The effect of work-related psychosocial stressors on musculoskeletal disorder symptoms in hospital attendants

Abstract

BACKGROUND:

Psychosocial stress at work is an important issue among hospital attendants.

OBJECTIVE:

This study aimed to examine psychosocial stressors in the work environment and assess their impacts on WMSD symptoms among hospital attendants in Shiraz, southern Iran.

METHODS:

This cross-sectional study was conducted on 198 hospital attendants from Shiraz. The study data were collected using a basic demographic questionnaire, Nordic Musculoskeletal Questionnaire (NMQ), the Persian version of Effort-Reward Imbalance Questionnaire (F-ERIQ), and an individual risk assessment (Evaluación del Riesgo Individual [ERIN]). The data were entered into SPSS version 16 and analyzed using Mann-Whitney U, Chi-square, and Spearman’s correlation tests.

RESULTS:

The prevalence of WMSD symptoms was 29.8% in the lower back, 25.3% in knees, and 20.7% in ankles/feet. Posture analysis by the ERIN technique demonstrated that 95.5% of the postures were high risk for WMSDs. F-ERIQ identified that 83.4% of the hospital attendants belonged to the “1 < ER-ratio” category. Besides, the “effort” subscale of the F-ERIQ was significantly associated with reporting of MSD symptoms in the neck, shoulders, wrists/hands, and lower back. In addition, a significant correlation was observed between effort (r = 0.367, p = 0.028), esteem (r = –0.273, p = 0.041), security (r = –0.253, p = 0.045), and over-commitment (r = 0.301, p = 0.019) and the total score of the ERIN technique.

CONCLUSION:

Intervention programs and coping strategies for reduction of work-related stress and, subsequently, prevention of WMSD symptoms are recommended among hospital attendants.

Keywords

Effort posture workload reward healthcare

1 Introduction

Work-related musculoskeletal disorders (WMSDs) are a common health problem [1 –4] and the major cause of work-related disability among healthcare workers [1 , 6]. According to Occupational Safety and Health Administration (OSHA, 2012) [7], WMSDs are almost four times more prevalent among nursing aides and orderlies compared to other healthcare workers [7, 8].

Hospital attendants are a group of healthcare workers who undertake a range of duties, such as transporting patients by the wheelchair or gurney to the operating room, x-ray department, other wards, or other locations around the facility, and moving and carrying the hospital waste. These duties include physically (e.g., prolonged static postures and repetitive motions) and psychosocially (e.g., high demands and low job control or social support) demanding tasks, which have been linked to the development of WMSDs [9].

The prevalence of WMSDs among healthcare workers, such as hospital attendants, has been re-ported in different studies [10] and has been menti-oned to vary across countries [11]. Nursing aides/ orderlies had the highest prevalence of WMSD symptoms (77.1%) among a sample of Turkish healthcare workers [12]. In Norway, the prevalence of WMSD symptoms in nursing aides/orderlies was as high as 89% [13], whereas it was much lower and around 37% in Japan [14].

Psychosocial stressors in the hospital environment are common due to high work demands and low con-trol and social support for some occupational groups, such as hospital attendants [15, 16]. Psychosocial stress at work is considered to be among the most important predictors of employees’ wellbeing. Over the last few decades, the impact of the psychosocial work environment on employees’ health, workers’ performance, and the whole organization has been acknowledged [17]. These environmental factors include long working hours, quality of relationships among workers, poor supervision, poor work environment, and high workload [18, 19]. Psychosocial stress at work also exerted a significant impact on workers’ health and wellbeing, quality of life and family life, job satisfaction/dissatisfaction, turnover, and absence from work [18, 20].

There are many psychosocial work environment stressors that could potentially lead to WMSD symptoms [21 –24]. There is evidence that psychosocial factors at work, such as high psychosocial demands and low job control or social support, could also play a role [25]. Work-related stress, as one of the most important occupational stressors [25], had a direct impact on development of WMSDs among personnel due to excessive mental workload [24, 26]. Some previous systematic reviews have reported an association between psychosocial factors in the workplace and WMSDs in hospital nurses and nursing aides [15, 16]. Indeed, different studies have shown a significant correlation between psychosocial stress among healthcare workers at work and the incidence of low back pain in the work environment [27, 28].

WMSDs and psychosocial stress at work are important issues that have been neglected in healthcare workers, especially hospital attendants [17]. Assessing the psychosocial work environment and musculoskeletal symptoms is an important issue in order to better manage and prevent WMSD symptoms and workforce disability. Therefore, the present study aims to: a) examine the psychosocial work environment and b) assess its effect on WMSD symptoms among employed hospital attendants in Shiraz, southern Iran.

2 Materials and methods

This cross-sectional study was conducted among hospital attendants in Shiraz, southern Iran.

2.1 Subjects

This study was performed among 198 hospital attendants with at least one-year of work experience. The subjects were randomly selected from different hospital wards (response rate: 99%). Individuals with underlying diseases or accidents affecting the musculoskeletal system were excluded from the study. All participants voluntarily took part in the study after receiving oral information about the aims and protocol of the study. Additionally, the study was conducted in accordance with the Helsinki Declaration of 1964 and its later amendment in 2008 [29]. Figure 1 shows the hospital attendants while performing different tasks.

Fig. 1

Hospital attendants while performing different tasks. a) A hospital attendant while transferring a patient from the bed to the Magnetic Resonance Imaging (MRI) apparatus. b) A hospital attendant while moving and carrying the hospital waste.

2.2 Data gathering tools

In this study, the data were gathered with the following tools:

a) Demographic and job characteristics questi-onnaire:

Demographic and job characteristics in-cluded age, weight, height, work experience, daily working time, sex, marital status, number of children, level of education, type of employment, and having a second job.

b) Nordic Musculoskeletal Questionnaire (NMQ):

The general Nordic questionnaire of musculoskeletal symptoms was used to examine WMSD symptoms in different parts of the body among the study population. The NMQ provides a mean to screen cases with WMSD symptoms and to determine the prevalence of WMSD symptoms in epidemiological studies [30]. The validity and re-liability of the Persian version of NMQ has been previously reported by Choobineh et al. [31].

c) Individual risk assessment (Evaluación del Riesgo Individual [ERIN]) checklist:

The risk of WMSDs was determined using the ERIN technique, which is a method for performing large-scale assessment of individuals exposed to WMSDs risk factors in static and dynamic tasks. ERIN was introduced by Rodríguez et al. in 2013 [32]. It was developed in line with the International Ergonomics Association (IEA) and World Health Organization’s (WHO) initiative for developing toolkits that non-experts can use at the workplace level to assess the risk of WMSDs [32].

In this study, the postures of the hospital attendants were photographed and the most repeated and awkward ones were selected for analysis. The proposed method involved the measurement or assessment of the following seven variables: posture and frequency of movement of the trunk, shoulder/arm, hand/wrist and neck, the rhythm resulting from the interaction of work speed and the duration of each task, intensity of effort (which included both the intensity and frequency of the perceived effort), and self-assessment (workers were asked about their perception of how stressful they found their work to be).

The total risk score would be extracted from a relevant matrix and table. The total score could be categorized into four action levels as follows:

Low level (the total risk score is between 7 and 14: no changes are required).

Medium level (the total risk score is between 15 and 23: further investigation is needed and changes may be required).

High level (the total risk score is between 24 and 35: investigation and changes are required soon). 4. Very high level (the total risk score is more than 36: investigation and changes are required immediately).

d) Effort-Reward Imbalance Questionnaire (ERIQ):

The 23-item Effort-Reward Imbalance (ERI) model was used to measure occupational stress in the participants. The ERI model was introduced by Siegrist et al. (1996) and is one of the most important models for guiding occupational stress and health research [33]. The ERIQ consisted of three scales and was applied without any changes in this study. The three scales included effort (6 items), reward (11 items, including esteem, promotion, and job security), and over-commitment (6 items).

Responses to the items of “effort” and “reward” scales were scored on a 5-point scale where a value of 1 indicated no respective stressful experience and a value of 5 indicated a very stressful experience. The items of the “over-commitment” scale were scored on a 4-point scale (1 = complete disagreement and 4 = complete agreement with the statement). Consequently, the scores for the “effort” scale ranged from 6 to 30, the scores for the “reward” scale ranged from 11 to 55, and the scores for the “over-commitment” scale ranged from 6 to 24. Moreover, according to a predefined algorithm, a ratio between the “effort” and “reward” scales was calculated to quantify the degree of mismatch between effort and reward as follows [34, 35]: $ER - ratio = k \frac{E}{R}$ (1) Where:

$k = \frac{Number of reward items}{Number of effort items}$ (2)

For ER = 1, the person reports one effort for one reward. For ER < 1, there are less efforts for each reward. For ER > 1, the person reports more efforts for each reward [34]. The psychometric properties of the Persian version of ERIQ (F-ERIQ) have been reported by Yadegarfar et al. [36, 37].

The participants received the mentioned questionnaires in their workplace. The questionnaires were completed by the participants while performing their jobs during their work shifts in the presence of an ergonomist.

2.2.1 Statistical methods

The study data were analyzed using the Statistical Package for Social Sciences, version 16 (SPSS Inc., Chicago, IL, USA). Kolmogorov-Smirnov test was used to test the normality of the data. Because the data did not appear to follow a normal distribution, non-parametric statistical tests were used. Descriptive statistics (mean, standard deviation, number, and percent), Mann-Whitney U test (for assessment of the difference between male and female workers as well as between the participants with and without WMSD symptoms regarding the mean score of F-ERIQ subscales), Chi-square test (for assessment of the difference between ER-ratio levels), and Spearman’s correlation coefficient (for assessing the relationship between the scores of F-ERIQ subscales and the total score of the ERIN technique) were used to analyze the data. P-values less than 0.05 were considered to be statistically significant.

3 Results

The demographic characteristics of the participants are presented in Table 1. The prevalence of the reported symptoms of WMSDs in different body regions among the hospital attendants during the past 12 months has been shown in Table 2. Accordingly, the highest prevalence of WMSD symptoms in the participants was related to the lower back, knees, and ankles/feet. Additionally, the prevalence of WMSD symptoms was higher among female workers than in male workers in all body regions, except for elbows and knees. Moreover, the presence of WMSD symptoms was determined in at least one region of the body (48.8% and 59.4% for male and female workers, respectively). Then, the association between WMSD symptoms prevalence and the participants’ sex was examined. The results of Chi-square test revealed no statistically significant association between sex and WMSD symptoms prevalence (p = 0.155). However, as mentioned above, the prevalence of WMSD symptoms was higher in female workers compared to male workers.

Table 1
Some personal details of the participants (n = 198)

Quantitative variable Mean (SD)

Age (years) 31.98 (7.98)

BMI^* (kg.m^–2) 24.22 (3.78)

Job tenure (years) 5.58 (6.97)

Working hours per day 9.85 (1.99)

Qualitative variable No. (%)

Sex

Male 129 (65.2)

Female 69 (34.8)

Marital status

Single 61 (30.8)

Married 137 (69.2)

Number of children

0 89 (44.9)

1 45 (22.7)

2 41 (20.7)

≥3 23 (11.6)

Education level

Associate degree and lower 175 (88.4)

Bachelor’s degree and higher 23 (11.6)

Shiftwork

Yes 79 (39.9)

No 119 (60.1)

Type of employment

Contractual workers^** 80 (40.4)

Private workers^† 118 (59.6)

Second job

Yes 19 (9.6)

No 179 (90.4)

Quantitative variable	Mean (SD)
Age (years)	31.98 (7.98)
BMI^* (kg.m^–2)	24.22 (3.78)
Job tenure (years)	5.58 (6.97)
Working hours per day	9.85 (1.99)
Qualitative variable	No. (%)
Sex
Male	129 (65.2)
Female	69 (34.8)
Marital status
Single	61 (30.8)
Married	137 (69.2)
Number of children
0	89 (44.9)
1	45 (22.7)
2	41 (20.7)
≥3	23 (11.6)
Education level
Associate degree and lower	175 (88.4)
Bachelor’s degree and higher	23 (11.6)
Shiftwork
Yes	79 (39.9)
No	119 (60.1)
Type of employment
Contractual workers^**	80 (40.4)
Private workers^†	118 (59.6)
Second job
Yes	19 (9.6)
No	179 (90.4)

^*Body mass index. ^**Employees who are under contract to provide a certain service in a particular period of time. ^† Employees who work for systems that are run by individuals and companies rather than the government.

Table 2

The frequency of reported WMSD symptoms in different body regions among the participants during the past 12 months

Body region	Total	Male	Female
	(n = 198)	(n = 129)	(n = 69)
	No. (%)	No. (%)	No. (%)
Neck	21 (10.6)	9 (7.0)	12 (17.4)
Shoulders	25 (12.6)	15 (11.6)	10 (14.5)
Elbows	19 (9.6)	14 (10.9)	5 (7.2)
Wrists/hands	26 (13.1)	13 (10.1)	13 (18.8)
Upper back	24 (12.1)	14 (10.9)	10 (14.5)
Lower back	59 (29.8)	38 (29.5)	21 (30.4)
Thighs	25 (12.6)	14 (10.9)	11 (15.9)
Knees	50 (25.3)	34 (26.4)	16 (23.2)
Ankles/feet	41 (20.7)	23 (17.8)	18 (26.1)
WMSD symptoms in at least one body region	104 (52.5)	63 (48.8)	41 (59.4)

The results of physical exposure assessment of musculoskeletal risks using the ERIN technique have been depicted in Table 3. Accordingly, 95.5% of the participants were at a high risk for WMSDs.

Table 3

Physical exposure assessment of musculoskeletal risks among the participants using the ERIN technique (n = 198)

Results of the ERIN technique
Score of section	Mean (SD)
Trunk posture	3.55 (0.62)
Movement of the trunk	7.73 (1.75)
Shoulders/arms posture	3.22 (0.76)
Movement of the shoulders/arms	7.12 (2.03)
Hands/wrists posture	2.62 (0.54)
Movement of the hands/wrists	4.87 (1.18)
Neck posture	2.54 (0.55)
Movement of the neck	5.37 (1.85)
Rhythm of work	4.81 (1.16)
Perceived effort	7.84 (1.63)
Self-assessment of stress	4.06 (1.10)
Total score	41.80 (7.01)
Action level	No. (%)
Action level 1	–
Action level 2	9 (4.5)
Action level 3	18 (9.1)
Action level 4	171 (86.4)

The mean (standard deviation) score of F-ERIQ subscales and ER-ratio in the participants have been presented in Table 4. As shown in this table, 83.4% of the hospital attendants were in the “1 < ER-ratio” category. Besides, females scored higher in “effort”, “reward”, “esteem”, “promotion”, and “ov-er-commitment” in comparison to male workers. The results of Mann-Whitney U test showed that this difference was significant for “promotion” and “over-commitment” (p = 0.003 and p = 0.005, respectively), but not for “effort”, “reward”, and “esteem” (p > 0.05).

Table 4

Mean (SD) scores of F-ERIQ subscales and ER-ratio of the participants

F-ERIQ subscale	Total	Male	Female	P-value ^*
	(n = 198)	(n = 129)	(n = 69)
	Mean ( SD)	Mean ( SD)	Mean ( SD)
Effort	20.52 (4.49)	20.50 (4.73)	20.54 (4.06)	0.767
Reward	24.19 (4.39)	23.97 (4.06)	24.59 (4.92)	0.734
–Esteem	6.38 (1.18)	6.23 (1.74)	6.68 (1.90)	0.201
–Promotion	8.62 (1.92)	8.34 (1.65)	9.13 (2.27)	0.003
–Security	6.02 (2.11)	6.22 (2.10)	5.66 (2.11)	0.130
Over-commitment	18.08 (2.75)	17.69 (2.66)	18.81 (2.78)	0.005
ER-ratio	No. (%)	No. (%)	No. (%)	P-value ^†
1≥	33 (16.6)	22 (17.0)	11 (15.94)	0.705
1<	165 (83.4)	107 (83.0)	58 (84.05)

^* Mann-Whitney U test. ^† Chi-square test.

The relationships between WMSD symptoms and F-ERIQ subscales in the participants have been shown in Table 5. Accordingly, the mean score of the “effort” subscale of the F-ERIQ was significantly higher among the participants with WMSD symptoms in the neck, shoulders, wrists/hands, and lower back compared to those without WMSD symptoms. In addition, the mean score of the “over-commitment” subscale of the F-ERIQ was significantly higher in the participants with WMSD symptoms in their ankles/feet in comparison to those without WMSD symptoms. On the other hand, the results of Mann-Whitney U test revealed an association between the “security” subscale of the “reward” scale derived from F-ERIQ and elbow symptoms (p = 0.027). Acc-ordingly, the “job security” score was lower in the participants suffering from a disorder. Moreover, the results of Chi-square test showed a significant association between ER-ratio categories (ER-ratio≤1 and ER-ratio > 1) and wrist/hand symptoms (p = 0.032).

Table 5

The relationship between the WMSD symptoms and F-ERIQ subscales in the participants (n = 198)

Body region		F-ERIQ
		Effort	P-value^*	Reward	P-value^*	Over-commitment	P-value^*
		M (SD)		M (SD)		M (SD)
Neck	Yes	22.28 (3.78)	0.035	24.12 (4.27)	0.568	18.38 (2.85)	0.620
	No	20.30 (4.53)		24.85 (5.42)		18.05 (2.74)
Shoulders	Yes	22.70 (3.48)	0.003	24.12 (4.27)	0.607	18.92 (2.53)	0.091
	No	20.20 (4.54)		24.70 (5.24)		17.96 (2.77)
Elbows	Yes	21.89 (4.50)	0.175	24.04 (4.21)	0.246	18.26 (3.22)	0.802
	No	20.36 (4.48)		25.72 (5.79)		18.06 (2.70)
Wrists/hands	Yes	22.61 (3.13)	0.010	23.92 (4.21)	0.727	18.80 (2.41)	0.119
	No	20.19 (4.59)		24.24 (4.43)		17.97 (2.79)
Upper back	Yes	22.09 (4.03)	0.066	24.17 (3.74)	0.974	18.91 (2.12)	0.059
	No	20.31 (4.52)		24.20 (4.48)		17.97 (2.81)
Lower back	Yes	21.98 (3.90)	0.004	24.04 (4.04)	0.506	18.11 (2.62)	0.913
	No	19.91 (4.59)		24.55 (5.13)		18.07 (2.81)
Thighs	Yes	20.64 (4.53)	0.275	23.29 (5.44)	0.379	18.28 (2.60)	0.697
	No	19.60 (4.14)		24.32 (4.22)		18.05 (2.78)
Knees	Yes	21.24 (3.64)	0.194	24.14 (5.31)	0.928	18.02 (2.75)	0.843
	No	20.27 (4.73)		24.21 (4.05)		18.10 (2.76)
Ankles/feet	Yes	21.28 (4.31)	0.227	24.11 (4.20)	0.665	18.87 (2.37)	0.024
	No	20.32 (4.53)		24.50 (5.09)		17.87 (2.81)

^* Mann-Whitney U test.

The correlations between F-ERIQ subscale scores and the total score of the ERIN technique among the studied population have been presented in Table 6. As the table depicts, “effort”, “esteem”, “security”, and “over-commitment” were significantly correlated to the total score of the ERIN technique. Based on the rule of thumb in interpreting the size of the correlation coefficient, these correlation coefficients were in the negligible or low correlation category (0–0.5) [38].

Table 6

The correlation between the F-ERIQ subscales scores and the total score of the ERIN technique among the studied population (n = 198)

F-ERIQ subscale	Total score of the ERIN technique
	r^*	P-value
Effort	0.367	0.028
Reward	–0.178	0.054
–Esteem	–0.273	0.041
–Promotion	–0.140	0.061
–Security	–0.253	0.045
Over-commitment	0.301	0.019

^*Spearman’s correlation coefficient.

4 Discussion

This study aimed to identify the association between WMSDs and psychosocial stress at work among hospital attendants. The results indicated that the most commonly affected regions of WMSD symptoms among the hospital attendants were the lower back, knees, and ankles/feet. Additionally, less than 17% of the participants belonged to the ER-ratio > 1 category. Moreover, the effort subscale of the F-ERIQ had a significant effect on the prevalence of the WMSD symptoms in some body regions of the participants. In addition, some factors of the F-ERIQ were correlated to the WMSDs risk level.

4.1 The prevalence of musculoskeletal symptoms

Over the 12-month period, WMSD symptoms were most prevalent in the lower back (29.8%), knees (25.3%), and ankles/feet (20.7%) among the participants. This was in accordance with the findings of the previous studies among healthcare workers [9 , 39]. In this context, studies have shown that WMSD symptoms were common in healthcare workers, particularly nurses, nursing aides, and orderlies [9 , 40]. A previous study reported that the prevalence rate of WMSDs was seven folds higher among nursing assistants/orderlies compared to other occupations [41]. According to the OSHA also, WMSDs were almost four times more prevalent among nursing assistants/orderlies compared to other healthcare workers [7]. The high prevalence rate of WMSD symptoms in the hospital attendants may be attributed to work-related psychosocial stressors such as “effort” subscale of the F-ERIQ.

The present study results demonstrated that the prevalence of WMSD symptoms was higher among female workers compared to male workers in all body regions, except for elbows and knees. The prevalence of WMSD symptoms in at least one body region was also higher among female hospital attendants (59.4% vs. 48.8%). This was in accordance with the results of other studies, showing that WMSD symptoms in various parts of the body were linked to sex. Indeed, the odds of WMSD occurrence was higher among female workers compared to male workers, with odds ratios ranging from 1.62 to 2.35 [2, 10]. The higher risk of WMSD symptoms among female workers might be attributed to both biological (sex) differences as well as differences in social roles, activities, and behaviors (gender) [42]. According to our culture, in the current study, different tasks were assigned to females and males. Additionally, based on the observation, there was a mismatch between the workplace/equipment and females’ anthropometric dimensions. Hence, females made use of different strategies and work methods when performing physically demanding tasks.

4.2 Physical exposure assessment of the WMSDs risk via the ERIN technique

Postures analysis via the ERIN technique showed that more than 90% of the postures were in the high action level (3 and 4 action levels), indicating immediate need for corrections and ergonomic interventions. In this context, the findings of some studies have shown that WMSD risk was particularly high among the healthcare workers who were in direct contact with patients, including hospital attendants [43, 44]. Factors contributing to WMSDs include arm or wrist twisting, awkward posture and overexertion, rhythm of work, perceived effort, and work-related stress. The present study findings were in line with another study showing a correlation between frequent repetitive movements and WMSDs [9]. Heavy load handling, such as transferring overweight or obese patients, is yet another risk factor causing WMSDs among hospital attendants. This result was consistent with that of a previous study conducted on the issue [45]. Similar results were also obtained by Munabi et al. [46] and Khudhir et al. [44].

4.3 The prevalence of psychosocial stress at work

Based on the ERI, the prevalence of occupational stress was low in the present study compared to the results of other studies performed in Korea [47], China [35], Thailand [9], and Iran [36]. The current study results showed that more than 80% of the participants had a balance between efforts and rewards. This implies that the participants had little stress in their work environment. This finding was in contrast to those of other studies [9 , 50]. This difference could be attributed to the following factors: 1) data gathering tools and work environment were different from the mentioned studies, 2) the present study participants were younger than those of the mentioned studies and, consequently, they might have experienced less work-related stress, 3) the participants might not have answered the questions honestly because of being afraid of losing their jobs, and 4) the society’s economic conditions and the participants’ education levels (almost 90% of the participants had below bachelor’s degrees). Therefore, the participants had low expectations and low rewards were valuable and sufficient from their viewpoints. On the other hand, the results indicated that female staff scored higher in “effort”, “reward”, “esteem”, “promotion”, and “over-commitment” compared to male workers. Statistical analyses showed that this difference was significant for “promotion” and “over-commitment”, but not for “effort”, “reward”, and “esteem”. These results were in line with those of other studies [34, 51].

4.4 The relationship between psychosocial stress at work and prevalence of musculoskeletal symptoms

The study findings showed that the mean score of the “effort” subscale of the F-ERIQ was higher in the participants with WMSD symptoms in their necks, shoulders, wrists/hands, and lower backs compared to other workers. This could be interpreted as those hospital attendants who reported higher time pressure and insufficient equipment or personnel to adequately perform their duties were also more likely to report WMSD symptoms.

In a previous meta-analysis, a significant association was found between exposure to psychosocial factors in the workplace and WMSD symptoms in nursing aides/orderlies. Specifically, exposure to high demands/low control, effort-reward imbalance, and low social support were found to be associated with WMSD symptoms in lower back, neck, shoulders, upper extremities, and knees and/or pain at any anatomical sites [15]. Similar results were also obtained by Chanchai et al. [9]. However, the systematic and critical review of cohort studies performed by Hartvigsen et al. demonstrated no significant associations between organizational factors (such as social support) and low back pain [52].

4.5 The relationship between psychosocial stress at work and physical exposure assessment of the WMSDs risk via the ERIN technique

The study results revealed that “effort”, “esteem”, “security”, and “over-commitment” derived from the F-ERIQ were significantly correlated to the total score of the ERIN technique. This means that the participants with higher “effort” and “over-com-mitment” had a greater ERIN total score, while those with low “esteem” and “security” had a higher total score of the ERIN method. This might be due to the fact that individuals with low “esteem” and “job security” and high “effort” and “over-commitment” neglect healthy issues, such as neutral/ergonomic postures and safe patient handling.

4.5.1 Limitations

Given the cross-sectional nature of the study and data collection by self-report, the findings should be interpreted cautiously. Moreover, this study was performed among hospital attendants in Shiraz. Therefore, the results might not be generalized to other hospital attendants and working groups. Furthermore, this study was conducted on a small sample size. Hence, using a larger sample size is needed to achieve more robust results in this context.

4.5.2 Suggestions for reduction of work-related stress and prevention of WMSDs

Using aid devices for handling patients and moving and carrying wastes could reduce the effort level of the hospital attendants.

Organizational support could reduce work environment stressors to relieve psychosocial stress at work and musculoskeletal symptoms.

Allowing for recovery from demanding tasks could increase control over work pace.

5 Conclusions

The highest prevalence of WMSD symptoms among hospital attendants was linked to lower back, knees, and ankles/feet. Indeed, posture analysis using the ERIN method showed that most postures were in high and very high action levels. Moreover, a small number of participants reported more efforts for each reward, and female staff scored higher in “effort”, “reward”, and “over-commitment” compared to male workers. The “effort” subscale of the F-ERIQ had a significant effect on the prevalence of WMSD symptoms in some body regions of the participants. In addition, some factors of the F-ERIQ were correlated to the WMSDs risk level derived from the ERIN technique.

Overall, intervention programs and coping strategies for reduction of work-related stress and, subseq-uently, prevention of WMSDs are recommended among hospital attendants.

Conflicts of interest

None declared.

Footnotes

Acknowledgments

Hereby, the authors would like to thank Mrs. Zahra Momeni from the Occupational Engineering Unit of Shiraz University of Medical Sciences (SUMS) for the coordination of data gathering. They would also like to appreciate hospital managers, supervisors, and attendant personnel for their valuable cooperation. Thanks also goes to Ms. A. Keivanshekouh at the Research Improvement Center of SUMS for improving the use of English in the manuscript.

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