Introduction Musculoskeletal injuries are common in healthcare workers. Research and prevention have been focussing on back injuries, the scientific evidence on work-related upper limb disorders (WRULDs) is scarce. Physical and psychosocial work exposures are considered as relevant in the aetiology. Hand-intensive health care occupations, e.g. physiotherapists are commonly exposed to physical risk factors including repetitive movements while applying force and sustained awkward positions. The objective was to investigate associations between physical and psychosocial work exposures and ULDs while adjusting for non-work-related explanations.

Methods Cross-sectional with 347 Irish Chartered Physiotherapists, Physical and Athletics Therapists in hospitals and private practice (proportionate cluster and random sampling). Participants completed questions about neck, shoulder, elbow, wrist, thumb and finger symptoms (Nordic Questionnaire); psychosocial work exposures (COPSOQ), rest breaks, scheduling, physical work load, Physical Exertion (Borg scale), lifestyle and mental health. Logistic regression with psychosocial and physical factors and ULDs with adjustment for lifestyle-related issues (bmi, smoking), depression (GHQ) and leisure time injury.

Result Work tempo (OR=1.17), predictability (OR=0.76), peer support (OR=0.81) and supervisory support (OR=0.71) were significantly associated with UL symptoms in the past 12 months, work predictability (OR=0.82), influence at work (OR=0.91), supervisory support (OR=0.81) and peer support (OR=0.77) were significantly associated with incapacitating symptoms. Therapists who did not schedule their appointments were twice as likely for ULDs in a least one body site (OR=2.3), those with rests breaks below 5 min after each treatment were at increased odds for incapacitating symptoms. (OR=2.3), physical exertion and repetitive movements were associated with 12 month prevalence (OR=1.3). All analyses adjusted for confounders.

Discussion Comprehensive guidance beyond patient handling policies and training is needed for prevention of work-related ULDs that address physical and psychosocial exposures. Work organisation changes such as increased control over work, scheduling and rest breaks emerge as simple interventions to manage physical and psychosocial exposures. Examples will be provided.