Work factors and musculoskeletal disorders : an epidemiological approach focusing on female nursing personnel

Sammanfattning: The overall aim of this thesis was to examine the association between job factors and the occurTence of musculoskeletal disorders, and in particular low back disorders, among female nursing personnel. The thesis is based on three separate projects. Two training programs for nursing personnel and one population-based case-referent study, called the MUSIC-Norrtälje study. The specific aim of the first study was to evaluate the implementation of a patient transfer technique at a hospital. According to the nurses who participated in the training program, the patient transfer technique was used and appreciated. During the study period, four yearly repeated surveys among the nurses indicated that psychological job strain was associated with back and neck/shoulder symptoms. High perceived physical exertion showed a consistent association with musculoskeletal symptoms. The prevalence of symptoms was rather stable, even though almost half of the nurses varied between reporting intensive ongoing musculoskeletal symptoms or not. In the second project, the study group consisted of assistant nurses in geriatric care, who took part in a program of physical training and education. The cross- sectional analysis and the follow-up demonstrated a weak tendency towards higher prevalence of low back symptoms among assistant nurses who reported a high level of physical exertion at work. Individual physical capacity was not related to perceived physical exertion. In the Music-Norrtälje study, high physical workload and perceived physical exertion were associated with a relative risk of seeking care for low back disorders, when exposed nursing personnel were compared to unexposed. The study indicated a positive relation between low intellectual discretion, insufficient social support, terms of employment and seeking care for low back disorders. When all women with paid jobs were included, i.e. women with nursing work and other occupations, self-reported adverse psychosocial work conditions were related to a high general physical workload. Long hours of paid work, or of unpaid work, separately, indicated a relative risk of seeking care for low back and/or neck/shoulder disorders. These studies show that in nursing work, the environmental demands, and the interaction between these demands and the nurses, were related to musculoskeletal disorders.