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Work organization factors and musculoskeletal symptoms and claims among health care workers

University of British Columbia

This dissertation is a study of health care workers and the relationship between work organization factors and work-related musculoskeletal outcomes. It was hypothesized that rates of upper-body and lower-body musculoskeletal symptoms and compensation claims would increase with exposure to adverse work organization factors defined by low job control, low work support, high job demands or time pressures, and high levels of workload, while controlling for individual and biomechanical risk factors. Theoretically, both models of work-related musculoskeletal morbidity and job stress informed the study. Musculoskeletal morbidity is believed to develop when the conditions of work exceed the capacity of the worker. These conditions may be the result of adverse work organization factors that produce a stress response among workers with a direct effect on the musculoskeletal system, or they may modify other workplace factors that in turn influence musculoskeletal conditions. The study employed a retrospective, longitudinal cohort design and followed 4020 health care workers from an acute-care hospital over a four-year period. Workers were enumerated from hospital personnel records and outcome data were ascertained from the hospital's occupational health and safety database. Biomechanical scores for occupations were assessed by direct observation and scored using checklists. Scores for the work organization measures of control, demands, support and pressure were assigned to cohort members using a job exposure matrix. The matrix was developed from responses to validated scales included in three random sample surveys of employees over the four-year study period. Workload measures were defined by time-varying levels of departmental sicktime, overtime and work units, calculated from financial reports. The risk of musculoskeletal symptoms and claims associated with work organization factors, controlling for individual and biomechanical factors, was assessed using Poisson regression. In the final models, low levels of job control and work support, as well as high levels of workload related to departmental sicktime, were significantly associated with an elevated risk of upper-body musculoskeletal symptoms and claims. The risk of lower-body musculoskeletal symptoms and claims was significantly elevated for workload due to high levels of departmental sicktime, and that for lower-body compensation claims with low job control. Individual and biomechanical factors were also significant predictors of musculoskeletal outcomes, which gives support to the idea that these outcomes have a multi-factorial etiology.

Thesis/Dissertation

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2009-07-02

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http://hdl.handle.net/2429/9983

Health Care and Epidemiology

University of British Columbia

UBCV

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