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Musculoskeletal injuries among health care workers: Individual, biomechanical and work organization factors
1150-20 U 1997
(97FS-36)
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Issue: |
To identify factors that place hospital workers at an increased risk for musculoskeletal injury resulting in compensation claims. |
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Agency: |
University of British Columbia: School of Occupational and Environmental Hygiene and Department of Health Care and Epidemiology |
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Representative: |
Mieke Koehoorn, Susan Kennedy, Paul Demers, Clyde Hertzman and Judy Village |
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Funding: |
$22,369 |
Context: The risk of musculoskeletal injury cannot be attributed to a single risk factor. This study explores the relationships between musculoskeletal injuries and worker characteristics (age, gender and years of experience, and time since previous musculoskeletal injury), biomechanical factors, and work organization factors (e.g. job control, supervisor support, psychological job demands, overtime).
Objective: To determine whether work organization factors are related to the risk for upper and lower-body musculoskeletal injuries among health care workers and to determine the relative importance of individual, biomechanical and work organization factors to the risk for musculoskeletal injuries among those workers.
Design: A retrospective, longitudinal, four-year, cohort study. Personnel records were used to gather data on worker characteristics (age, gender and years experience) and occupational histories. Direct observations of biomechanical risks were completed by a trained observer for all hospital occupations. Representative scores for job control, supervisor support, psychological job demands and time pressures were developed from the responses to questionnaires administered to three, random, representative samples of workers. Four indicators of workload within a department were investigated. Relationships between individual, biomechanical, work organization factors and the rate of musculoskeletal injuries resulting in compensation were analyzed using Poisson Regression.
Setting: An acute care hospital in the lower mainland of British Columbia, Canada.
Subjects: 3769 health care workers, which worked at the hospital for more than one month during the four-year period. Physicians, students and off-site workers were not included. The number of subjects included in the analysis of work organization factors was reduced due to data availability.
Main Outcome Measures: The magnitude of an association between a risk factor and a health outcome for all risk factors investigated were calculated and expressed as relative risk ratios (RR). A RR of 2.0 for workers in occupations with high biomechanical demands, for example, means that are twice as likely to suffer a musculoskeletal injury relative to those with low levels of biomechanical demands. Adjusted risk ratios were calculated which estimate the magnitude of an association between a factor and the risk of an injury after adjusting for the effect of other factors. An adjusted RR of 2.0 associated with low job control for example indicates a two-fold increased risk of injury after adjusting for the effect of individual and biomechanical factors.
Results: The risk of musculoskeletal injury resulting in a compensation claim was associated with individual, biomechanical and work organization factors. The magnitude of the risk differed for upper-body and lower-body injuries.
The risk for upper-body musculoskeletal injuries resulting in a claim was significantly increased for employees working in occupations with low job control, low supervisor support and during periods of high departmental sick time. Low job control and high departmental sick time were also associated with an increased risk for lower-body musculoskeletal injuries.
The risk of musculoskeletal injuries increased as the level of exposure to biomechanical factors in an occupation increased. The risk also increased if an employee had a recent previous musculoskeletal injury and less experience on the job.
For upper-body injuries, job control and time since previous injury were associated with the largest increases in risk, whereas biomechanical factors and time since previous injury were the strongest risk factors for lower body injuries.
Conclusion: Interventions aimed at reducing biomechanical demands and job strain associated with low job control, low supervisor support and periods of high department sick time, and at providing modified work options for workers with prior injuries, are warranted for preventing work-related musculoskeletal injuries among health care workers.
Interventions for upper-body musculoskeletal injuries should be weighted toward modified work options and job control intervention. For lower-body injuries the combination of interventions should be weighted toward modified work options and biomechanical interventions.