Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study

The use of individual and collective selection, optimisation and compensation (SOC) strategies and their association with work ability among senior workers

Background Selection, optimisation, and compensation (SOC) can be important strategies for maintaining work ability as we age. This study aimed to explore differences in self-reported individual and collective use of SOC strategies across job functions, as well as their association with self-rated work ability.

METHODS

In the third wave of the SeniorWorkingLife study, 10,798 workers aged 50 + , across the job function categories "Office work", "work with people", and "work in the field of production", replied to questions about collective and individual SOC strategies and work ability. Using multiple regression, we modelled associations between SOC and work ability.

RESULTS

Associations between SOC and work ability were generally weaker among participants working in the field of production. Both individual and collective use of selection had much weaker associations with work ability in the job functions "office work" and "working with people". In the job function "working in the field of production", only collective compensation was positively associated with work ability while individual selection was significantly but negatively associated with work ability.

CONCLUSIONS

The use of SOC may be particularly beneficial for older employees working with people. Optimisation and compensation may be the most important SOC strategies for maintaining the work ability of older employees working with people and doing office work. For older employees working in the field of production, collective optimisation may support the maintenance of work ability while reduced work ability may be associated with the use of individual selection as a "coping strategy".

Identifying pain profiles in employees including work-related factors and pain perceptions: a cross-sectional study in Belgian companies

OBJECTIVES

Studies usually investigate a limited number or a predefined combinations of risk factors for sickness absence in employees with pain. We examined frequently occurring combinations across a wide range of work-related factors and pain perceptions.

DESIGN

Cross-sectional study.

SETTING

Belgian companies that are under supervision of IDEWE, an external service for prevention and protection at work.

PARTICIPANTS

In total, 249 employees experiencing pain for at least 6 weeks were included and filled out an online survey.

OUTCOMES

Latent profile analysis was used to differentiate profiles of work-related factors (physical demands, workload, social support and autonomy) and pain perceptions (catastrophising, fear-avoidance beliefs and pain acceptance). Subsequently, profiles were compared on sociodemographics (age, gender, level of education, work arrangement, duration of complaints, multisite pain and sickness absence in the previous year) and predictors of sickness absence (behavioural intention and perceived behavioural control).

RESULTS

Four profiles were identified. Profile 1 (38.2%) had favourable scores and profile 4 (14.9%) unfavourable scores across all indicators. Profile 2 (33.3%) had relatively high physical demands, moderate autonomy levels and favourable scores on the other indicators. Profile 3 (13.7%) showed relatively low physical demands, moderate autonomy levels, but unfavourable scores on the other indicators. Predictors of profiles were age (OR 0.93 and 95% CI (0.89 to 0.98)), level of education (OR 0.28 and 95% CI (0.1 to 0.79)) and duration of sickness absence in the previous year (OR 2.29 and 95% CI (0.89 to 5.88)). Significant differences were observed in behavioural intention (χ2=8.92, p=0.030) and perceived behavioural control (χ2=12.37, p=0.006) across the four profiles.

CONCLUSION

This study highlights the significance of considering the interplay between work-related factors and pain perceptions in employees. Unfavourable scores on a single work factor might not translate into maladaptive pain perceptions or subsequent sickness absence, if mitigating factors are in place. Special attention must be devoted to employees dealing with unfavourable working conditions along with maladaptive pain perceptions. In this context, social support emerges as an important factor influencing sickness absence.

Early career demanding psychosocial work environment and severe back pain and neck/shoulder pain in experienced nurses: A cohort study

AIMS

Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later.

METHODS

The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression.

RESULTS

The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively.

CONCLUSIONS

Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

Risk assessment of healthcare workers' exposure to physical load in relation to patient handling and movement: a feasibility study of the instrument TilThermometer

BACKGROUND

Work-related musculoskeletal disorders are common among healthcare workers (HCWs) but might be prevented by risk assessment and further promotion of occupational safety and health. The aim of this study was to investigate if the risk assessment instrument TilThermometer can be used to identify risk profiles of physical exposure in HCWs working with patient handling and movement (PHM). Further aims were to describe HCWs' perceptions and experiences of using the TilThermometer.

METHODS

This feasibility study has a mixed design methodology. In total, 54 HCWs from 17 Swedish care units participated and performed risk assessments with the TilThermometer. Data collected from the risk assessments were used to identify risk profiles of physical exposure. HCWs' experiences of using the TilThermometer were collected from activity logs and analysed qualitatively. Three questionnaires were used to assess perceived acceptability, appropriateness, and feasibility of the risk assessment, and eight study specific questions were used for perceived usefulness.

RESULTS

The TilThermometer was used at the care units by assessing each care recipient, and when compiling the data at a group level, a summarized risk profile for the care unit could be provided. Risk for physical exposure was reported as high in two work tasks; no care unit used the high-low adjustable seat when showering care recipients sitting down, and 13% used the recommended assistive devices when putting compression stockings on. However, 99% used high-low adjustable assistive devices when caring and bathing care recipients lying down. TilThermometer was described as easy to use, enabling team reflections and providing an overview of the care units' recipients and workload, but difficulties in categorizing for mobility groups were also reported. The TilThermometer was, on a five-point scale, perceived as acceptable (mean 3.93), appropriate (mean 3.9), and feasible (mean 3.97). These scores are in line with questions evaluating usefulness.

CONCLUSION

The risk assessment provided risk profiles with potential to contribute to care units' development of a safe patient handling and movement practice. The findings suggest that the TilThermometer can be used to assess risks for physical exposure in relation to patient handling and movement in care units at hospital and nursing homes.

Mental health and vitality predict spinal pain in healthcare workers

BACKGROUND

Despite extensive investigation of ergonomic risk factors for spinal pain in healthcare workers, limited knowledge of psychological risk factors exists.

AIMS

To assess the prospective association of mental health and vitality with development of spinal pain in healthcare workers.

METHODS

A prospective cohort study was carried out involving 1950 healthcare workers from 19 hospitals in Denmark. Assessments were done at baseline and at 1-year follow-up. Mental health and vitality were measured using the Short Form-36 Health Survey, while spinal pain intensity was measured using a 0-10 scale in the low-back, upper-back and neck, respectively. Cumulative logistic regressions adjusted for several confounding factors were applied, reporting risk estimates as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Using good mental health as reference, moderate (but not poor) mental health at baseline was associated with increased pain intensity in the low-back (OR: 1.41 [95% CI: 1.21-1.77]), upper-back (OR: 1.63 [95% CI: 1.31-2.02]) and neck (OR: 1.31 [95% CI: 1.07-1.61]) at 1-year follow-up. Likewise, using high vitality as reference, both moderate and low vitality at baseline were associated with increased pain intensity in the low-back (OR: 1.54 [95% CI: 1.22-1.94] and OR: 2.34 [95% CI: 1.75-3.12], respectively), upper-back (OR: 1.72 [95% CI: 1.34-2.23] and OR: 2.46 [95% CI: 1.86-3.25], respectively) and neck (OR: 1.66 [95% CI: 1.34-2.06] and OR: 2.06 [95% CI: 1.61-2.63], respectively) at 1-year follow-up.

CONCLUSIONS

Compared to healthcare workers with good mental health and high vitality, those with moderate mental health and low/moderate vitality, respectively, were more likely to increase spinal pain intensity at 1-year follow-up. These components should also be considered in the prevention of spinal pain in healthcare workers.

Workplace Psychosocial Factors and Their Association With Musculoskeletal Disorders: A Systematic Review of Longitudinal Studies

This systematic review examines literature regarding the relationship between workplace psychosocial factors and musculoskeletal disorders (MSDs). Musculoskeletal disorders are the leading cause of work disability, resulting in billions of dollars of financial losses. Evidence suggests that workplace psychosocial factors can lead to the development and progression of MSDs. A data search was conducted in MEDLINE, EMBASE, PsychINFO, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from August 2009 to May 2020 inclusive. Other eligibility criteria included studies published in English, conducted on adults within a workplace setting, conducted in developed economies, and were stability-control longitudinal observational studies. Studies were independently screened for eligibility, using COVIDENCE (software for managing and streamlining systematic reviews) and assessed for quality by multiple authors, using the JBI Evidence synthesis tool. From 6,812 studies, 47 articles were included in the final analysis. The most common MSDs investigated were lower back pain, neck and shoulder pain, and upper extremity symptoms and disorders. Included articles identified that psychosocial workplace factors of support, collaboration, job control, and job demands were statistically significantly associated with risk and progression of MSDs. Review of the articles included in this article supports the theory that MSDs have a multifactorial, complex etiology that includes psychosocial factors. Interventions to enhance psychosocial work environment provide opportunities to reduce the risk of MSDs.

Calidad de vida y factores asociados de empleados jubilados por invalidez de universidades públicas

Resumen Objetivo: analizar la calidad de vida y los factores asociados de empleados de universidades públicas jubilados por invalidez. Método: estudio transversal, con una muestra de trabajadores jubilados por invalidez de universidades públicas. Se aplicó un cuestionario de caracterización y el World Health Organization Quality of Life - Disabilities mediante contacto telefónico u online desde noviembre de 2019 hasta septiembre de 2020. Los factores asociados se verificaron mediante regresión lineal múltiple. Resultados: de los 80 jubilados por invalidez, el 15% era docente y el 85% era técnico-administrativo. En cuanto a los factores asociados a la calidad de vida, el uso continuo de medicamentos (βaj: -0,25; p=0,02) y los problemas del sistema nervioso (βaj: -0,21; p<0,05) se asociaron al dominio overall; el uso continuo de medicamentos (βaj: -0,23; p=0,04) el dominio físico; el tabaquismo (βaj: -0,21; p<0,05) y los trastornos mentales y conductuales (βaj: -0,21; p<0,01) al dominio psicológico; el tabaquismo (βaj: -0,46; p<0,01), los problemas respiratorios (βaj: -0,21; p=0,03) y circulatorios (βaj:-0,21;p=0,03) al dominio social; el tabaquismo (βaj: -0,33; p<0,01) y los problemas del sistema nervioso (βaj: -0,22; p=0,04) al dominio ambiental; los trastornos mentales y conductuales al módulo discapacidad (βaj: -0,29; p<0,01) y al dominio discriminación (βaj: -0,21; p<0,05); el tabaquismo (βaj: -0,32; p<0,01) y los problemas del sistema nervioso (βaj: -0,20; p<0,05) al dominio inclusión. El dominio autonomía no mostró asociación. Conclusión: la calidad de vida de los jubilados por invalidez que participaron del estudio estaba deteriorada.

Qualidade de vida e fatores associados entre servidores aposentados por invalidez de universidades públicas

Resumo Objetivo: analisar a qualidade de vida e os fatores associados entre servidores de universidades públicas aposentados por invalidez. Método: estudo transversal, com amostra de servidores aposentados por invalidez de universidades públicas. Um questionário de caracterização e o World Health Organization Quality of Life - Disabilities foram aplicados por contato telefônico ou online no período de novembro de 2019 a setembro de 2020. Verificaram-se os fatores associados por regressão linear múltipla. Resultados: dos 80 aposentados por invalidez, 15% eram docentes e 85% da carreira técnica-administrativa. Quanto aos fatores associados à qualidade de vida, o uso de medicação contínua (βaj: -0,25; p=0,02) e os problemas do sistema nervoso (βaj: -0,21; p<0,05) associaram-se ao domínio Overall; o uso de medicação contínua (βaj: -0,23; p=0,04) ao domínio físico; o tabagismo (βaj: -0,21; p<0,05) e os transtornos mentais e comportamentais (βaj: -0,21; p<0,01) ao domínio psicológico; o tabagismo (βaj: -0,46; p<0,01), os problemas respiratórios (βaj: -0,21; p=0,03) e circulatórios (βaj: -0,21; p=0,03) ao domínio social; o tabagismo (βaj: -0,33; p<0,01) e os problemas do sistema nervoso (βaj: -0,22; p=0,04) ao domínio ambiental; os transtornos mentais e comportamentais ao módulo incapacidades (βaj: -0,29; p<0,01) e ao domínio discriminação (βaj: -0,21; p<0,05); o tabagismo (βaj: -0,32; p<0,01) e os problemas do sistema nervoso (βaj: -0,20; p<0,05) ao domínio inclusão. O domínio autonomia não apresentou associação. Conclusão: os aposentados estudados apresentaram uma qualidade de vida prejudicada.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Effects of Slide Sheet Use and Bed Position on Muscle Activities in the Low Back and Extremities: A Pilot Experimental Simulation Study

BACKGROUND

Low-friction slide sheets (SS) are designed to reduce compression loads on the body during manual handling tasks, such as boosting patients. Using SS has been shown to decrease muscle activity in the lower back and upper extremities. However, it is unclear if this effect varies with different bed positions. To investigate this, we studied the effects of SS use, bed height, and their combination on muscle activity during a simulated patient boost.

METHODS

Thirty-three Japanese undergraduate students (age 21.0 ± 1.1 years; 14 men, 19 women) participated. Participants were asked to boost a dummy figure on the bed three times each using four conditions. During the repositioning task, electromyography of eight muscles of the lower back and upper and lower extremities, hip and knee joint flexion angles, pelvic forward tilt angle, and position of the center of mass based on the posterior superior iliac spine were evaluated.

FINDINGS

Electrophysiological activities of muscles of lower back and upper extremities were significantly lower with SS than without it in both bed positions (30% and 40% of body height); the reduction in muscle activities with SS use was 20% to 40%. Lowering the bed did not affect the SS effect magnitude on reducing muscle activities, although postural changes, including hip and knee joint flexion, were observed.

CONCLUSIONS/APPLICATION TO PRACTICE

SS reduced muscle activities in the back, upper, and lower extremities when the bed was in the low position, and this effect persisted at a bed height of ≥30% of the participant's height.

Biomechanical evaluation of midwifery tasks and its relationship with the prevalence of musculoskeletal disorders

Introduction

As an important occupational group in the healthcare system, midwives face various ergonomic risk factors such as musculoskeletal disorders (MSDs) risks. Moreover, an accurate job evaluation can help to design appropriate ergonomic interventions and more accurately estimate the probability of developing MSDs. Therefore, the present study aimed to investigate musculoskeletal discomforts and biomechanical stresses using the Three-Dimensional Static Strength Prediction Program (3DSSPP Ver. 7.1.3) to find the association of these factors with the prevalence of MSDs among midwives.

Materials and methods

A total of 91 midwives with at least two years of work experience participated in this cross-sectional descriptive study. All midwifery duties were analyzed using the hierarchical task analysis (HTA) method. Moreover, time analysis was performed for this job, and data were collected using the Nordic Musculoskeletal Questionnaire (NMQ) and body mapping. The 3DSSPP software was used to investigate the forces acting on the lumbar region, and finally, the association of individual characteristics and the forces exerted on the body with MSDs was investigated.

Results

According to the results, the highest level of pain and discomfort was related to the back and neck regions. The software analysis of the four major midwifery tasks showed that the highest biomechanical forces were exerted on the L5/S1 disc during lifting the mothers from bed (to help them sit or walk) and breastfeeding training. Accordingly, only in the task of lifting the mothers and helping them to sit or walk, the balance status was inappropriate and critical due to the improper distribution of forces. The analysis of the associations between variables showed that biomechanical forces, age, height, body mass index, and job tenure were among the risk factors affecting MSDs.

Conclusion

According to the results of this study, MSDs were highly prevalent, especially in the neck and back regions; this can be attributed to the nature of midwifery tasks. The software analysis results of the tasks showed that the biomechanical forces on the spine in each of the tasks can be affected by the weight of the mother, the height of the bed, static posture, and the bending/twisting of the whole body. Compression and shear forces were among the risk factors that can affect MSDs. To prevent MSDs in midwives, it is appropriate to improve the workstations.

Influence of a passive back support exoskeleton on simulated patient bed bathing: results of an exploratory study

Low-back pain is a major concern among healthcare workers. One cause is the frequent adoption of repetitive forward bent postures in their daily activities. Occupational exoskeletons have the potential to assist workers in such situations. However, their efficacy is largely task-dependent, and their biomechanical benefit in the healthcare sector has rarely been evaluated. The present study investigates the effects of a passive back support exoskeleton in a simulated patient bed bathing task. Nine participants performed the task on a medical manikin, with and without the exoskeleton. Results show that working with the exoskeleton induced a significantly larger trunk forward flexion, by 13 deg in average. Due to this postural change, using the exoskeleton did not affect substantially the muscular and cardiovascular demands nor the perceived effort. These results illustrate that postural changes induced by exoskeleton use, whether voluntary or not, should be considered carefully since they may cancel out biomechanical benefits expected from the assistance. Practitioner summary: Low-back pain is a major concern among nurses, associated with bent postures. We observed that using a passive back-support exoskeleton during the typical patient bed bathing activity results in a larger trunk flexion, without changing muscular, cardiovascular or perceived physical effort.

Evaluation of the implementation and effectiveness of a multifactorial intervention strategy for safe patient handling and movement in the healthcare sector: a study protocol of a cluster randomised controlled trial

INTRODUCTION

Healthcare workers with physically demanding work tasks, such as patient handling and movement (PHM), are at high risk of musculoskeletal disorders. To facilitate safe PHM and prevent musculoskeletal disorders, a combination of workplace interventions, including risk assessments, is needed. The aim of this study is to implement and evaluate a multifactorial intervention strategy for safe PHM and compare it with a single intervention strategy.

METHODS AND ANALYSIS

This cluster randomised controlled trial will compare a multifactorial intervention strategy with a single intervention strategy for safe PHM in workplaces in the Swedish regional and municipal healthcare systems. At least twelve healthcare units will be recruited. Care units belonging to arm A will receive: (1) guidelines for PHM, (2) training modules, (3) risk assessment with TilThermometer, (4) risk assessment with Downtown Fall Risk Index and (5) work environment mapping. Care units belonging to Arm B will receive interventions (1) and (5). The two strategies will be evaluated with regards to (1) the primary outcome of the applied strategies' intervention effectiveness (safety climate in relation to aspects of PHM) and (2) the primary implementation outcome (acceptability, appropriateness and feasibility). This study will also explore the implementation process and intervention fidelity, examine the influence of contextual factors and investigate participants' experiences of working with strategies for safe PHM. A mix of quantitative and qualitative methods will be used. The data collection is based on questionnaires, interviews and field notes of contextual factors.

ETHICS AND DISSEMINATION

The study is approved by the Swedish national ethical board (Dnr 2021-00578). Study results will be published in peer-reviewed journals, presented at conferences and distributed on social media. A lay summary and dissemination strategy will be codesigned with a reference group and participating healthcare units.

TRIAL REGISTRATION NUMBER

NCT05276180.

Motor variability during a repetitive lifting task is impaired by wearing a passive back-support exoskeleton

PURPOSE

Evaluate whether wearing a passive back-support exoskeleton during repetitive lifting impairs motor variability of erector spinae muscle and spine movement and whether this association is influenced by lifting style.

SCOPE

Thirty-six healthy males performed ten lifts in four randomized conditions with exoskeleton (without, with) and lifting style (squat, stoop) as dependent variables. One lifting cycle contained four phases: bending/straighten without/with load. Erector spinae muscular activity, thoracic kyphosis and lumbar lordosis were measured with surface electromyography and gravimetric position sensors, respectively. Absolute and relative cycle-to-cycle variability were calculated. The effects of exoskeleton and exoskeleton × lifting style were assessed on outcomes during the complete lifting cycle and its four phases.

RESULTS

For the complete lifting cycle, muscular variability and thoracic kyphosis variability decreased whereas lumbar lordosis variability increased with exoskeleton. For lifting phases, effects of exoskeleton were mixed. Absolute and relative muscular variability showed a significant interaction effect for the phase straighten with load; variability decreased with exoskeleton during squat lifting.

CONCLUSION

Using the exoskeleton impaired several motor variability parameters during lifting, supporting previous findings that exoskeletons may limit freedom of movement. The impact of this result on longer-term development of muscular fatigue or musculoskeletal disorders cannot yet be estimated.

Perceived strategies for reducing staff-turnover and improving well-being and retention among professional caregivers in Alberta's continuing-care facilities: A qualitative study

This qualitative study explored potential factors that lead to turnover and absenteeism and how to improve well-being and retention among professional older-adult-caregivers in Alberta's assisted living (AL) and long-term care (LTC) facilities. Four hundred and forty-seven participants aged 45-54 years were interviewed through a five-item, content-validated open-ended questionnaire. The questionnaire was self-administered in the English language and the soft copy of their responses was transferred into NVIVO version 12 software for coding. A thematic narrative analysis grounded in the "happy productive worker" theory was completed. The main themes were caregivers' perception of the factors affecting their well-being, absenteeism, and turnover, and caregivers' suggestions on ways to improve their well-being and retention. Participants reported that their professional well-being was suboptimal. They suggested that their employers should provide them with the needed social, psychological, and professional support, improve wages and hire more staff to ameliorate absenteeism and turnover rates.

Quality of life and factors associated among public university employees retired due to disabilities

OBJECTIVE

to analyze quality of life and factors associated among public university employees retired due to disabilities.

METHOD

a cross-sectional study conducted with a sample of public university employees retired due to disabilities. A characterization questionnaire and the World Health Organization Quality of Life - Disabilities instrument were applied via telephone or online contacts from November 2019 to September 2020. The associated factors were verified through multiple linear regression.

RESULTS

of the 80 retirees due to disability, 15% were professors and 85% had a technical-administrative career. As for the factors associated with Quality of Life, continuous medication use (βadj: -0.25; p=0.02) and problems in the nervous system (βadj: -0.21; p<0.05) were associated with the Overall domain; continuous medication use (βadj: -0.23; p=0.04), to the Physical domain; smoking (βadj: -0.21; p<0.05) and mental and behavioral disorders (βadj: -0.21; p<0.01), to the Psychological domain; smoking (βadj: -0.46; p<0.01) and respiratory (βadj: -0.21; p=0.03) and circulatory (βadj: -0.21; p=0.03) problems, to the Social domain; smoking (βadj: -0.33; p<0.01) and problems in the nervous system (βadj: -0.22; p=0.04), to the Environmental domain; mental and behavioral disorders, to the Disabilities module (βadj: -0.29; p<0.01) and to the Discrimination domain (βadj: -0.21; p<0.05); and smoking (βadj: -0.32; p<0.01) and problems in the nervous system (βadj: -0.20; p<0.05), to the Inclusion domain. The Autonomy domain did not present any association.

CONCLUSION

the retirees under study presented impaired Quality of Life.

THE RELATIONSHIP BETWEEN PSYCHOSOCIAL WORK ENVIRONMENT AND NURSES' PERFORMANCE, ON STUDIES THAT USED THE VALIDATED INSTRUMENT COPENHAGEN PSYCHOSOCIAL QUESTIONNAIRE (COPSOQ): AN EMPTY SCOPING REVIEW

OBJECTIVE

Aim: This study was to map the relationship between psychosocial work environment and nurses' performance, on studies that used the Copenhagen Psychosocial Questionnaire (COPSOQ).

PATIENTS AND METHODS

Materials and Methods: The review intended to answer following questions: 'Can COPSOQ screen completely psychosocial risks of nurses' work environment?' 'Which of these dimensions affect more nurses psychosocial world? A scoping review was developed guided by the JBI methodology and using PRISMA-ScR.

CONCLUSION

Conclusions: Hospital workers, and in particular nurses, are exposed to different risk factors with the most important being psychosocial risks. These arise from problematic work planning, organization and management, as well as from an unhealthy social context of work and may lead to negative psychological, physical and social outcomes. The review highlighted the need for further research using the entire COPSOQ questionnaire in order to fully study the psychosocial risks that nurses face in their work environment.

Co-exposures to physical and psychosocial work factors increase the occurrence of workplace injuries among French care workers

Objective

The aim of this study was to analyze the effect of co-exposures to physical and psychosocial factors (PSF) regarding the incidence of workplace injuries (WI) among care workers. Additional objective was to identify the work factors associated with the co-exposure combinations leading to the highest rates of WI.

Methods

The study sample consisted of 4,418 care workers participating to the French Working Conditions Survey both in 2013 and 2016. WI were assessed during the 4-year follow-up by matching the databases of the National Health Insurance Funds' compensation system. We assessed exposure for physical factors and PSF using factorial analyses and hierarchical clustering. We implemented a Poisson regression model with the WI incidence as the outcome and the clusters as independent variables of interest. Logistic regression model allowed identifying the work factors that predicted co-exposure combinations with a WI rate > 40%.

Results

WI were highly related to both physical and psychosocial exposures. With low exposure to one or the other, there was no increased risk of WI. Physical factors and PSF potentiated each other and their co-exposure significantly increased the risk of WI, with model predicted rates per 1,000 persons-year for those most exposed to physical risk of 14.6 [4.5-24.8] with low PSF and 38.0 [29.8-46.3] with high PSF. Work factors that predicted co-exposure combinations with a rate > 40 WI% were: working as nursing assistant or hospital services officer, lack of predictability and flexibility of schedules, overtime, controlled schedules, work-family imbalance and insufficient preventive measures.

Conclusions

Our findings highlight the need to take into account psychosocial factors in addition of only considering physical factors when analyzing WI occurrence, as usually done. Prevention actions must be taken to reduce both physical and psychosocial exposure. These results provide keys points for the prevention of WI among care workers.

Association between work content and musculoskeletal disorders among home caregivers: a cross-section study

In Taiwan, over 80% of home caregivers have experienced musculoskeletal disorders (MSD) in the past year. Although MSDs in health care workers have been discussed in existing literature (e.g., in nursing staff), there is limited understanding of the association between MSD and the work content of home caregivers. This study aimed to investigate the correlation between the work content and MSD of home caregivers. This cross-sectional study was conducted in long-term care units in central Taiwan. A structured questionnaire was used to collect data, including basic information, work content survey, and information from the Nordic Musculoskeletal Questionnaire. Logistic regression analysis was used to examine the association between work content and MSD. A total of 149 home caregivers with a mean age of approximately 50.97 ± 9.80 years were recruited for the study. The frequency of transfer of toilet and wheelchair was significantly associated with shoulder discomfort, upper back discomfort, and wrists/hands discomfort. In addition, the frequency of passive range of motion exercise was significantly associated with elbows discomfort. The results of this study indicated that the highest risk factor for MSD was transfer of toilet and wheelchair followed by passive range of motion exercise.

ICU nurses' safety performance related to respect for safety and management commitment: A cross-sectional study

BACKGROUND

Healthcare work is one of the most accident-prone occupations globally. Nurses, especially those who work in Intensive Care Units (ICU), are very likely to experience mishaps on the job due to the complicated duties they perform. Safety performance through compliance and participation in safety is a proactive approach and a critical tool to measure the protection of employees, like these, in the workplace. Although interest in this tool has increased among hospital administrators and managers, scientific research has been limited in this area.

AIMS

The study's purposes were twofold: (1) to explore the effect of perceived respect safety on the safety performance of ICU nurses and (2) to explore the mediation effect of Management Commitment to Safety (MCS) between the relationship of perceived respect safety and safety performance.

METHODS

Eight public hospitals from the Jordanian Ministry of Health (JMoH) were selected randomly using cluster sampling, and their ICU nurses were surveyed. A total of 285 nurses completed questionnaires. The SmartPLS3 bootstrapping technique was used to analyse data.

RESULTS

The results established that the perceived respect for the safety of nurses has a significant and positive effect on their safety compliance (β = .39, p < .01) and safety participation (β = .34, p < .01), and that MCS mediated these associations.

CONCLUSION

The findings support the importance of developing and maintaining a culture of respect between management and employees, especially in terms of perceived respect for safety issues, and that culture will improve safety performance. The study explains the role of an active MCS, which contributes to understanding the research model fully. Practical implications for improving workplace safety also are added.

IMPACT STATEMENT

Recognition of the study's findings by healthcare organisation managers would improve ICU nurses' safety and ultimately decrease undesirable outcomes.

Application of MAPO (Movement and Assistance of Hospitalized Patients) method in hospitals and nursing homes: frequency of manual patient handling-part 2

This study examines the evolution of MAPO method for estimating the frequency of overloading tasks in healthcare workers during different shifts. The data presented were collected from 51 in-patient wards (25 hospitals and 26 nursing homes), and 917 workers: the frequency of MPH tasks is a complementary value to the MAPO exposure level, which is useful to implement a prevention plan targeted towards the reduction of overloading tasks. Based on the frequency of manual patient handling, it appears that the afternoon shift is at greatest risk, with tasks liable to cause overloading occurring within a frequency range of 70-85 per worker. The study analyzes different pieces of equipment and their relative percentages of use, concluding that, overall, they are underutilised (especially minor aids and height-adjustable beds). Practitioner summary: The organisational data collected in hospitals and nursing homes confirms the availability of patient handling aids and equipment, but also indicates that they are underutilised with respect to the frequency of overloading tasks.

An Examination of Washington State Workers’ Compensation Claims for Home-Based Health Care Workers, 2006 to 2016: Part 2. Injury Rates and Trends

Research of home-based health care (HBHC) has shown that care providers suffer from a high rate of injuries. Analysis of workers’ compensation records, a reliable source for injury and illness data, enables the identification of trends within a specific working population. HBHC workers’ compensation compensable claims in Washington State from 2006 to 2016 were compared to clinical health care (CHC) claims. Injury event and source attributed to HBHC claims were also analyzed, with a focus on work-related musculoskeletal disorders (WMSDs). Though CHC had 5 times the number of full-time employees during the study period, HBHC grew by 61.1%, compared to 28.7% in CHC. Claim rates for all compensable claims and WMSD claims consistently decreased year-over-year for both HBHC and CHC. WMSD claims experienced a year-over-year decline of 5.3%; for all compensable claims the decline was 4.5%. Analysis of HBHC claim rates by injury event found WMSD had the highest rates, followed by falls from the same level. However, the largest annual change was for the injury event overexertion (−10.1%, 95%CI: −13.4, −6.8). HBHC injuries attributable to the health care patient were the most common. Claims with this injury source declined annually by 6.0%. Claim rates for injuries to the back region, and specifically back WMSDs, were consistently higher year-over-year compared to other body regions and WMSD types. Claims for injuries to the back declined by an annual rate of 6.6% (95% CI: −7.9, −5.3), while back WMSD claims decreased by 6.4% (94% CI: −7.8, −4.9).

An Examination of Washington State Workers’ Compensation Claims for Home-Based Health Care Workers, 2006 to 2016: Part 1. Description of Claims and Claimants

Home-based health care can be physically and emotionally demanding, resulting in injury or illness. Washington State’s workers’ compensation compensable claims between 2006 and 2016 were analyzed to describe the characteristics of injured home-based health care (HBHC) providers and the burden created by these injuries. Comparisons were made with clinical health care (CHC) providers, as well as between all compensable claims and work-related musculoskeletal disorder (WMSD) claims. Over 90% of claimants for both HBHC and CHC were female. The mean age of all compensable HBHC claimants (45.7 years) was significantly older than for CHC, with the majority (54.5%) between the ages of 40 and 59. However, HBHC claimants with WMSDs were younger, overall. Across health care type and claim type, the majority of injured care providers were overweight or obese (BMI ≥ 25). The highest mean age occurred among claimants injured from falls, either on the same level or to a lower level (HBHC: 48.3-48.6 years, CHC: 46.1-48.1 years). This same group also had the highest BMIs. WMSDs accounted for 47.3% of HBHC compensable claims and 50.3% for CHC. Falls on the same level were the second most common injury event among HBHC claims. For both HBHC and CHC, back injuries were the most common body part for both claim types (all compensable claims: 28.8% HBHC and 23.9% CHC, WMSD claims: 60.8% HBHC and 47.5% CHC). Overexertion was the injury event most attributed to WMSDs (HBHC: 82.6%, CHC: 71.6), overexertion during lifting being the most prevalent overexertion type (HBHC: 27.8%, CHC: 19.6%).

The association between work-related physical and psychosocial factors and musculoskeletal disorders in healthcare workers: Moderating role of fear of movement

Objectives

Knowledge is lacking on the interaction between fear of movement (FOM) and work‐related physical and psychosocial factors in the development and persistence of musculoskeletal disorders (MSDs).

Methods

In this cross‐sectional study, 305 healthcare workers from several Belgian hospitals filled out a questionnaire including sociodemographic factors, work‐related factors (social support, autonomy at work, workload, and physical job demands), FOM, and MSDs for different body regions during the past year. Path analysis was performed to investigate (1) the association between the work‐related factors, FOM and MSDs, and (2) the moderating role of FOM on the association between the work‐related factors and MSDs among healthcare workers.

Results

Complaints were most frequently located at the neck–shoulder region (79.5%) and lower back (72.4%). Physical job demands (odds ratio [OR] 2.38 and 95% confidence interval [CI] 1.52–3.74), autonomy at work (OR 1.64 CI [1.07–2.49]) and FOM (OR 1.07 CI [1.01–1.14] and OR 1.12 CI [1.06–1.19]) were positively associated with MSDs. Healthcare workers who experienced high social support at work (OR 0.61 CI [0.39–0.94]) were less likely to have MSDs. Fear of movement interacted negatively with workload (OR 0.92 CI [0.87–0.97]) and autonomy at work (OR 0.94 CI [0.88–1.00]) on MSDs.

Conclusions

Work‐related physical and psychosocial factors as well as FOM are related to MSDs in healthcare workers. FOM is an important moderator of this relationship and should be assessed in healthcare workers in addition to work‐related physical and psychosocial factors to prevent or address MSDs.

A systematic review of work interventions to promote safe patient handling and movement in the healthcare sector

PURPUSE

The aim of this systematic review was to describe interventions which promote safe patient handling and movement (PHM) among workers in healthcare by reviewing the literature of their effectiveness for work and health-related outcomes.

METHODS

Data bases were searched for studies published 1997‒2018. Measures was operationalised broadly, capturing outcomes of work and health. Only Randomized controlled trials (RCTs) and cohort studies with control group were included. Quality was assessed using evidence-based checklists by Swedish Agency for Health Technology Assessment and Assessment of Social Services.

RESULTS

The systematic review included 10 RCTs and 19 cohort. Providing work equipment and training workers is effective: it can increase usage. Training workers to be peer coaches is associated with fewer injuries. Other effective strategies are participatory ergonomics and management engagement in collaboration with workers, facilitating safe PHM.

CONCLUSIONS

This systematic review suggests interventions for safe PHM with an impact of health-related outcomes should include access to work equipment, training as well as employer and employee engagement. The additional impact of multifaceted interventions is inconclusive.

PRACTITIONER SUMMARY

In clinical practice, there is a need for employers in healthcare to; 1) provide healthcare workers access to suitable work equipment. 2) provide training on how to use work equipment to prevent work-related injuries. Furthermore, the study also indicates that 3) training and appointing peer coaches can facilitate safe manual handling and movement (PHM) and, 4) It can be beneficial to involve workers in a participatory approach.

A passive back exoskeleton supporting symmetric and asymmetric lifting in stoop and squat posture reduces trunk and hip extensor muscle activity and adjusts body posture - A laboratory study

The influence of a passive exoskeleton was assessed during repetitive lifting with different lifting styles (squat, stoop) and orientations (frontal/symmetric, lateral/asymmetric) on trunk and hip extensor muscle activity (primary outcomes), abdominal, leg, and shoulder muscle activity, joint kinematics, and heart rate (secondary outcomes). Using the exoskeleton significantly and partially clinically relevant reduced median/peak activity of the erector spinae (≤6%), biceps femoris (≤28%), rectus abdominis (≤6%) and increased median/peak activity of the vastus lateralis (≤69%), trapezius descendens (≤19%), and median knee (≤6%) and hip flexion angles (≤11%). Using the exoskeleton had only limited influence on muscular responses. The findings imply the exoskeleton particularly supports hip extension and requires an adjusted body posture during lifting with different styles and orientations. The potential of using exoskeletons for primary/secondary prevention of musculoskeletal disorders should be investigated in future research including a greater diversity of users in terms of age, gender, health status.

Effect of Joint Exposure to Psychosocial and Physical Work Factors on the Incidence of Workplace Injuries: Results From a Longitudinal Survey

OBJECTIVE

To analyze the interaction between physical and psychosocial work factors regarding the workplace injuries incidence among 6900 workers out of a longitudinal survey.

METHODS

Based on responses to questionnaires, we obtained exposure groups respectively for physical factors and for psychosocial factors using hierarchical clustering. We performed multiple Poisson regression model with the workplace injuries incidence during 4 years of follow-up as the outcome and the clusters as the independent variables of interest.

RESULTS

High psychosocial exposure had a deleterious effect on workplace injuries incidence, which was no longer significant when adjusting for physical factors. The difference in model-based workplace injuries rates between high and low psychosocial exposures seemed to increase (non-significantly) with increasing physical exposure.

CONCLUSIONS

The risk of workplace injuries was highest among workers with high physical exposures regardless of the psychosocial exposures.

The Influence of Nursing Home, Ward, and Eldercare Workers on the Number of Resident Handlings Performed per Shift in Eldercare

The purpose of our study was to investigate which organizational levels and factors determine the number of resident handlings in eldercare. We conducted a multi-level study, stratified on day and evening shifts, including information on four levels: nursing homes (n = 20), wards within nursing homes (day, n = 120; evening, n = 107), eldercare workers within wards (day, n = 619; evening, n = 382), and within eldercare workers (i.e., days within eldercare workers; day, n = 5572; evening, n = 2373). We evaluated the influence of each level on the number of resident handlings using variance components analysis and multivariate generalized linear mixed models. All four levels contributed to the total variance in resident handlings during day and evening shifts, with 13%/20% at “nursing homes”, 21%/33% at “wards within nursing homes”, 25%/31% at “elder-care workers within wards”, and 41%/16% “within eldercare workers”, respectively. The percentage of residents with a higher need for physical assistance, number of residents per shift, occupational position (only within day shifts), and working hours per week (only within day shifts) were significantly associated with the number of resident handlings performed per shift. Interventions aiming to modify number of resident handlings in eldercare ought to target all levels of the eldercare organization.

Single-item measures of stress during work- and private time in healthcare workers

BACKGROUND

While the psychosocial work environment within the hospital sector is a topic of great debate, surveys assessing stress often do not differentiate between stress related to work- and private life. Identifying risk factors associated with these domains of daily life would help improve policies as well as target relevant treatment options. Therefore, the aim of this study was to evaluate associations between stress during to work- and private time with Cohen's Perceived Stress Scale (CPSS).

METHODS

Perceived stress was assessed by the full version of CPSS (scores 0-40) as well as by two single-item questions related to stress related to work- and private life, respectively. Associations between these single-items and CPSS were modelled using general linear models controlling for lifestyle factors.

RESULTS

Overall, stress due to both work- and private time was strongly associated with CPSS scores. In the full population (n = 3,600), "never experiencing stress" during both work- and private time was associated with low stress scores (6.0, 95%CI 5.1-6.9). "Never experiencing" work-related stress but experiencing private time stress "very often" was associated with high stress scores (22.4, CI 19.8-25.1). Likewise, experiencing work-related stress "very often" but "never experiencing" private time stress was also associated with high stress scores (22.2, CI 20.3-24.2). Lastly, Spearman's r between the full CPSS and the two single-item questions about work- and private time stress were 0.62 (p < 0.0001) and 0.52 (p < 0.0001), respectively, while the two items were only weakly correlated (r = 0.32).

CONCLUSION

The present study shows that perceived stress due to both work and private time is strongly associated with Cohen's Perceived Stress Scale scores. The results illustrate the feasibility of using single-item questions related to work- and private time in identifying domain-specific risk factors for psychosocial stress.

Musculoskeletal pain intensity in different body regions and risk of disability pension among female eldercare workers: prospective cohort study with 11-year register follow-up

Background

Musculoskeletal pain is a risk factor for leaving the labour market temporarily and permanently. While the presence of multi-site pain increases the risk of disability pension, we lack detailed knowledge about pain intensity as a risk factor. This study investigated the association between musculoskeletal pain intensity in different body regions and risk of future disability pension among eldercare workers.

Methods

Eight thousand seven hundred thirty-one female eldercare workers replied to a questionnaire on work and health in 2005 and were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated hazard ratios (HR) for disability pension from pain intensities (0–9 numeric rating scale (NRS)) in the low-back, neck/shoulders, and knees during the previous 3 months. Analyses were mutually adjusted for pain regions, age, education, lifestyle, psychosocial work factors, and physical exertion at work.

Results

During 11-year follow-up, 1035 (11.9%) of the eldercare workers received disability pension. For all body regions among all eldercare workers, dose-response associations were observed between higher pain intensity and risk of disability pension (p < 0.001). The risk for disability pension was increased when reporting “very high” pain levels (≥7 points on the 0–9 NRS) in the low-back (HR 2.19, 95% CI 1.70–2.82), neck/shoulders (HR 2.34, 95% CI 1.88–2.92), and knees (HR 1.89, 95% CI 1.44–2.47). Population attributable risks (PAR) were 15.5, 23.2, and 9.6% for pain > 2 on NRS in the low-back, neck/shoulders, and knees, respectively, indicating that 15.5, 23.2, and 9.6% fewer eldercare workers would likely receive disability pension if the pain intensity was reduced to 2 or less. For workers ≤45 years and > 45 years, PAR was highest for neck/shoulder pain (27.6%) and low-back pain (18.8%), respectively.

Conclusions

The present study found positive dose-response associations between pain intensity in the low-back, neck/shoulders, and knees, and risk of disability pension during 11-year follow-up. Moderate to very high levels of musculoskeletal pain in eldercare workers should, therefore, be considered an early warning sign of involuntary premature exit from the labour market. These findings underscore the importance of preventing, managing, and reducing musculoskeletal pain to ensure a long and healthy working life.

A systematic overview on the risk effects of psychosocial work characteristics on musculoskeletal disorders, absenteeism, and workplace accidents

The present article provides a systematic overview on the relationship between psychosocial work characteristics and musculoskeletal disorders, absenteeism, and workplace accidents. The study identified and reviewed the findings of 24 systematic reviews or meta-analysis and 6 longitudinal studies. Publications were systematically searched in several databases from 1966 to January 2021. To summarize the level of evidence, a best evidence synthesis was performed, and the quality of included studies was rated. High job demands, high job strain, high effort/reward-imbalance and low social support showed a strong evidence to increase the risk for musculoskeletal disorders. In addition to job demands and job strain, low perceived fairness proved to be a risk factor of absenteeism with strong evidence. Due to the small number of studies, no reliable evidence assessment for workplace accidents was possible. The summarized findings can improve risk assessment methods, by providing a systematic estimation of the potential risk severity of psychosocial work characteristics and assist practitioners in further developing the psychosocial risk assessment.

Ergonomic Challenges in the Perioperative Setting

Working in health care can be physically stressful. The perioperative setting, which is largely concealed from other health care workers and the general public, places unique physical demands on its workers. Perioperative personnel are responsible for a variety of physical tasks, including moving and positioning patients, holding extremities, and moving equipment and supplies. As the nursing workforce ages, the physical demands of the perioperative environment may affect the development of musculoskeletal disorders in older nurses. The purpose of this article is to review published research and describe the ergonomic challenges of working in the OR. There currently is a paucity of literature on the effects of ergonomic risk factors on perioperative nurses in the United States. This article also provides some recommendations for perioperative staff members and leaders that may assist them with creating and maintaining a healthy and safe work environment.

Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis

Background

Health care workers (HCWs) are at high risk of occupational injuries and approximately 10–15% of patients are affected by an adverse event during their hospital stay. There is scarce scientific literature about how HCWs manage these risks in practice and what support they need. This knowledge is needed to improve safety for patients and HCWs. This study explores HCWs’ experiences of workplace incidents that led to injury or posed a risk of patient and worker injury, with focus on HCWs’ emotions and actions.

Methods

This study employed a qualitative design using the critical incident technique. Semi-structured individual interviews were held with 34 HCWs from three regions in Sweden. Data were analysed using inductive category development.

Results

Altogether 71 workplace incidents were reported. The analysis of two dimensions – the emotions HCWs feel and the actions team members and managers take when a workplace incident occurs – yielded two categories each: Anxiety during the incident, Persistent distress after the incident, Team interplay for safety actions and Support and ratification from managers and colleagues. Health care workers risked their own safety and health to provide patient safety. Teamwork and trustful relationships were critical for patient and worker safety. Support and validation from colleagues and managers were important for closure; unsatisfactory manager response and insufficient opportunities to debrief the incident could lead to persistent negative emotions. Participants described insecurity and fear, sadness over being injured at work, and shame and self-regret when the patient or themselves were injured. When the workplace had not taken the expected action, they felt anger and resignation, often turning into long-term distress.

Conclusions

Work situations leading to injury or risk of patient and worker injury are emotionally distressing for HCWs. Team interplay may facilitate safe and dynamic practices and help HCWs overcome negative emotions. Organizational support is imperative for individual closure. For safety in health care, employers need to develop strategies for active management of risks, avoiding injuries and providing support after an injury.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06517-x.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters

Objective

The aim was to explore firefighter’s experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work.

Methods

Semi-structured interviews were used to provide an in-depth understanding of the firefighter’s experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method.

Results

Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch.

Conclusions

Consideration should be made for the consistency of procedures followed during an individual’s return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01712-z.

Prevalence of musculoskeletal low back pain among registered nurses: Results of an online survey

AIMS AND OBJECTIVES

The aim of this study was to describe the prevalence of low back pain (LBP) and the use of lifting aids and ergonomics among Czech registered nurses.

BACKGROUND

Low back pain is the most common occupational health problem affecting nurses. Frequent manual lifting of heavy loads, including patients, is one of the main duties of nursing staff, which causes compressive and shear forces on the vertebrae of the lower spine. Training in manual handling and lifting aids reduce the physical burden on the musculoskeletal system, thus decreasing work-related back injuries and further back problems.

DESIGN

A cross-sectional survey.

METHODS

The online survey was distributed to 1460 randomly selected nurses involved in caring for patients. The survey comprised the extended version of the Nordic Musculoskeletal Questionnaire and a self-structured questionnaire. Data were analysed using STATA 15 at a significance level of 0.05.

RESULTS

Of the 569 respondents, 84.7% reported high occurrence of LBP over the previous 12-month period. The lower back was the most commonly reported body region for pain, followed by the neck, shoulders and upper back. LBP was found to occur significantly less among nursing staff who used mechanical lifting aids. Nurses with a higher level of education were found significantly more likely to use mechanical patient-lifting equipment in their clinical practice.

CONCLUSIONS

The study findings show that LBP is a frequent problem among nurses and has highlighted a lack of organisational safety practices and culture in clinical nursing practice.

RELEVANCE TO CLINICAL PRACTICE

This study provides valuable information about the extent of LBP among nurses with insufficient preventive measures or health and safety practices at work. The results provide useful baseline data for the Czech Republic, that may lead to increased awareness and therefore implementation of preventative strategies, and thus enable a reduction in the risk of back injuries among nursing professionals.

Combined Effects of Physical Behavior Compositions and Psychosocial Resources on Perceived Exertion Among Eldercare Workers

Objectives

High perceived physical exertion is common in eldercare workers and a strong predictor for impaired health. However, little is known on how physical behaviors at work associate with physical exertion in this group. The aim of this study was to determine the extent to which the composition of physical behaviors at work is associated with perceived physical exertion in nursing home eldercare workers, and the extent to which these associations are modified by psychosocial resources.

Methods

Our population consisted of 399 female eldercare workers from 126 wards in 20 different nursing homes. We evaluated time spent in physical behaviors at work [sitting, standing still, light activities (LAs), and moderate to vigorous activities (MVAs)] using triaxial accelerometers worn, on average, for three working days. We accounted for inherent codependency between the behaviors using compositional data analysis. We used multilevel linear mixed regression models to determine associations between the behaviors and perceived exertion, measured on a numeric rating scale (0–10), and included interactions between each behavior and psychosocial resources (influence at work, social support, and quality of leadership) to determine a possible moderating effect of resources. Regression results were illustrated using isotemporal substitution.

Results

Sitting was negatively (β: −0.64; P < 0.01) while MVA was positively (β: 0.95; P = 0.02) associated with perceived exertion. According to isotemporal substitution, replacing 30 min of MVA by sitting would, for an average worker, be associated with a decrease in physical exertion by −0.14 on the 0–10 scale. Job resources marginally moderated the association between LA and exertion. Thus, among workers with low influence and low social support, we found a positive association between LA and exertion, while that was not found for workers with medium or high influence and support (interactions for influence and support: P = 0.08 and P = 0.10).

Conclusions

Our findings suggest that reallocating time from MVA to sitting can mitigate perceived physical exertion in eldercare workers. More time in LA increased physical exertion only for workers with low psychosocial resources, supporting a positive effect of a better psychosocial work environment in elderly care.

Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study

BACKGROUND

Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs.

METHODS

By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure.

RESULTS

Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively.

CONCLUSIONS

Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden

Employees in health and social care are often simultaneously exposed to both physical and psychosocial challenges that may increase their risk for sickness absence. The study examines interaction effects of physical and psychosocial work conditions on the future risk for sickness absence among nurses and care assistants in Sweden. The study was based on 14,372 participants in any of the Swedish Work Environment Surveys conducted during the years 1993-2013 with linked register information on background factors and compensated sickness absence. Adjusted hazard ratio (HR), stratified by occupation, and measures of additive interaction effects were estimated. The combinations of high psychosocial job demands and heavy physical work and strenuous postures, respectively, significantly increased the risks for sickness absence among nurses (HR 1.43; CI 1.09-1.88 and HR 1.42; CI 1.16-1.74, respectively), as well as among care assistants (HR 1.51; CI 1.36-1.67 and HR 1.49; CI 1.36-1.63, respectively). The combinations of low job control and both heavy physical work (HR 1.44; CI 1.30-1.60) and strenuous postures (HR 1.42; CI 1.30-1.56) were also associated with excess risk for sickness absence among care assistants. We also found interaction effects among care assistants but not among nurses. The results indicate that the high sickness absence rate among care workers in Sweden can be reduced if the simultaneous exposures of high psychosocial and high physical challenges are avoided. Management policies for reduced time pressure, improved lifting aids, and measures to avoid awkward work postures are recommended. For care assistants, increased influence over work arrangements is likely to lower their sickness absence risk.

Biomechanical load during patient transfer with assistive devices: Cross-sectional study

This study utilised a cross-sectional design to perform measurements of muscle activity as well as forward - and lateral trunk inclination angle during a full workday among 52 female healthcare workers from 16 different departments at five Danish hospitals. Using linear mixed models, the 95th percentile ranks of the normalised root mean square (nRMS) values were analysed for the different types of assistive devices. Compared to no assistive device (mean nRMS 27.9%, 95% CI 24.8%-31.0%), the use of intelligent beds (23.9%, CI 20.2%-27.6%) and ceiling-lifts (24.0%, CI 20.3%-27.7%) led to lower erector spinae nRMS values across all types of patient transfers. Conversely, the use of bedsheets (30.6%, CI 27.1%-34.2%), sliding-sheets (30.3%, CI 26.8%-33.9%) and sliding-boards (33.5%, CI 29.5%-37.6%) were associated with higher levels of erector spinae muscle activity.Consistent use of ceiling-lifts and intelligent beds reduces the physical workload and may thereby decrease the risk of musculoskeletal disorders among healthcare workers. Practioner Summary: Frequent patient transfer is associated with an increased risk of back pain and injury among healthcare workers. This analysis compares the level of physical load during patient transfer with commonly used assistive devices. The results show that use of the ceiling-lift and intelligent bed is associated with relatively low physical load during patient transfer. Abbreviations: RMS: root mean square; nRMS: normalized root mean square; EMG: electromyography; MSD: musculoskeletal disorder; LBP: low-back pain; VAS: visual analogue scale; MVC: maximal voluntary contraction.

Perceived Stress and Low-Back Pain Among Healthcare Workers: A Multi-Center Prospective Cohort Study

Objective: This study aimed to investigate the association between perceived stress and odds of low-back pain (LBP) in a population of Danish healthcare workers.

Methods: Utilizing a prospective cohort design with 1-year follow-up, a total of 1,944 healthcare workers from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Using Cohen's Perceived Stress Scale, associations between baseline stress levels and LBP intensity (0–10 scale) at follow-up were modeled using cumulative logistic regression, accounting for clustering at the department level and adjusting for age, sex, baseline intensity of LBP, education, seniority, number of daily patient transfers, psychosocial work environment, and lifestyle factors.

Results: For the entire population, moderate and high stress (reference: low stress) at baseline increased the odds of LBP at 1-year follow-up with odds ratios (ORs) of 1.39 (95% CI 1.13–1.71) and 1.99 (95% CI 1.49–2.66), respectively. Sensitivity analyses among female nurses showed similar results [i.e., OR 1.40 (95% CI 1.08–1.80) and OR 2.08 (95% CI 1.44–3.00) for moderate and high stress, respectively], while only high stress significantly increased the odds among those without LBP at baseline.

Conclusions: Psychological stress increases the odds of LBP among healthcare workers. Identifying and diminishing work-related psychosocial stressors should be included in strategies that aim to prevent musculoskeletal disorders in this population.

Musculoskeletal disorders in aged care workers: a systematic review of contributing factors and interventions

BACKGROUND

There is limited evidence on contributing factors and effective interventions for musculoskeletal injuries in aged care workers.

PURPOSE

To systematically review the factors that contribute to musculoskeletal disorder risk amongst workers in the aged care industry, and to undertake a qualitative comparison of the interventions designed and implemented to prevent injury within this workforce.

METHODS

A systematic review of the literature was conducted in Web of Science, Scopus, ProQuest, Medline, and PubMed. Relevant grey literature was also examined. Articles that reported factors that contribute to musculoskeletal injuries, or interventions to prevent and manage musculoskeletal injuries in residential aged care workers were included.

FINDINGS

Of the 864 articles and 35 grey literature publications found, 63 and 29 were included in the review respectively. Results indicate that physical factors such as manual handling of people, use of assistive devices, and physical work environment are most commonly associated with musculoskeletal disorders in this population. Limited evidence of organisational and psychosocial factors considered staffing issues, work schedules, and violence. The heavy emphasis on physical factors is echoed in the grey literature in relevant guidance material and codes of practice focused on assessment and control of risks. There was limited evidence for interventions specific to aged care; existing evidence focused on equipment, training and education, policy and procedure. Interventions incorporating a combination of approaches, such as equipment and training, showed promise while preliminary evidence of the effectiveness of participatory approaches are positive.

DISCUSSION

Interventions which address multiple types of contributing factors are needed to adequately prevent musculoskeletal injuries in aged care workers. Tweetable abstract: Review of contributing factors, interventions, and application of knowledge for work-related musculoskeletal injuries in aged care.

Poor Sleep Is a Risk Factor for Low-Back Pain among Healthcare Workers: Prospective Cohort Study

This study aimed to investigate the association between poor sleep and risk of low-back pain (LBP) in healthcare workers. Using a prospective cohort design with 1-year follow-up, a total of 1955 healthcare workers (60% nurses) from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Associations between sleep scores (0-100) at baseline and LBP intensity (0-10) at follow-up were modelled using cumulative logistic regression accounting for clustering at the department level and adjusted for lifestyle and psychosocial confounders. In the full population of healthcare workers, 43.9% and 24.4% experienced moderate and poor sleep, respectively. In the fully adjusted model with good sleep as reference, moderate, and poor sleep increased the risk of LBP at follow-up, with odds ratios (OR's) of 1.66 (95% confidence interval (CI) 1.35-2.04) and 2.05 (95% CI 1.57-2.69), respectively. Three sensitivity analyses including healthcare workers free from LBP, nurses, and nurses free from LBP at baseline, respectively, yielded similar results. In conclusion, poor sleep constitutes a potent risk factor for LBP among healthcare workers. The presented results provide strong incentives to evaluate and weigh current prevention policies against an updated biopsychosocial framework.