ReviewWork-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: A systematic review and meta-analysis
Introduction
Work-related musculoskeletal disorders (MSD) are defined as symptoms caused or aggravated by occupational risk factors, including discomfort, damage or persistent pain in body structures, such as muscles, joints, tendons, ligaments, nerves, bones, and the circulatory system (Barboza et al., 2008, Cherry et al., 2001, Kee et al., 2007, Trinkoff et al., 2002). MSD are the most common health problem associated with work in Europe, affecting millions of workers. It has been estimated that 25% of European workers complain of back pain and 23% of muscle aches. MSD are the main cause of sickness absence in western European countries (Murray et al., 2012), and in the United States and Canada (Punnett and Wegman, 2004). In Europe, costs due to MSD represent approximately 2 per cent of their Gross Domestic Product (GDP) (Bevan et al., 2009), without considering productivity losses and social costs (Choobineh et al., 2010, Menzel, 2007, Podniece and Taylor, 2008). Furthermore, MSD is also one of the main causes of sickness absence among hospital nurses and nursing aides, although underreporting is common (Menzel, 2008).
Factors associated with MSD include individual characteristics, such as age and sex, occupational risk factors and non-work related exposures. Physical risk factors that arise from a worker's tasks (e.g. physical demands, handling loads, repetitive movements or vibration) are well established workplace risk factors for the occurrence of MSD. However, there is some evidence that occupational psychosocial risk factors, such as high psychosocial demands, low job control or low social support, could also have a role (European Agency for Safety and Health at Work, 2007, Magnago et al., 2007). Hospital nurses and nursing aides are occupational groups especially at risk of developing MSD (Magnago et al., 2007, Solidaki et al., 2010). The prevalence of MSD in nursing professionals has been documented in different studies (Choobineh et al., 2010, Smith et al., 2003) and varies across countries (Coggon et al., 2013). Karahan et al. found that hospital nurses and nursing aides had the highest prevalence of MSD (77.1%) in a sample of Turkish health care workers (Karahan et al., 2009). In Norway the prevalence of MSD in nursing aides has been found to be as high as 89% (Willy, 2003), whereas in Japan it is much lower at around 37% (Matsudaira et al., 2011). Several studies have shown a high risk of developing neck and low back pain in hospital nurses, attributed to both physical and psychosocial factors at work, such as shift work, long hours at work (Magnago et al., 2007, Menzel, 2007, Trinkoff et al., 2002) and the stress related to patient's management (Solidaki et al., 2010).
Although some previous systematic reviews have reported an association between psychosocial risks factors in the workplace and MSD in hospital nurses and nursing aides, to our knowledge no meta-analysis has yet been published. Thus, the aim of our study was to evaluate and quantify the association between exposure to psychosocial factors in the workplace and MSD in nurses and nursing aides in hospital settings.
Section snippets
Search strategy
An electronic search was carried out using MEDLINE (Pubmed), Psychinfo, Web of Science, Tripdatabase, Cochrane Central Controlled Trials, NIOSHTIC and Joanna Briggs Institute of Systematic Reviews on Nursing and Midwifery. Our search strategy was applied similarly to all databases and combined four blocks of keywords intended to capture different aspects of our review: (1) the outcome (prevalence and incidence of MSD), (2) the study population (nurses and nursing aides), (3) exposure
Systematic review
Of the 24 intermediate and high quality studies included in the review (Table 1), 18 had a cross-sectional design (Alexopoulos et al., 2003, Alexopoulos et al., 2006, Bos et al., 2007, Carugno et al., 2012, Choobineh et al., 2010, De Souza Magnago et al., 2010, Golabadi et al., 2013, Hoe et al., 2012, Mehrdad et al., 2010, Sembajwe et al., 2013, Simon et al., 2008, Smith et al., 2006, Sorour and El-Maksoud, 2012, Stone et al., 2007, Surawera et al., 2012, Violante et al., 2004, Warming et al.,
Discussion
According to our findings, work-related psychosocial factors seem to be associated with MSD in hospital nurses and nursing aides. Specifically, exposure to high demands/low control, effort-reward imbalance and low social support were found to be associated with low back, neck, shoulder, upper extremity, knee, and/or pain at any anatomical site, either in nurses, aides or both.
To our knowledge this is the first meta-analysis that explores the association between the exposure to psychosocial
References (63)
- et al.
Metaanalysis in clinical trials
Control. Clin. Trials
(1986) - et al.
Links between nurses’ organisational work environment and upper limb musculoskeletal symptoms: independently of effort-reward imbalance! The ORSOSA study
Pain
(2011) - et al.
Musculoskeletal disorders among nursing personnel in Korea
Int. J. Ind. Ergon.
(2007) - et al.
Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms
Appl. Ergon.
(1987) Psychosocial factors in musculoskeletal disorders
Crit. Care Nurs. Clin. North Am.
(2007)- et al.
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Population-based cohort study of incident and persistent arm pain: role of mental health, self-rated health and health beliefs
Pain
(2008) - et al.
Work-related musculoskeletal disorders: the epidemiologic evidence and the debate
J. Int. Soc. Electrophysiol. Kinesiol.
(2004) - et al.
Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries – results from the European NEXT-Study
Int. J. Nurs. Stud.
(2008) - et al.
Musculoskeletal disorders self-reported by female nursing students in central Japan: a complete cross-sectional survey
Int. J. Nurs. Stud.
(2003)