Elsevier

Applied Ergonomics

Volume 43, Issue 4, July 2012, Pages 727-737
Applied Ergonomics

Prevalence and work-related risk factors for reduced activities and absenteeism due to low back symptoms

https://doi.org/10.1016/j.apergo.2011.11.004Get rights and content

Abstract

Although quite a lot is known about the risk factors for low back symptoms (LBS), less is known about the risk factors for the consequences of LBS. A sample of 3003 men and women randomly selected from the New Zealand Electoral Roll, were interviewed by telephone about self reported physical, psychosocial, organizational, environmental factors and the consequences of LBS (i.e. self-reported reduced activities and absenteeism). The 12-month period prevalence of reduced activities and absenteeism were 18% and 9%, respectively. Lifting (OR 1.79 95% CI 1.16–2.77) increased the risk of reduced activities. Working in awkward/tiring positions (OR 2.11 95% CI 1.20–3.70) and in a cold/damp environment (OR 2.18 95% CI 1.11–4.28) increased the risk of absenteeism. Among those with LBS, reduced activities increased with working in a hot/warm environment (OR 2.14 95% CI 1.22–3.76) and absenteeism was increased with work in awkward/tiring positions (OR 2.06 95% CI 1.13–3.77), tight deadlines (OR 1.89 95% CI 1.02–3.50), and a hot/warm environment (OR 3.35 95% CI 1.68–6.68). Interventions to reduce the consequences of LBS should aim to reduce awkward/tiring positions, lifting and work in a cold/damp environment. For individuals with LBS, additional focus should be to reduce tight deadlines, and work in hot/warm environments.

Highlights

► The prevalence of reduced activities and absenteeism due to LBS were 18% and 9%. ► Lifting increased the risk of reduced activities. ► Awkward/tiring positions and a cold/damp environment increased the risk of absenteeism. ► Interventions: reduce awkward/tiring positions, lifting, work in a cold/damp environment.

Introduction

Low back symptoms (LBS) are very prevalent amongst general and working populations and are a significant health problem due to their serious economic and social impact (Hanson et al., 2006, National Research CouncilInstitute of Medicine, 2001). Between 1997 and 2005 27% of all Washington State fund-accepted health insurance claims were for work-related musculoskeletal disorders (WMSDs) involving the back (51%), upper extremity (37%), neck (12%) with an average direct cost of USD 12,377 per claim (Silverstein and Adams, 2007). In Finland, the direct and indirect cost of managing patients with LBS was 624 EUR per visit to general practitioners (Mantyselka et al., 2002). A study in Sweden estimated the annual cost for sick listed more than one month due to back and neck problems was about 1.3% of Gross National Product (Hansson and Hansson, 2005).

The social consequences of LBS, including its severity, may be assessed in terms of the extent to which people are prevented from carrying out their normal activities (i.e. reduced activities) and absenteeism. Although many studies have reported on this, the findings of those that have used identical or very similar methods to that of the present study are summarised below. The social consequences of LBS arise from disability (i.e. diminished capacity for everyday activities and gainful employment, etc) (Wadell, 1991) and absenteeism. Although 10% of Chinese offshore workers (Chen et al., 2005), 17% of New Zealand dentists (Palliser et al., 2005), 21% of Swedish ambulance personnel (Aasa et al., 2005), and 42% of New Zealand veterinarians (Scuffham et al., 2010) are reported to have had reduced activities due to LBS, there are few other similar studies. The prevalence of absenteeism due to LBS was 9% for Irish health service workers (Cunningham et al., 2006), 9% of New Zealand veterinarians Scuffham et al. (2010), and 10% of dentists in Greece (Alexopoulos et al., 2004). Ijzelenberg et al. (2004) reported a similar figure of 14% of laundry and dry-cleaning workers in Netherlands whereas 15% of Greek shipyard workers had absenteeism due to LBS (Alexopoulos et al., 2008). Among general working populations in Netherland, 9% of workers took sick leave due to absenteeism (Hooftman et al., 2009), 18% of workers had ≥1 days of absenteeism due to LBS (van den Heuvel et al., 2004), and 20% of workers had ≥3 days of absenteeism due to LBS (Hoogendoorn et al., 2002). The last these three studies (Hooftman et al., 2009, Hoogendoorn et al., 2002, van den Heuvel et al., 2004) used the company’s register sickness absence data in their analysis.

Previous studies have identified physical and psychosocial risk factors for reduced activities and absenteeism due to LBS. Two cross-sectional studies by Aasa et al. (2005) and Simon et al. (2008) showed that physical factors (i.e. awkward posture and lifting) were associated with reduced activities due to LBS among Swedish ambulance personnel and nurses and auxiliary staff in various countries in Europe. Psychosocial risk factors for reduced activities due to LBS have been reported as: worry about work conditions (i.e. worry about being diseased/injured, worry about making mistakes, worry about being subjected to threats and/or violence) (Aasa et al., 2005), lack of social support (Aasa et al., 2005), high quantitative demands (Simon et al., 2008), low influence at work (Simon et al., 2008), and high effort reward imbalance ratio (Simon et al., 2008).

Some prospective cohort studies have shown an association between physical risk factors and absenteeism from work due to LBS. These include: manual material handling (Bergström et al., 2007, Hooftman et al., 2009, Hoogendoorn et al., 2002) and awkward posture (Hooftman et al., 2009, Hoogendoorn et al., 2002, Tubach et al., 2002). A case control among Dutch farmers also indicated twisting and whole body vibration to be significantly associated with absenteeism due to LBS (Hartman et al., 2005). Some psychosocial risk factors have also been shown to be predictors for absenteeism due to LBS in a few prospective cohort studies. These include: job dissatisfaction (Hoogendoorn et al., 2002, van den Heuvel et al., 2004) and lack of social support (Tubach et al., 2002, van den Heuvel et al., 2004). In addition, Bartys et al. (2005) found that low job control, psychological distress and poor organisational climate was associated with absenteeism due to musculoskeletal symptoms among UK workers.

Although some studies have reported the risk factors for the consequences of LBS, most of them have explored only limited risk factors at a time. For example, Hoogendoorn et al. (2002) investigated the association between two physical factors (i.e. awkward posture and lifting), psychosocial factors (using Karasek’s job content questionnaire (JCQ)) and absenteeism due to LBS among a general working population. Similarly, Hooftman et al. (2009) and van den Heuvel et al. (2004) assessed awkward posture, lifting, driving, and psychosocial factors in relation to absenteeism due to LBS. A wider range of physical factors were explored by Alexopoulos et al. (2006) and Alexopoulos et al. (2004). They assessed awkward posture, repetitive movements, prolonged sitting or standing, strenuous arm positions, and use of vibrating tools, psychosocial (using Karasek’s JCQ), perceived general health, and need for recovery in relation to LBS’ consequences. However, to our knowledge only one study has explored environmental factors (noise, draft, heat, cold, poor quality of internal air, and poor of blinding lighting) in relation to absenteeism due to LBS (Virtanen et al., 2008). This study also included a wide range of psychosocial factors, but only a few physical factors (i.e. work posture, repetitive movements, and physical strain) in its analysis. Since workers are most commonly exposed to physical, psychosocial, organisational and environment factors simultaneously, and each of these factors may be correlated with each other in the workplace, it is possible that there may be additional risk factors unreported in previous studies. Thus, the present study investigated a wider range of physical factors as well as psychosocial, organisational, and environmental factors in relation to the consequences of LBS, in which exposures were simultaneous. In addition, most studies cited above (Aasa et al., 2005, Alexopoulos et al., 2006, Bartys et al., 2005, Hartman et al., 2005, Hoogendoorn et al., 2002, Simon et al., 2008, Tubach et al., 2002) examined the risk factors for the consequences of LBS in the whole population, regardless of the presence of LBS. In order to be more focused in preventive strategies, therefore, the present study also examined the risk factors for the consequences of LBS for only those individuals who reported LBS.

Section snippets

Participants

This study was part of a recent large national survey of self-reported current occupational exposures, workplace practices and occupational ill-health which has been described in detail elsewhere (Eng et al., 2010). Ten thousand potential participants aged 20–64 years randomly selected from the New Zealand Electoral Roll (7000 from 2003 and 3000 from 2005) were invited by mail (three letters were sent) to have a telephone interview (Eng et al., 2010). Of 10,000 mail-outs, 1209 were returned to

Descriptive data for the sample

The overall response rate (the number interviewed as a proportion of the total eligible sample) was 37%. Forty-eight percent of the study participants were male (n = 1431) and 52% female (n = 1572). The age distributions of the sample were: 20–34 years −22%; 35–44 years–27%; 45–54 years −29%, and; 55 + years −22%, with a median age of 45 years (interquartile range 36–54 years). Table 1 presents the distribution of the sample in relation to age and occupational group for males, females, and the

Prevalence of reduced activities and absenteeism due to LBS

The prevalence of reduced activities due to LBS in the present study was 18%. This finding is similar to that of Palliser et al. (2005) who reported 17% in a survey of musculoskeletal symptoms among New Zealand dentist. It is higher than for Chinese offshore workers (10%) (Chen et al., 2005), but it is lower than for New Zealand veterinarians (42%) (Scuffham et al., 2010). Of those who reported LBS, 33% reported reduced activities during the last 12 months. It is similar with previous studies

Acknowledgements

We acknowledge funding support from the Joint Research Portfolio of the Health Research Council, Accident Compensation Corporation, and Department of Labour (HRC 04/072) of New Zealand. We would like to thank Tracey Whaanga, Zoe Harding, Cecil Priest, Penelope Whitson, Michaela Skelly, Phoebe Taptiklis, Emma Drummond, Anna McCarty, Natasha Holland, Kelly Gray, Adam Hoskins, Alister Thomson, Jessica Fargher, Cilla Blackwell, Emma Turner, Selena Richards, Kim Crothall, Alice Harding, Joelene

References (72)

  • M. Simon 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

    International Journal of Nursing Studies

    (2008)
  • G. Sundelin et al.

    Effects of exposure to excessive drafts on myoelectric activity in shoulder muscles

    Journal of Electromyography and Kinesiology

    (1992)
  • B. Widanarko et al.

    Prevalence of musculoskeletal symptoms in relation to gender, age, and occupational/industrial group

    International Journal of Industrial Ergonomics

    (2011)
  • U. Aasa et al.

    Relationship between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel

    Journal of Occupational Health

    (2005)
  • E.C. Alexopoulos et al.

    Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals

    International Archives of Occupational and Environmental Health

    (2003)
  • E.C. Alexopoulos et al.

    Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers

    European Spine Journal

    (2008)
  • E.C. Alexopoulos et al.

    Prevalence of musculoskeletal disorders in dentists

    BMC Musculoskeletal Disorders

    (2004)
  • E.C. Alexopoulos et al.

    Musculoskeletal disorders in shipyard industry: prevalence, health care use, and absenteeism

    BMC Musculoskeletal Disorders

    (2006)
  • H.M. Arrighi et al.

    The evolving concept of the healthy worker survivor effect

    Epidemiology

    (1994)
  • B.E. Bang et al.

    Feeling cold at work increases the risk of symptoms from muscles, skin, and airways in seafood industry workers

    American Journal of Industrial Medicine

    (2005)
  • L.H. Barrero et al.

    Validity of self-reported mechanical demands for occupational epidermiologic research of musculoskeletal disorders

    Scandinavian Journal of Work, Environment & Health

    (2009)
  • S. Bartys et al.

    A prospective study of psychosocial risk factors and absence due to musculoskeletal disorders - implications for occupational screening

    Occupational Medicine

    (2005)
  • G. Bergström et al.

    Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up

    Occupational and Environmental Medicine

    (2007)
  • H.B. Bressler et al.

    The prevalence of low back pain in the elderly - a systematic review of the literature

    Spine

    (1999)
  • J.A. Buckwalter

    Spine update - aging and degeneration of the human intervertebral disc

    Spine

    (1995)
  • A. Burdorf et al.

    Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability

    Occupational and Environmental Medicine

    (2006)
  • A. Burdorf et al.

    Prognostic factors for musculoskeletal sickness absence and return to work among welders and metal workers

    Occupational and Environmental Medicine

    (1998)
  • W.Q. Chen et al.

    Impact of occupational stress and other psychosocial factors on musculoskeletal pain among Chinese offshore oil installation workers

    Occupational and Environmental Medicine

    (2005)
  • S.N. Cheuvront et al.

    Mechanisms of aerobic performance impairment with heat stress and dehydration

    Journal of Applied Physiology

    (2010)
  • C. Cunningham et al.

    Low back pain and occupation among Irish health service workers

    Occupational Medicine-Oxford

    (2006)
  • R. Dykes

    Prevalence of Musculoskeletal Discomfort in Seventy Three Primary and Secondary School Teachers in New Zealand, School of Management

    (2009)
  • K. Ekberg et al.

    Cross-sectional study of risk factors for symptoms in the neck and shoulder area

    Ergonomics

    (1995)
  • A. Eng et al.

    The New Zealand workforce survey I: self-reported occupational exposures

    Annals of Occupational Hygiene

    (2010)
  • L.I. Gardner et al.

    Risk factors for back injury in 31,076 retail merchandise store workers

    American Journal of Epidemiology

    (1999)
  • M.A. Hanson et al.

    The Costs and Benefits of Active case Management and Rehabilitation for Musculoskeletal Disorders (RR 493)

    (2006)
  • E.K. Hansson et al.

    The costs for persons sick-listed more than one month because of low back or neck problems. A two-year prospective study of Swedish patients

    European Spine Journal

    (2005)
  • Cited by (45)

    • Influence of risk factors associated with musculoskeletal disorders on an inner population of northeastern Brazil

      2021, International Journal of Industrial Ergonomics
      Citation Excerpt :

      Given the above and the results of the regression models, the following hypotheses may be tested: Keeping the upper limbs in an uncomfortable position (Widanarko et al., 2012; Nogueira et al., 2018; Silva et al., 2020) directly increases the perception of physical demands, symptoms in the upper back, and the perception of stress; The perception of physical demands directly influences the symptoms in the upper back and the perception of stress (Fernandes et al., 2010; Silva et al., 2014; Du et al., 2021);

    • A comparison of manual handling risks in different domestic waste collection systems using three separate evaluation methods

      2021, International Journal of Industrial Ergonomics
      Citation Excerpt :

      One of the greatest challenges faced is to increase recycling rates (UKG 2019 and EU 2008) which had plateaued at 45% in 2019 (DEFRA 2019). This, combined with lower operating budgets (Frew and Breheny 2020), can affect systems of work, which must not increase worker ill health absence (Thomas et al., 2019 and Widanarko et al., 2012). Of equal difficulty has been how to integrate Health and Safety considerations into the decision making process (WYG 2011; HSE 2010a) as well as the importance of developing a sustainable workforce (Black and Frost 2011; UKG 2010; Gladwin et al., 1995; Herrera and Heras-Rosas 2020).

    • A review of work environment risk factors influencing muscle fatigue

      2020, International Journal of Industrial Ergonomics
    View all citing articles on Scopus
    View full text