Background

Musculoskeletal disorders (MSDs), including injury to or disease of the body’s musculoskeletal system, are the leading cause of work disability in developed countries that result in billions of dollars of financial losses. In NSW only, data from the State Insurance Regulatory Authority show that workplace MSDs resulted in a loss of $606 million in 2015/16, and $671 million in 2016/17. In the 2017-2022 MSD strategy, the NSW government set a target to reduce the incidence rate of claims due to MSDs, and subsequently to materialise a saving of $415 million to NSW businesses by 2022.

The research project on the link between workplace psychosocial factors and MSDs is an important component of the MSD strategy, contributing toward the goal in reducing MSDs among employees in NSW. The project comprises of three complementary studies, which were conducted by three university research partners:

1. A systematic review on the effects of workplace psychosocial factors and MSDs, led by Professor Carole James, the University of Newcastle: This study aimed to systematically collect the latest evidence from longitudinal/follow-up studies estimating the lagged effect of psychosocial risk factors on musculoskeletal problems in industrialised work settings. The study focuses on the peer-reviewed scientific literature pertaining to the nexus between workplace psychosocial factors and MSDs.
2. A cross-sectional survey of MSDs in NSW employees, led by Professor Maureen Dollard, the University of South Australia. The aim of this study was to provide up-to-date prevalence estimates of MSDs among NSW employees in 2020-21 and to estimate the association of workplace psychosocial, physical and demographic factors with MSDs.
3. Systematic reviews of available tools to address MSDs (review 1), barriers and facilitators to implementing tools (review 2) and a qualitative study on barriers/ facilitators to implement tools in NSW businesses, led by Professor Jodi Oakman, La Trobe University. Collectively, these studies aim to identify tools to support comprehensive MSD prevention and to explore barriers and enablers to the implementation of comprehensive MSD prevention tools in a range of industry settings in NSW.

What we found

1. Systematic review of the effects of workplace psychosocial factors and MSDs

From searches in five academic research databases (Medline, Embase, PsychINFO, Scopus and CINAHL) and grey literatures yielding 4,999 research articles, James and colleagues identified 47 relevant studies and included these for analysis. Participants in the included studies were workers employed in a range of industries, with a wide spectrum of physical demands, including healthcare, professional drivers, manufacturing and production, and office workers. There was a large range in sample size (from 53 to 12,714 participants) and the lag-time of follow-ups (from every 14 days for 12 months, to biannual follow-ups for six years).

Low job control, low job decision, low social/co-worker/supervisor support and high job dissatisfaction, high psychological demands, high psychosocial stress were common risk factors for MSDs. In summary, MSDs have a complex, multifactorial aetiology. Psychosocial factors play a role in this relationship, although their magnitude and direction of causal impact is influenced by additional personal and workplace stressors and risks. Opportunities exist to reduce the risk of MSD via improvements to psychosocial workplace factors.

2. The cross-sectional survey of MSDs in NSW employees

Across a sample of 628 NSW employees, one quarter (26%) of respondents reported being in a lot of pain in at least one body area, and only 21% reported no pain in any area. Around 20% of women and 22% of men indicated they had received a lifetime doctor diagnosis of any of the common chronic MSDs, and half (49%) of those reported being in a lot of pain. The most common doctor diagnosed MSD for both men and women was chronic back pain or sciatica (6%) and osteoarthritis in women (6%). Injuries in the past year were reported by 11% (n=70), and of these 31% (n=22) were work-related. Around 2.5% of employees had made a worker’s compensation claim in the past year.

The different methods of assessing MSDs and related symptoms produce different results for both prevalence and risk analysis.

For MSD related pain, NSW industries with the highest estimated prevalence were Retail trade, Electricity/gas/water & waste services (both around 35%), and Financial/insurance, and Professional/scientific & technical services (both 25%+). Fewer than 15% of employees in Public administration, Mining, Information/media & telecommunication, Education & training, and Construction reported high pain levels.

For doctor diagnosed MSDs, the industry variability in prevalence was lower with no statistically significant differences between them and a range of 10-23%.

For work-related injury in the last 12 months, there was a low prevalence 4% (n=22) and not surprisingly, there were no significant differences between industries, although the prevalence was 10% or higher in Electricity/gas/water & waste services, Transport/postal & warehousing, and Retail trade, and less than 1% in finance.

Results from the analyses of the cross-sectional sample, it is clear that workplace physical risk factors are associated with MSDs. Psychosocial factors, such as an increase in psychological demands (work pressure), workplace harassment, or psychological distress (depression, burnout) are associated with a higher prevalence of some types of MSD outcomes, particularly pain. Since poor psychological safety climate (PSC) was related to increase in psychological risk and distress, and sometimes directly related to increased MSDs, there is some support for the proposition that PSC is an indicator of MSDs.

Some demographic factors were also associated with a higher prevalence of MSDs: MSD diagnosis was more common among older workers; MSD pain was more common among women workers, and work-related injuries were more common among male and low-income workers.

The plausible pathways for MSDs resulting from exposures to physical, psychological and demographic factors are summarised in Figure 1.

Figure 1. Plausible pathways to workplace MSDs

3. The systematic review of MSD tools, barriers/enablers for tool implementation and the qualitative study

For the systematic review of MSD tools, Oakman and colleagues conducted searches in four major academic research databases (Web of Science, Medline, ProQuest Central, and PsychInfo). Following the removal of duplications and screenings, 548 studies were assessed as relevant for inclusion. Of these, 137 reported on tools covering physical hazards, 254 on psychosocial and 228 covered comprehensive tools (both physical and psychosocial hazards). Some studies reported on more than one type of tool. These reported on 30 physical hazard tools, 35 psychosocial hazard tools, and 16 comprehensive tools. Six additional physical hazard tools were found through the grey literature search. There were 23 studies based in Australia, which represented 15 tools. An interim tool matrix for use in the qualitative study was developed (some examples, see Table 1).

Table 1. Examples of tools in managing MSDs

In reviewing current evidence of barriers and facilitators to the use of comprehensive tools in managing MSDs in the workplace, researchers also conducted searches in the following databases: Medline, Embase, PsychInfo, CINAHL and Proquest Central. Twenty-nine relevant studies were located. Studies involved tools that were implemented in at least nine industry sectors – some studies did not specify the industry sector. The most frequently reported sectors were Healthcare & Social Assistance (12 studies), Manufacturing (seven), and Construction (six). The studies covered a wide range of MSD risk management tools: ten studies looked at comprehensive tools (targeting both physical & psychosocial factors), 14 examined non-comprehensive tools (targeting only physical factors), and five included both types of tools (comprehensive and physical). There were no tools that only targeted psychosocial factors. Each of the reported barriers and facilitators were grouped into the relevant work-systems category: external factors, workplace environment, work organisation & job design, task & equipment, and workers’ personal characteristics. Analysis of the data revealed the work organisation & job design level as having the highest number of reported barriers. The main barriers in this level were related to lack of management commitment, counterproductive management attitudes, and high costs.

In the final stage, Oakman and colleagues conducted a qualitative study by interviewing industry stakeholders to explore barriers and enablers to the implementation of comprehensive MSD prevention tools in a range of NSW industry settings. Twenty-nine interviews were conducted with WHS professionals from six industry sectors: manufacturing, health & social assistance, public administration, construction, agriculture, and transport/postal & warehousing. The majority of participants (n=27) had a formal WHS qualification. Participants reported a range of barriers to effectively managing MSD risk. The majority of barriers were located in the organisational level of the workplace system model. Most of the MSD risk management strategies currently utilised by participants were focussed at the individual and equipment/task levels of the workplace system. All participants were aware of at least one validated tool from the tool matrix (from SR1), however only nine participants were currently using a validated tool in their workplace. Reported reasons for poor uptake of validated tools were related to 1) perceived deficits of the tools, or 2) barriers to implementation (mostly organisational level barriers).

Following the stakeholder interviews, the interim tool matrix was refined (which included the addition of a psychosocial tool identified through the interviews) to include only validated tools that were accessible (online tools or downloadable & includes instructions or guidance for use) and able to be used by workplace practitioners (tool matrix available in the PDF).

Why this matter

Findings from our research projects show clear impact of workplace factors on MSDs and that some risks identified are preventable or modifiable, action should be taken to target these. Physical demands should be reduced or controlled. Action should be taken to improve Psychosocial Safety Climate, improve skill discretion, reduce harassment and reduce work pressure.

Work health and safety regulators and organisations should consider plans to implement control strategies for physical and psychosocial risks identified, ultimately to reduce the significant burden of MSDs. Organisations need to be aware of tools and how to access them before they can benefit from improvements to existing tools. To ensure the effective implementation of comprehensive MSD risk management tools, it is essential that the organisational barriers are addressed. In addition, the uptake of validated comprehensive tools and strategies could be improved with greater promotion by the Regulator and Industry Associations.