Effort‐reward Imbalance and Low Back Pain among Eldercare Workers in Nursing Homes: A Cross‐sectional Study in Kagawa Prefecture, Japan

Job stress and chronic low back pain: incidence, number of episodes, and severity in a 4-year follow-up of the ELSA-Brasil Musculoskeletal cohort

ABSTRACT

We investigated the association between job stress, as assessed by the effort-reward imbalance model, and the incidence of chronic low back pain (CLBP) over a 4-year period. A total of 1733 participants from the ELSA-Brasil Musculoskeletal cohort, who were free from LBP at baseline (2012-2014), were included. Episodes of LBP in the past 30 days, intensity, and the presence of disability were investigated in annual telephone follow-ups (2015-2018). Chronic LBP was defined as episodes of LBP lasting >3 months with at least moderate intensity. We analyzed the incidence of at least one episode of CLBP (yes/no), the number of CLBP episodes (0, 1, ≥2), and CLBP severity/disability (absent, nondisabling, severe/disabling). The association between these outcomes and tertiles of the effort-to-reward ratio, as well as each dimension of the effort-reward imbalance model, was investigated using multinomial logistic and Poisson regression models adjusting for sociodemographic and occupational variables. The cumulative incidence of CLBP over 4 years was 24.8%. High effort-reward imbalance increased the chances of experiencing multiple CLBP episodes and severe/disabling CLBP by 67% (95% confidence interval [CI]: 1.12-2.47) and 70% (95% CI: 1.14-2.53), respectively. High overcommitment increased the incidence of CLBP by 23% (95% CI: 1.01-1.50) and the chances of multiple CLBP episodes and severe/disabling CLBP by 67% (95% CI: 1.11-2.50) and 57% (95% CI: 1.05-2.34), respectively. These results indicate that exposure to job stress is associated with a higher incidence, a greater number of episodes, and increased severity of CLBP over a 4-year period. If this association is causal, measures aimed at reducing exposure to job stress are likely to alleviate the burden of CLBP.

A cross-sectional study of the association between effort-reward imbalance and psychologic distress among Japanese dietitians

OBJECTIVES

This study aims to clarify dietitians' effort-reward imbalance (ERI) and examine its association with psychologic distress.

METHODS

A cross-sectional survey was conducted. A total of 3593 questionnaires were distributed to dietitians in about 110 organizations and 1890 responses were received (response rate 52.6%). Hence, a total of 1743 valid questionnaires were used in the analysis. Effort-reward (ER) ratio was measured by a subscale of the ERI Questionnaire, and psychologic distress was measured by the Kessler Psychological Distress Scale (K6). The association between the ER ratio and psychologic distress was analyzed by multiple logistic regression analysis with covariates.

RESULTS

The mean ER ratio was 0.83 (SD = 0.53) and ERI (ER ratio >1) prevalence was 26.3%. The mean K6 score was 7.1 (5.3), and psychologic distress (K6 score ≥5) prevalence was 62.4%. The increased psychologic distress was associated with a higher ER ratio, less support from supervisors and coworkers, and lower age and household income. ERI was significantly associated with psychologic distress, even after being adjusted for covariates.

CONCLUSIONS

Dietitians experience high stress, as shown by their high ER ratio and K6 scores. Their ERI was greatly associated with psychologic distress.

Investigating association between job stress dimensions and prevalence of low back pain among hospital nurses

BACKGROUND

There are a few studies conducted on job stress dimensions and their relationship with Low Back Pain (LBP) among Iranian nurses.

OBJECTIVE

The aim of the current study was to investigate the association between job stress dimensions assessed via Demand-Control-Social Support (DCS) and Effort-Reward Imbalance (ERI) models and prevalence of LBP among Iranian hospital nurses.

METHODS

In this cross-sectional study, 495 randomly selected nurses of Shiraz University of Medical Sciences (SUMS) participated. Demographic/occupational questionnaire, the Persian version of the Job Content Questionnaire (P-JCQ) and the Persian version of the ERI Questionnaire (P-ERIQ) were used for data collection. Data were analyzed by SPSS software (version 19) using descriptive statistics, independent sample t-test, and logistic regression.

RESULTS

The LBP prevalence was found to be 69.9%. The means±standard deviations of job stress dimensions were obtained as follows: decision latitude: 64.67±6.82, physical job demands: 15.52±2.6, social support: 23.18±3.65, psychological job demands: 38.02±4.98, effort: 8.73±2.62, reward: 23.12±5.31, over-commitment: 12.25±3.09, and effort-reward ratio: 0.86±0.3. The findings revealed that the work experience (OR = 1.56), psychological job demands (OR = 1.082), and effort-reward ratio (OR = 3.43) were predictors for LBP among the study population.

CONCLUSION

The prevalence rate of LBP among studied nurses was high. About half of nurses had high psychological demands, low decision latitude and low social support. Based on the effort-reward ratio, nurses had experienced high level of stress. Interventional programs and coping strategies for reduction of work-related stress and, subsequently, prevention of LBP are recommended among hospital nurses.

Association between pain-related fear and presenteeism among eldercare workers with low back pain

BACKGROUND

Presenteeism (work productivity loss at work) and low back pain (LBP) are prevalent among eldercare workers. Presenteeism is a serious emerging problem in an occupational setting. While many studies report the impact of pain-related fear on absenteeism, its impact on presenteeism remains unclear.

METHODS

We conducted a cross-sectional study to investigate the association between pain-related fear and presenteeism among 505 eldercare workers with LBP. We measured pain-related fear using the 11-item Tampa Scale for Kinesiophobia (TSK-11). We used the Work Limitations Questionnaire (WLQ) to estimate productivity loss due to presenteeism with items including Time Management, Mental-Interpersonal Demands, Physical Demands and Output Demands. The presenteeism was categorized into no (<5%), mild (5%-10.9%), moderate (11%-16.9%) and severe presenteeism (≥17%). We further performed ordinal logistic regression analyses, and the covariates were age, sex, pain intensity, pain disability and psychosocial factors. Multiple imputation was conducted to provide informed estimates for observations with missing data.

RESULTS

After adjustment, a higher TSK score was significantly associated with a higher presenteeism (proportional OR = 1.10, 95% CI = 1.06-1.15). A significant association of TSK with all WLQ subscales was retained even after the adjustment (Time Management: proportional OR = 1.04, 95% CI = 1.01-1.08; Mental-Interpersonal Demands: proportional OR = 1.08, 95% CI = 1.04-1.12; Physical Demands: proportional OR = 1.04, 95% CI = 1.01-1.08; and Output Demands: proportional OR = 1.06, 95% CI = 1.02-1.10).

CONCLUSIONS

Our findings suggest that pain-related fear is an important factor related to presenteeism among eldercare workers with LBP.

SIGNIFICANCE

This study describes an independent association of pain-related fear with presenteeism among eldercare workers with low back pain. Pain-related fear could be considered a vital factor of presenteeism in addition to absenteeism.

Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

Purpose There is growing research evidence that workplace factors influence disability outcomes, but these variables reflect a variety of stakeholder perspectives, measurement tools, and methodologies. The goal of this article is to summarize existing research of workplace factors in relation to disability, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Predominant factors in the scientific literature were categorized as physical or psychosocial job demands, work organization and support, and workplace beliefs and attitudes. Employees experiencing musculoskeletal disorders in large organizations were the most frequently studied population. Research varied with respect to the basic unit of assessment (e.g., worker, supervisor, policy level) and whether assessments should be based on worker perceptions, written policies, or observable practices. The grey literature suggested that employers focus primarily on defining roles and responsibilities, standardizing management tools and procedures, being prompt and proactive, and attending to the individualized needs of workers. Industry publications reflected a high reliance of employers on a strict biomedical model in contrast to the more psychosocial framework that appears to guide research designs. Conclusion Assessing workplace factors at multiple levels, within small and medium-sized organizations, and at a more granular level may help to clarify generalizable concepts of organizational support that can be translated to specific employer strategies involving personnel, tools, and practices.

Psychological distress between chronic hemodialysis patients with and without low back pain

OBJECTIVE

The aim of this study was to compare psychological distress between patients on chronic hemodialysis with and without chronic low back pain (CLBP).

SUBJECTS AND METHODS

A total of 72 patients on chronic hemodialysis, aged 72.9 ± 10.8 years, were enrolled in this cross-sectional study. Psychological distress using the K6, questionnaire for CLBP, and physical activity using the tri-accelerometer were evaluated.

RESULTS

Twenty-nine patients (40.3 %) were having CLBP. The K6 scores were 4.0 ± 4.6 and physical activity (n = 55) was 1.0 ± 1.0 METs h/day. K6 scores in patients on chronic hemodialysis with CLBP were significantly higher than those in patients on chronic hemodialysis without CLBP even after adjusting for sex, age, duration of hemodialysis and physical activity.

CONCLUSION

These results suggest that higher psychological distress was a fundamental feature in patients on chronic hemodialysis with CLBP.

Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests.