI 2.33–13.03) and reduced activities due to neck/shoulder symptoms (NSS) (OR 3.38, 95% CI 1.58–7.22) among females (Lapointe et al., 2009). Thorbjörnsson et al. (2000) examined the combined effect of physical and psychosocial risk factors on absenteeism due to LBS and reported that exposure to both increased the risk of absenteeism due to LBS. Although environmental factors may play a role in the occurrence of MSS and absenteeism due to MSS (Harkness et al., 2003, Piedrahita et al., 2004, Widanarko et al., 2012b), none of the studies cited above included environmental factors in their analyses.
With this background, the objective of this study was to quantify the combined effect of physical and psychosocial/organisational and/or environmental factors for MSS and its consequences (reduced activities and absenteeism due to MSS) for the body regions: neck/shoulder; arm/elbow; wrist; low back.
Section snippets
Participants
This study was part of a recent large national survey of self-reported current occupational exposures, workplace practices and occupational ill-health which has been described in detail elsewhere (Eng et al., 2010). Ten thousand potential participants aged 20–64 years randomly selected from the New Zealand Electoral Roll were invited by mail to have a telephone interview (Eng et al., 2010). Of 10,000 mail-outs, 1209 were returned to sender, 2719 did not reply to the three invitation letters and
Study population characteristics
The overall response rate (the number interviewed as a proportion of the total eligible sample) was 37%. Although the response rate of 37% was typical for this type of survey (Tourangeau, 2004), a major nonresponse bias was not found in this study population (Mannetje et al., 2011). Participants were involved in various occupations: legislator and administrator, professionals, technicians and associate professionals, clerks, service and sales workers, agriculture and fishery workers, trade
Discussion
The results of the multivariate analyses indicate that physical factors are associated with almost all of the outcomes assessed in this study. The analyses indicate that the physical factors involved in each outcome are specific for the various body regions. For example, NSS and LBS and absenteeism due to NSS and LBS were associated with exposure to an awkward or tiring position. This may be related to the non-neutral posture of the spine during working which may increase the force on the
Acknowledgements
We acknowledge funding support from the Joint Research Portfolio of the Health Research Council, Accident Compensation Corporation, and Department of Labour (HRC 04/072) of New Zealand. We would like to thank Tracey Whaanga, Zoe Harding, Cecil Priest, Penelope Whitson, Michaela Skelly, Phoebe Taptiklis, Emma Drummond, Anna McCarty, Natasha Holland, Kelly Gray, Adam Hoskins, Alister Thomson, Jessica Fargher, Cilla Blackwell, Emma Turner, Selena Richards, Kim Crothall, Alice Harding, Joelene
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