ReviewPsychosocial work stressors as antecedents of musculoskeletal problems: A systematic review and meta-analysis of stability-adjusted longitudinal studies
Highlights
► This is the first meta-analysis on the relationship between psychosocial risk factors at work and musculoskeletal symptoms. ► Psychosocial risk factors at work do in fact have a longitudinal effect on the development of musculoskeletal problems. ► Especially, high monotonous work and lack of social support at work have an influence on the onset of low back pain.
Introduction
Musculoskeletal disorders (MSD), especially chronic low back pain, are a prevalent global health problem related to high health-care and economic costs (Andersson, 1999). For example in Germany, most sick leave days (23.3%) in 2005 were due to MSDs that resulted in a gross value loss as high as 15.5 billion Euros (BDP, 2008). The majority of research studying the risk factors associated with the development of MSD has relied on the impact of physical exposures or ergonomic factors at the workplace. However, recently, researchers have also considered psychosocial workplace conditions as risk factors for musculoskeletal problems. Typically, psychosocial workplace conditions have been characterized as existing circumstances that an individual is exposed to at the workplace (e.g., Hartvigsen et al., 2004, Warren, 2000) and that exert their influence on the individual either through psychologically relevant task organization procedures (e.g., time pressure, job control) or through the social work environment (e.g., lack of social support). In fact, a large number of primary studies have documented a substantial association between several psychosocial workplace conditions and musculoskeletal problems (Skov et al., 1996, Violante et al., 2004). In an attempt to summarize empirical findings from previous literature, researchers have already conducted several reviews on the topic (Hartvigsen et al., 2004, Steenstra et al., 2005). Yet, results are inconclusive and sometimes also contradictory due to the different inclusion criteria for primary studies and methodological approaches.
Additionally, when considering past research the causal direction of the association between work-related psychosocial risk factors and MSD remains unclear. Even though many researchers have argued that psychosocial workplace conditions are a potential antecedent of musculoskeletal problems, from the variety of studies in the literature it cannot be concluded if and which of the studied psychosocial conditions might have a causal role in the emergence of musculoskeletal problems and should therefore be regarded as a psychosocial risk factor relevant for musculoskeletal problems.
A leading way to address the question of causality in field settings is to conduct longitudinal studies. When longitudinal studies adequately control for the stability (or baseline-level) of an outcome (i.e. musculoskeletal problems), longitudinal studies can provide evidence on causality under certain circumstances. Specifically, the lagged effect of a predictor (e.g., psychosocial stressors) at the first measurement occasion on the stability-adjusted outcome variable at the second measurement occasion can be interpreted as a measure of the causal effect of the predictor on the outcome (Finkel, 1995, Zapf et al., 1996). Accordingly, in order to assess the impact of psychosocial work stressors on health outcomes, occupational health researchers recommend stability-controlled longitudinal studies, thereby placing strong emphasis on the high quality level of research design and analysis (Zapf et al., 1996).
In recent years, a considerable number of longitudinal studies have investigated the lagged effect of psychosocial workplace conditions on musculoskeletal problems. To our knowledge, these studies have not systematically been integrated to assess fully the magnitude of potential causal effects of psychosocial work stressors on musculoskeletal problems. Thus, the aim of the present investigation was to conduct a systematic review and meta-analysis regarding the influence of occupational psychosocial risk factors on the development of MSD.
Section snippets
Search strategy
A systematic literature search of MEDLINE (1948 to August 2009), PsychINFO (1872 to August 2009) and Embase (1947 to August 2009) was conducted for studies that looked at the relationship between psychosocial work stressors and musculoskeletal problems. Additionally, reference lists of each of the located articles and key review articles were searched, manually.
When studying the relationship between occupational psychosocial risk factors and MSD, researchers rely on several theoretical models
Literature search results
Database searches in PubMed, Embase and PsychINFO retrieved a total of 5901 unique citations. The initial screening of abstracts and titles lead to the exclusion of 5652 citations, leaving 249 citations for full-text review. Manual searches of the reference lists of these articles identified one additional article for a total of 250 articles. The full-text review of these articles led to the identification of a total of 94 longitudinal studies, of which only 50 articles reported
Discussion
This meta-analytic investigation estimated the meta-analytic lagged effect of a considerable number of psychosocial work stressors on subsequent musculoskeletal problems. Our findings suggest that lagged effects of psychosocial work stressors are common, even when studies adequately control for prior musculoskeletal problems. When one assumes that an unstable unmeasured background variable is not the source of the findings, this investigation additionally provides evidence that a considerable
Funding
This project was funded by the German Statutory Accident Insurance [Deutsche Gesetzliche Unfallversicherung (DGUV)].
Disclosure statement
All authors have no financial disclosures or conflict of interest.
Acknowledgements
We thank Wolfgang Viechtbauer and Ute Hülsheger for answering questions on meta-analytic methods and procedures. We also thank Katharyn Bischof for proofreading the paper as a native speaker.
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