Abstract
BACKGROUND:
Musculoskeletal symptoms (MSS) are a major health problem in health professionals. However, there is very little evidence about predictors of MSS in the group of radiology technologists.
OBJECTIVES:
The aim of this study was to identify prevalence and predictors of MSS in radiology technologists working in Austrian Hospitals.
METHODS:
272 radiology technologists completed a self-report questionnaire including MSS, work demands, work strain and well-being (WHO-5 questionnaire).
RESULTS:
Lower back pain and upper back pain are the most frequent MSS in radiology technologists. A high proportion of participants experience these symptoms every day (20.1% and 19.8%, respectively). Work strain, age and well-being were the best predictors for MSS in a regression model.
CONCLUSIONS:
MSS is a major health issue for radiology technologist working in hospitals. Our results provide evidence for the assumption that psychological factors play an important role in development of MSS. Thus, beside physical health promotion programs (e.g. safe patient handling), psychological intervention may have positive effects on MSS.
Introduction
Musculoskeletal symptoms (MSS) have a high prevalence in health professionals that is commonly associated with work conditions. MSS are associated with sick leaves, premature leaving work and medical costs [1–3]. Most studies deal with nurses and their work demands. Forceful exertions, heavy lifting and movement of patients are associated with higher prevalence of MSS [4–7]. The link between physical demands and MSS is relatively consistent for nursing profession. A recent study (with a sample size of over 1000 nurses) linked highly demanding work and musculoskeletal problems by odds ratios between 4.98 and 6.13 [8]. Furthermore, cause-and-effect mechanism is well established and support epidemiologic data [9]. Recently, biomechanical model calculations that focused on lumbar load during patient transfer handling showed none of the analyzed activities were in an acceptable, i.e. healthy, load range [10].
However, despite this evidence from nursing and related health professionals, the group of radiology technologists (RT) has been surprisingly little addressed by research on MSS. The radiologic technologist has a very important role in different areas of healthcare. Diagnostic imaging (sonography, X-ray, CT or MRT) is essential for recognizing pathological changes. RT’s work is dominated by movement of patients, awkward postures and other manual handlings [11]. This seems to have negative health impacts: a majority of x-ray technologists reported back pain and multiple episodes of musculoskeletal pain [11]. Recent Italian studies identified 12-month-prevalences of 67% for X-ray technologists and 37% for X-ray students [12, 13]. However, this research did not take into account, that MSS may be associated with psychosocial and related factors. Arvidsson et al. found significant correlations between MSS and psychosocial factors associated with workplace. High job demands, low job control and high emotional demands are correlated with increased risk of MSS [14]. Different theoretical frameworks - like job demand/control model - hypothesize that job demands only result in psychological strain, if certain circumstances are on hand [15, 16]. An important mechanism is the appraisal process as described in Lazarus’ strain model [17]. This process is decisive if one believes that a demand is controllable by one’s resources or not (resulting in strain). For our study this difference between demands and strain plays a crucial role, thus this aspect has not been yet investigated in relation to MSS in radiology technologists. Hence, our research objectives were to assess if and to what extent radiology technologists experience MSS, if perceived physical work demands are associated with MSS, and if perceived work strain is associated with MSS.
Methods
Study design
This study is a cross sectional survey. We developed a questionnaire via a triangulation process. Existing literature and results from a qualitative interview study conducted with 10 radiology technologists from four different health organizations in Austria were integrated to the study tool. The online survey was administered via surveymonkey (www.surveymonkey.de). Head radiology technologists of all Austrian hospitals were addressed via e-mail requesting to distribute the survey link to their staff.
Participants
272 radiology technologists responded to the questionnaire (Table 1). In Austria 3,311 (77.65% female) radiology technologists work in hospitals [18], so the sample size corresponds with approximately 8% of the population. All procedures were consistent with the ethical guidelines of the expanded Helsinki Declaration (World Medical Association Declaration of Helsinki, 1997) and those suggested by the American Psychological Association (2002).
Participants’ demographic characteristics
Participants’ demographic characteristics
Musculoskeletal symptoms
Seven items were developed to assess musculoskeletal symptoms on basis of expert interviews and Nordic Musculoskeletal Questionnaire [19]. Participants were asked how often did you experience symptoms in the following body regions during the past 12 months and had to rate the frequency of symptoms on a range from 0 (never) to 4 (every day) for shoulder joint, arms, hands, legs, feet, high back, low back. Reliability analysis revealed a Cronbach’s Alpha of.81 for the whole scale.
Work demands
Participants were asked how often demanding work factors occur during working hours and had to rate a list of work demands from 0 (never) to 4 (very often). Factor analysis revealed two factors of work demands, i.e. physical work demands (9 items) and mental work demands (3 items). Reliability analysis resulted in Cronbach’s Alpha = 0.86, and 0.87, respectively.
Work strain
Participants were asked “how strongly do you feel strained during working hours?” and had to rate the intensity of strain for different factors (e.g. immobile patients, lifting heavy burdens) from 0 (not at all) to 4 (very strong). Reliability analysis revealed a Cronbach’s Alpha = 0.91 (10 items).
The World Health Organisation – Five well-being index (WHO-5)
Recent evidence indicates that MSS is associated with psychosocial factors [14]. Thus, we used the WHO-5 as valid instrument to assess psychological well-being and depressive symptoms. Furthermore, the WHO-5 questionnaire is widely used as a reliable screening instrument for depression [20]. WHO-5 questionnaire consists of five items that are related with well-being of the recent two weeks, e.g. I felt cheerful and in good spirits. Participants respond from 0 (at no time) to 5 (all of the time). WHO-5 is a highly reliable instrument: Previous studies reported Cronbach’s Alpha of.82 or even over.90 for different samples, respectively [21, 22]. Reliability analysis for our sample revealed a Cronbach’s Alpha = 0.88.
Statistics analysis
Statistical Analysis was conducted by IBM SPSS Statistics 21. We calculated descriptive statistics for all relevant items and factors. We obtained factor analysis for scale construction of musculoskeletal symptoms, work demands and work strain. We used principal component analysis as extraction method and Varimax with Kaiser normalisation as rotation method. Scree plot curve was used to identify the number of factors (which corresponded to a eigenvalue cut-off point = 2) [23]. Items with factor loadings lower than.20 were omitted [24]. Reliability was assessed by Cronbach’s Alpha for musculoskeletal symptoms, physical work demands, mental work demands, work strain and WHO-5. Items that reduced reliability of the scale were omitted, respectively. We obtained correlation analysis to assess the association between musculoskeletal symptoms and physical work demands, mental work demands, work strain, WHO-5 score, age, professional experience, gender.Significant factors were included in a stepwise regression model with musculoskeletal symptoms as dependent variable. Furthermore, correlation analysis for lower back pain, upper back pain and single items of work strain was performed.
Results
Musculoskeletal symptoms
Frequency of musculoskeletal symptoms is presented in Table 2 Most frequent symptoms were low back pain (LBP) and upper back pain (UBP).
Proportion (%) of participants experiencing a musculoskeletal symptom every day
Proportion (%) of participants experiencing a musculoskeletal symptom every day
Correlation analysis showed significant associations (Pearson’s r) between musculoskeletal symptoms and work strain (.43), WHO-5 score (–.38), year of birth (age) (–.38), years of professional experience (.35), physical work demands (.32), mental work demands (.24) and physical activity (–.21) (p < = 0.001, for all).
In a stepwise linear regression model work strain, year of birth (age), and WHO-5 score turned out to be the best predictors of musculoskeletal symptoms (Table 3).
Stepwise linear regression analysis with musculoskeletal symptoms as a dependent variable
Stepwise linear regression analysis with musculoskeletal symptoms as a dependent variable
A correlation analysis on item-level showed that LBP and UBP are strongly associated to work strain items (Table 4).
Correlations (Pearson’s r) between HBP, LBP and work strain on item-level
All values are significant on p < 0.01-level, all fat values are significant on p < 0.001-level.
Low and upper back pain were the most frequent MSS in radiology technologists. Approximately, 20% of participants experience these symptoms every day. Previous research of MSS in health professionals has mainly focused on nurses [4–6]. These studies have revealed similar high prevalence of MSS in nurses. However, our alarming results are also in line with scarce evidence for radiology technologists or sonographers. Studies in Italy and Canada showed high prevalence of MSS in radiology technologists working in hospitals [11, 12]. A recent study indicated a 7-day-prevalence of 24% for lower back pain in sonographers [14]. Especially, low back pain was associated with handling of overweight patients in our study. This is in line with a recent review that demonstrated elevated risks of nurses dealing with obese patients. Therefore, future health promotion projects for both professional groups - nurses and radiology technologists - have to address save patient handling, the usage of lifting devices and so on [25].
Furthermore, we identified significant correlations between perceived physical/mental work demands and MSS. However, a linear regression model revealed perceived work strain as the best predictor of MSS. This is line with the assumption, that high work demands alone do not have negative health effects, if they do not lead to strain. The latter is dependent of appraisal processes described by the Lazarus stress model [17]. These appraisal processes try to connect demands with resources to deal with these demands. The appraisal of insufficient resources leads to work strain and the feeling of excessive demands. Our study shows that this is not only psychologically relevant, but also associated with MSS. Studies from other businesses emphasize the importance of these appraisal processes. De Croon et al. showed in a study with 820 truck drivers that stressful work alone is not a reason for turnover, it is rather mediated by strain [15]. In a further study participated by nurses, organizational commitment has been a buffer between job demands and strain, indicating one aspect of these appraisal processes [16]. Recapitulated, the negative impact of high work demands is to be put into effect by negative appraisal processes that lead to work strain.
Earlier research supports our findings that link work strain with MSS [26]. Job strain was found to be a significant risk factor for MSS in nurses [27]. Besides work strain and age, the WHO-5 score (depressive symptoms) predicted significantly MSS in our regression model. This is very close to the study reported by Freiman et al. that mental health problems (e.g. Stress, burnout, somatic stress symptoms, depression) were strong predictors for MSS [28]. Chronic pain and mood have very similar neurotransmitter pathways, which explains the relationship between depressive symptoms and MSS [29]. Especially the serotonin pathway and its genetic variation is associated with somatic awareness, depressive and anxious symptoms. Further, recent research indicates that the serotonin pathway is also prominently involved in the development of chronic pain syndroms [29].
Limitations
A limitation of this study is the relatively small sample size and the cross-sectional character of this study. Future longitudinal research has to challenge our results and give more insights about cause-and-effect relationships.
Conclusions
Finally, we conclude that MSS are a significant and serious health issue in radiology technologists working in hospitals. Thus, Workplace Health Promotion has to address the improvement of working conditions of radiology technologists, e.g. safer patient handling or light strength training. However, in our study MSS is best predicted by work strain, age and WHO-5 score (depressive symptoms), indicating the importance of psychological aspects in the development of MSS. Since the affective, cognitive and sensory dimensions of pain triggered by MSS are so strongly interrelated [29], the practical implication of our study is to address all these dimensions in Workplace Health Promotion. Psychological interventions, e.g. cognitive restructuring, relaxation exercises, can be successful in reducing MSS. We are currently working on a multimodal training program for radiology technologists that include all these aspects. Further studies will show if these interventions are effective.
Conflict of interest
None declared.
Source of funding
Not applicable.