Abstract
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.
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Selected References
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- Ariëns G. A., van Mechelen W., Bongers P. M., Bouter L. M., van der Wal G. Physical risk factors for neck pain. Scand J Work Environ Health. 2000 Feb;26(1):7–19. doi: 10.5271/sjweh.504. [DOI] [PubMed] [Google Scholar]
- Armstrong T. J., Buckle P., Fine L. J., Hagberg M., Jonsson B., Kilbom A., Kuorinka I. A., Silverstein B. A., Sjogaard G., Viikari-Juntura E. R. A conceptual model for work-related neck and upper-limb musculoskeletal disorders. Scand J Work Environ Health. 1993 Apr;19(2):73–84. doi: 10.5271/sjweh.1494. [DOI] [PubMed] [Google Scholar]
- Bergqvist U., Wolgast E., Nilsson B., Voss M. Musculoskeletal disorders among visual display terminal workers: individual, ergonomic, and work organizational factors. Ergonomics. 1995 Apr;38(4):763–776. doi: 10.1080/00140139508925148. [DOI] [PubMed] [Google Scholar]
- Bergqvist U., Wolgast E., Nilsson B., Voss M. The influence of VDT work on musculoskeletal disorders. Ergonomics. 1995 Apr;38(4):754–762. doi: 10.1080/00140139508925147. [DOI] [PubMed] [Google Scholar]
- Bernard B., Sauter S. L., Fine L. J., Petersen M. R., Hales T. R. Psychosocial and work organization risk factors for cumulative trauma disorders in the hands and wrists of newspaper employees. Scand J Work Environ Health. 1992;18 (Suppl 2):119–120. [PubMed] [Google Scholar]
- Bernard B., Sauter S., Fine L., Petersen M., Hales T. Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees. Scand J Work Environ Health. 1994 Dec;20(6):417–426. doi: 10.5271/sjweh.1379. [DOI] [PubMed] [Google Scholar]
- Bovenzi M., Zadini A. Self-reported low back symptoms in urban bus drivers exposed to whole-body vibration. Spine (Phila Pa 1976) 1992 Sep;17(9):1048–1059. doi: 10.1097/00007632-199209000-00007. [DOI] [PubMed] [Google Scholar]
- Burdorf A., Naaktgeboren B., Post W. Prognostic factors for musculoskeletal sickness absence and return to work among welders and metal workers. Occup Environ Med. 1998 Jul;55(7):490–495. doi: 10.1136/oem.55.7.490. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Devereux J. J., Buckle P. W., Vlachonikolis I. G. Interactions between physical and psychosocial risk factors at work increase the risk of back disorders: an epidemiological approach. Occup Environ Med. 1999 May;56(5):343–353. doi: 10.1136/oem.56.5.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gail M. H. A bibliography and comments on the use of statistical models in epidemiology in the 1980s. Stat Med. 1991 Dec;10(12):1819–1885. doi: 10.1002/sim.4780101204. [DOI] [PubMed] [Google Scholar]
- Gerard M. J., Armstrong T. J., Foulke J. A., Martin B. J. Effects of key stiffness on force and the development of fatigue while typing. Am Ind Hyg Assoc J. 1996 Sep;57(9):849–854. doi: 10.1080/15428119691014549. [DOI] [PubMed] [Google Scholar]
- Grieco A., Molteni G., De Vito G., Sias N. Epidemiology of musculoskeletal disorders due to biomechanical overload. Ergonomics. 1998 Sep;41(9):1253–1260. doi: 10.1080/001401398186298. [DOI] [PubMed] [Google Scholar]
- Hagberg M. ABC of work related disorders. Neck and arm disorders. BMJ. 1996 Aug 17;313(7054):419–422. doi: 10.1136/bmj.313.7054.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hales T. R., Bernard B. P. Epidemiology of work-related musculoskeletal disorders. Orthop Clin North Am. 1996 Oct;27(4):679–709. [PubMed] [Google Scholar]
- Hales T. R., Sauter S. L., Peterson M. R., Fine L. J., Putz-Anderson V., Schleifer L. R., Ochs T. T., Bernard B. P. Musculoskeletal disorders among visual display terminal users in a telecommunications company. Ergonomics. 1994 Oct;37(10):1603–1621. doi: 10.1080/00140139408964940. [DOI] [PubMed] [Google Scholar]
- Hallqvist J., Ahlbom A., Diderichsen F., Reuterwall C. How to evaluate interaction between causes: a review of practices in cardiovascular epidemiology. J Intern Med. 1996 May;239(5):377–382. doi: 10.1046/j.1365-2796.1996.431782000.x. [DOI] [PubMed] [Google Scholar]
- Hedberg G. E. The period prevalence of musculoskeletal complaints among Swedish professional drivers. Scand J Soc Med. 1988;16(1):5–13. doi: 10.1177/140349488801600102. [DOI] [PubMed] [Google Scholar]
- Holmström E. B., Lindell J., Moritz U. Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 2: Relationship to neck and shoulder pain. Spine (Phila Pa 1976) 1992 Jun;17(6):672–677. doi: 10.1097/00007632-199206000-00006. [DOI] [PubMed] [Google Scholar]
- Kamwendo K., Linton S. J., Moritz U. Neck and shoulder disorders in medical secretaries. Part I. Pain prevalence and risk factors. Scand J Rehabil Med. 1991;23(3):127–133. [PubMed] [Google Scholar]
- Karlqvist L. K., Bernmark E., Ekenvall L., Hagberg M., Isaksson A., Rostö T. Computer mouse position as a determinant of posture, muscular load and perceived exertion. Scand J Work Environ Health. 1998 Feb;24(1):62–73. doi: 10.5271/sjweh.279. [DOI] [PubMed] [Google Scholar]
- Koopman J. S. Interaction between discrete causes. Am J Epidemiol. 1981 Jun;113(6):716–724. doi: 10.1093/oxfordjournals.aje.a113153. [DOI] [PubMed] [Google Scholar]
- Magnusson M. L., Pope M. H., Wilder D. G., Areskoug B. Are occupational drivers at an increased risk for developing musculoskeletal disorders? Spine (Phila Pa 1976) 1996 Mar 15;21(6):710–717. doi: 10.1097/00007632-199603150-00010. [DOI] [PubMed] [Google Scholar]
- Malchaire J. B., Cock N. A., Robert A. R. Prevalence of musculoskeletal disorders at the wrist as a function of angles, forces, repetitiveness and movement velocities. Scand J Work Environ Health. 1996 Jun;22(3):176–181. doi: 10.5271/sjweh.128. [DOI] [PubMed] [Google Scholar]
- Marcus M., Gerr F. Upper extremity musculoskeletal symptoms among female office workers: associations with video display terminal use and occupational psychosocial stressors. Am J Ind Med. 1996 Feb;29(2):161–170. doi: 10.1002/(SICI)1097-0274(199602)29:2<161::AID-AJIM6>3.0.CO;2-V. [DOI] [PubMed] [Google Scholar]
- Marras W. S., Schoenmarklin R. W. Wrist motions in industry. Ergonomics. 1993 Apr;36(4):341–351. doi: 10.1080/00140139308967891. [DOI] [PubMed] [Google Scholar]
- Moore A., Wells R., Ranney D. Quantifying exposure in occupational manual tasks with cumulative trauma disorder potential. Ergonomics. 1991 Dec;34(12):1433–1453. doi: 10.1080/00140139108964888. [DOI] [PubMed] [Google Scholar]
- Ohlsson K., Hansson G. A., Balogh I., Strömberg U., Pålsson B., Nordander C., Rylander L., Skerfving S. Disorders of the neck and upper limbs in women in the fish processing industry. Occup Environ Med. 1994 Dec;51(12):826–832. doi: 10.1136/oem.51.12.826. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Polanyi M. F., Cole D. C., Beaton D. E., Chung J., Wells R., Abdolell M., Beech-Hawley L., Ferrier S. E., Mondloch M. V., Shields S. A. Upper limb work-related musculoskeletal disorders among newspaper employees: cross-sectional survey results. Am J Ind Med. 1997 Dec;32(6):620–628. doi: 10.1002/(sici)1097-0274(199712)32:6<620::aid-ajim8>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
- Rempel D., Serina E., Klinenberg E., Martin B. J., Armstrong T. J., Foulke J. A., Natarajan S. The effect of keyboard keyswitch make force on applied force and finger flexor muscle activity. Ergonomics. 1997 Aug;40(8):800–808. doi: 10.1080/001401397187793. [DOI] [PubMed] [Google Scholar]
- Riihimäki H., Tola S., Videman T., Hänninen K. Low-back pain and occupation. A cross-sectional questionnaire study of men in machine operating, dynamic physical work, and sedentary work. Spine (Phila Pa 1976) 1989 Feb;14(2):204–209. [PubMed] [Google Scholar]
- Ryan G. A., Bampton M. Comparison of data process operators with and without upper limb symptoms. Community Health Stud. 1988;12(1):63–68. doi: 10.1111/j.1753-6405.1988.tb00573.x. [DOI] [PubMed] [Google Scholar]
- Silverstein B. A., Fine L. J., Armstrong T. J. Hand wrist cumulative trauma disorders in industry. Br J Ind Med. 1986 Nov;43(11):779–784. doi: 10.1136/oem.43.11.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Skov T., Borg V., Orhede E. Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople. Occup Environ Med. 1996 May;53(5):351–356. doi: 10.1136/oem.53.5.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sorock G. S., Courtney T. K. Epidemiologic concerns for ergonomists: illustrations from the musculoskeletal disorder literature. Ergonomics. 1996 Apr;39(4):562–578. doi: 10.1080/00140139608964481. [DOI] [PubMed] [Google Scholar]
- Stewart P. A., Herrick R. F., Blair A., Checkoway H., Droz P., Fine L., Fischer L., Harris R., Kauppinen T., Saracci R. Highlights of the 1990 Leesburg, Virginia, International Workshop on Retrospective Exposure Assessment for Occupational Epidemiology Studies. Scand J Work Environ Health. 1991 Aug;17(4):281–285. doi: 10.5271/sjweh.1701. [DOI] [PubMed] [Google Scholar]
- Strömberg U. Prevalence odds ratio v prevalence ratio. Occup Environ Med. 1994 Feb;51(2):143–144. doi: 10.1136/oem.51.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tola S., Riihimäki H., Videman T., Viikari-Juntura E., Hänninen K. Neck and shoulder symptoms among men in machine operating, dynamic physical work and sedentary work. Scand J Work Environ Health. 1988 Oct;14(5):299–305. doi: 10.5271/sjweh.1916. [DOI] [PubMed] [Google Scholar]
- Toomingas A., Alfredsson L., Kilbom A. Possible bias from rating behavior when subjects rate both exposure and outcome. Scand J Work Environ Health. 1997 Oct;23(5):370–377. doi: 10.5271/sjweh.234. [DOI] [PubMed] [Google Scholar]
- Torp S., Riise T., Moen B. E. Work-related musculoskeletal symptoms among car mechanics: a descriptive study. Occup Med (Lond) 1996 Dec;46(6):407–413. doi: 10.1093/occmed/46.6.407. [DOI] [PubMed] [Google Scholar]
- Viikari-Juntura E., Rauas S., Martikainen R., Kuosma E., Riihimäki H., Takala E. P., Saarenmaa K. Validity of self-reported physical work load in epidemiologic studies on musculoskeletal disorders. Scand J Work Environ Health. 1996 Aug;22(4):251–259. doi: 10.5271/sjweh.139. [DOI] [PubMed] [Google Scholar]
- Walker A. M. Proportion of disease attributable to the combined effect of two factors. Int J Epidemiol. 1981 Mar;10(1):81–85. doi: 10.1093/ije/10.1.81. [DOI] [PubMed] [Google Scholar]
- Westerling D., Kilbom A. Physical strain in the handling of gas cylinders. Ergonomics. 1981 Aug;24(8):623–632. doi: 10.1080/00140138108924884. [DOI] [PubMed] [Google Scholar]
- Wiktorin C., Karlqvist L., Winkel J. Validity of self-reported exposures to work postures and manual materials handling. Stockholm MUSIC I Study Group. Scand J Work Environ Health. 1993 Jun;19(3):208–214. doi: 10.5271/sjweh.1481. [DOI] [PubMed] [Google Scholar]
- de Zwart B. C., Broersen J. P., Frings-Dresen M. H., van Dijk F. J. Musculoskeletal complaints in The Netherlands in relation to age, gender and physically demanding work. Int Arch Occup Environ Health. 1997;70(5):352–360. doi: 10.1007/s004200050229. [DOI] [PubMed] [Google Scholar]