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Page 1: Psychosocial factors and musculoskeletal disorders in the construction industry: a systematic review

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Psychosocial factors andmusculoskeletal disorders in theconstruction industry: a systematicreviewTarek M. Sobeih a , O. Salem b , Nancy Daraiseh c , Ash Genaidy c

& Richard Shell ca Department of Environmental Health , College of Medicine ,University of Cincinnati , Cincinnati, OH 45267-0056, USAb Department of Civil and Environmental Engineering , Universityof Cincinnati , Cincinnati, OH 45221-0071, USAc Department of Mechanical , Industrial, and NuclearEngineering , University of Cincinnati , Cincinnati, OH45221-0072, USAPublished online: 02 Nov 2010.

To cite this article: Tarek M. Sobeih , O. Salem , Nancy Daraiseh , Ash Genaidy & Richard Shell(2006) Psychosocial factors and musculoskeletal disorders in the construction industry: a systematicreview, Theoretical Issues in Ergonomics Science, 7:3, 329-344, DOI: 10.1080/14639220500090760

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Page 2: Psychosocial factors and musculoskeletal disorders in the construction industry: a systematic review

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Page 3: Psychosocial factors and musculoskeletal disorders in the construction industry: a systematic review

Psychosocial factors and musculoskeletal disorders in the

construction industry: a systematic review

TAREK M. SOBEIH*y, O. SALEMz, NANCY DARAISEHx,

ASH GENAIDYx and RICHARD SHELLx

yDepartment of Environmental Health, College of Medicine,University of Cincinnati, Cincinnati, OH 45267-0056, USAzDepartment of Civil and Environmental Engineering,

University of Cincinnati, Cincinnati, OH 45221-0071, USAxDepartment of Mechanical, Industrial, and Nuclear Engineering,

University of Cincinnati, Cincinnati, OH 45221-0072, USA

(Received 15December 2004; in final form 1April 2005)

Background: Recent reports indicate that construction workers are at a significantrisk of musculoskeletal disorders. While there are several reviews investigating theassociation between psychosocial factors and musculoskeletal disorders, there arenone focusing on those specific to the construction industry.Objective: To review and critically appraise the current epidemiological literaturelinking psychosocial work factors to musculoskeletal disorders among construc-tion workers.Methods: An online search of relevant databases was conducted. The quality ofidentified articles was assessed using a quality scoring checklist. The evidencefrom selected studies was summarized and the results of the critical appraisalwere discussed.Results: Eight cross-sectional and two cohort studies were included in this review.High job stress was the most commonly investigated factor followed by jobsatisfaction, job control and high quantitative job demands. All studies reportedan association between musculoskeletal disorders and at least one psychosocialfactor. Many of the associations reported were significant even after adjustingfor demographics and physical demands of the job.Conclusion: Despite some methodological concerns discussed in this review,there is evidence that psychosocial factors are associated with musculoskeletaldisorders. This information is essential to the construction industry since mostintervention programmes focus only on the physical demands of the job.

Keywords: Construction industry; Psychosocial factors; Musculoskeletaldisorders; Job stress; Job control

1. Introduction

The term musculoskeletal disorders (MSD) refers to an alteration in an individual’susual sense of wellness or ability to function that involve the nerves, tendons, mus-cles and supporting structures of the body, which may or may not be associated withwell-recognized anatomic, physiologic or psychiatric pathology (National Institutefor Occupational Safety and Health 1997, Research Council and Institute of

Theoretical Issues in Ergonomics ScienceVol. 7, No. 3, May–June 2006, 329–344

*Corresponding author. Email: [email protected]

Theoretical Issues in Ergonomics ScienceISSN 1463–922X print/ISSN 1464–536X online # 2006 Taylor & Francis

http://www.tandf.co.uk/journalsDOI: 10.1080/14639220500090760

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Medicine 2001). In the US, MSD result in more than 70 million physician office visitseach year. Conservative estimates of the economic burden resulting from MSD, asmeasured by compensation costs, lost wages and lost productivity, are $50 billionannually (Research Council and Institute of Medicine 2001). Although constructionworkers in the US constitute �5.2% of the total workforce (6 732 000 workers in2002) their injury rates are among the highest (US Department of Labor (DOL)2002a, b, c, d). In 2002, MSD accounted for more than 40% of days lost fromwork among construction workers (US DOL 2002a). The magnitude of the problemwas further confirmed by a recent study that found construction workers to beat a significantly higher risk for MSD that relates to their work (Schneider 2001).

Several studies, mostly European, focused on identifying the risk factors behindsuch high injury rates as a first step in solving the problem (Bye 1991, Schneider andSusi 1994, Churmantaeva et al. 1995, Holmstrom et al. 1995, Latza et al. 2000,Lipscomb et al. 2000, Elders and Burdorf 2001, Kaneda et al. 2001, Rosecranceet al. 2001). The majority of research focused on physical job demands includingmanual material handling and awkward positions while fewer studies considered therole of psychosocial factors. Psychosocial factors are becoming an integral part ofrecent epidemiologic studies on MSD. Recent systematic reviews found psychosocialfactors to be independently associated with MSD of the back and upper extremities;however, these reviews included studies on different occupations (e.g. office workers,industrial workers, newspaper workers and nurses) and did not focus specificallyon construction workers (NIOSH 1997, Hoogendoorn et al. 2000, Research Counciland Institute of Medicine 2001, Bongers et al. 2002, Daraiseh et al. 2003, Yeunget al. 2005).

Construction workers, due to the nature of their work, may be exposed todifferent psychosocial stressors in their environment than those discussed in previousreviews. Many construction workers are stressed to meet certain deadlines andare faced with periods of unemployment between projects. In addition, their tasksare very diverse, there is continuous and rapid change in the environment andcolleagues come and go when moving from one project to another. Even in largeconstruction firms, the transition from one work site to another with different site-managers can be detrimental to worker morale, especially when there is a lack ofcommunication and/or misunderstanding of the general firm’s policies. Jobstress and low job control were investigated among construction workers byfew investigators; however, the results were inconsistent (Holmstrom et al. 1992a,LeMasters et al. 1998, Jensen and Kofoed 2002).

The aim of this paper was to examine the epidemiological evidence of therelationship between psychosocial factors and MSD among construction workers.A critical assessment of the articles investigating the association was carried out andresults analysed. To the best of the authors’ knowledge, no systematic review of thiskind has been conducted before.

2. Methods

2.1. Selection of articles

An online literature search was carried out using the following databases: Medline,Ergonomics Abstracts, NIOSHTIC, NIOSHTIC-2, Biological Abstracts/BIOSIS

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Previews and Psychinfo. The keywords used were selected to retrieve all possiblearticles investigating musculoskeletal disorders among construction workers.Titles and abstracts were reviewed to identify those investigating psychosocialfactors. The following keywords were used to form combinations (MeSH headingand text-words): construction, carpenter(s), floorlayer(s), bricklayer(s), painter(s),electrician(s), plumber(s), scaffolder(s), roofer(s), mason(s), musculoskeletalabnormalities, back, neck, shoulder, arm and knee. Additional studies wereidentified from reference lists.

The inclusion criteria used in the search consisted of: reports published inEnglish; in peer-reviewed journals; evaluating the role of work and/or individualpsychosocial factors on musculoskeletal disorders. No restrictions on study designwere made. The lead author (TS) checked the results of the literature search andwhen abstract data were not sufficient the full article was reviewed.

2.2. Critical appraisal

The methodological quality of all studies chosen for review was assessed by usingthe Epidemiological Appraisal Instrument (EAI) Version 2.6 (Genaidy andLeMasters 2005). The EAI allows for the evaluation of study quality on thebasis of a critical appraisal system that is rooted in sound epidemiological prin-ciples. The EAI consists of 43 questions where scores between 0–2 can be assignedto each question. Those questions evaluate the study quality in five sub-domains;evidence description, subject/record selection, evidence observation, data analysisand generalization of results. The final quality score for each study (QS) is theaverage score of all applicable questions (based on the study type). In addition,the average score for each of the five sub-domains individually allows for theidentification of the specific areas of strength and weakness of each study in astandardized fashion.

2.3. Assessment of strength of evidence

The strength of evidence for potential psychosocial risk factors was assessed byconsidering the percentage of investigations that revealed a statistically significantassociation between the factor under consideration and MSD of one or more bodyregions. The final conclusion was weighted by modifying the criteria adopted byBongers et al. (2002) adding more weight to evidence based on prospective studies,using a stricter rule regarding the QS (70% instead of 60%) and accounting forindividual and environmental confounders. Since the number of studies includedin this review was limited, the 75% majority criterion was not used. The followingstatements summarize the criteria used:

. Prospective cohort studies allow conclusions based on a temporal relationshipand, thus, will contribute more than cross-sectional studies to the evidence;

. Studies with a quality score higher than 70% of maximum attainable scorewill provide better evidence than those scoring less; and

. Controlling for individual and environmental risk factors for MSD in amulti-variate analysis will provide stronger evidence.

Psychosocial factors and musculoskeletal disorders 331

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3. Results

3.1. Identification of the studies

The literature search resulted in 122 journal articles with nine meeting the inclusioncriteria (Tola et al. 1988, Riihimaki et al. 1989, Holmstrom et al. 1992a, b, Sturmeret al. 1997, LeMasters et al. 1998, Latza et al. 2000, 2002, Jensen and Kofoed 2002).Two articles were excluded after reviewing the full text (Sturmer et al. 1997, Latzaet al. 2000) since they contained a sub-set analysis of a larger population fully studiedin another paper (Latza et al. 2002).

3.2. Description of studies

Table 1 shows a summary of the selected studies, including study population, expo-sure variables, outcome variables and significant results. Two studies were prospec-tive cohort (Riihimaki et al. 1989, Latza et al. 2002), while the remaining six werecross-sectional. The majority of studies (75%) focused on MSD in one body regionwhich included; lower back (six studies), neck and shoulder (three studies) and knee(two studies) and one study (LeMasters et al. 1998) examined MSD of the entirebody (divided into eight regions). Five studies investigated more than one psycho-social variable in the same sitting while the remaining three focused on one factor.The psychosocial factors assessed by the identified studies were grouped into eightcategories (see table 2) according to Bongers et al. (2002). Subjects included carpen-ters, concrete workers, painters, floor layers, bricklayers and general labourers.

3.3. Quality assessment

3.3.1. Overall quality assessment. The quality assessment of the studies is presentedin table 3 and grouped by study design. Five studies scored higher than 70% ofthe maximum attainable score and only one (Jensen and Kofoed 2002) had a score ofless than 50%.

3.3.2. Detailed quality assessment. The results of the detailed assessment are pre-sented in figures 1–5. Higher scores were attained in the study description and subjectselection sub-domains. On the other hand, the sub-domains for observation and dataanalysis showed lower scores and higher variability. Major contributors to lowscores were the absence of sample size calculations and the lack of reportingreliability and validity of exposure and outcome assessment tools. A less commonreason was the failure of some studies to properly identify and account for allindividual and environmental confounders in the final analysis.

3.4. Description of evidence

Low job satisfaction was by far the most consistently studied psychosocial factor.All studies (one prospective cohort and three cross-sectional) revealed a positiveassociation that remained significant even after relevant individual and environmen-tal factors were accounted for in multi-variate analyses (see table 4).

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Table

1.

Summary

ofidentified

studies.

Study

Type

Studypopulation

Exposure

variables

Outcomevariables

Significantresults

Holm

strom

etal.

(1992a)

Cross-sectional

1773construction

workers

inSweden

Discretion;Qualitative

dem

ands;Quantitative

dem

ands;Solitary

work;

Support;Under-

stim

ulation;Anxiety

abouthealth;Anxiety

aboutwork;Job

satisfaction;Lifequality;

Psychosomatic;

Psychic;

Stress

Low

back

pain

Agestandardized

association

(prevalence

rate

ratioPRR

and95%

CI)

with:

�Quantitative

dem

ands

(1.3;

1.2–1.6)

�Anxiety

health(1.3;1.1–1.4)

�Psychosomatic(1.5;1.2–1.9)

�Psychic

(1.5;1.3–1.8)

�Stress(1.6;1.4–1.8)

�Discretion(0.8;0.7–0.9)

�Jobsatisfaction(0.7;0.6–0.9)

Holm

strom

etal.

(1992b)

Cross-sectional

1773construction

workers

inSweden

Discretion;Qualitative

dem

ands;Quantitative

dem

ands;Solitary

work;Support;

Understim

ulation;

Anxiety

abouthealth;

Anxiety

aboutwork;Job

satisfaction;Lifequality;

Psychosomatic;

Psychic;

Stress

Neck&

shoulder

trouble

Agestandardized

association

(prevalence

rate

ratioPRR

and95%

CI)

with:

�Quantitative

dem

ands

(1.4;

1.2–1.7)

�Anxiety

health(1.4;1.2–1.5)

�Psychosomatic(1.7;1.4–2.1)

�Psychic

(1.6;1.4–1.8)

�Stress(1.5;1.3–1.7).

�Discretion(0.7;0.6–0.8).

Jensenand

Kofoed

(2002)

Cross-sectional

102floorlayers

intheUSA

Psychologicalwork-strain;

Stress

Knee

complaints

&low

back

complaints

Oddsratio(O

Rand95%

CI)

associationbetween:

�StressandLBP(3.4;

1.46–8.15)

�Psychologicalstrain

andknee

(2.5;1.02–6.03)

(continued

)

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Table

1.

Continued.

Study

Type

Studypopulation

Exposure

variables

Outcomevariables

Significantresults

Latzaet

al.

(2002)

Incidence

study;

follow-up

for3years

488construction

workers

inGermany

Monotonouswork;Tim

epressure;Jobcontrol;

Socialsupport;

Satisfactionwithown

achievem

ents

Chronic

low

back

pain

Ageadjusted

prevalence

ratio

(PR

and95%

CI)

with:

�Low

satisfactionwith

achievem

ent

at

work

(2.07;

1.10–3.88)

LeM

asters

etal.

(1998)

Cross-sectional

522carpenters

intheUSA

Exhausted

attheendof

day;Minim

alschedule

influence

Pain

inneck,shoulder,

elbows,hand

andwrist,back,

hips,knees,ankles

Ageadjusted

oddsratio(O

Rand95%

CI)

for:

�Exhausted

attheend

ofthe

daywith:

�Knees(1.8;1.1–3.1)

�Minim

al

schedule

influence

with:

�Shoulders(1.9;1.1–3.2)

�Hips(2.9;1.1–7.2)

�Knees(2.3;1.2–4.1)

Riihim

aki

etal.

(1989)

Cross-sectional

167concrete

workersand

161house

painters

inGermany

Lifetim

estress

episodes

Sciaticpain

Ageadjusted

risk

ratio(R

Rand

95%

CI):

�Rare

vsveryrare

(1.0;

0.7–1.4)

�Frequent

vs

very

rare

(1.3;

1.0–1.7)

Riihim

aki

etal.

(1989)

Incidence

study;

follow-up

for5years

167concrete

workersand

161house

painters

inGermany

Lifetim

estress

episodes

Sciaticpain

Ageadjusted

risk

ratio(R

Rand

95%

CI):

�Rare

vsveryrare

(1.0;

0.5–1.9)

�Frequent

vs

very

rare

(1.2;

0.6–2.1)

Tola

etal.

(1988)

Cross-sectional

1174machineoperators,

1045carpenters

and

1013office

workers

inFinland

Jobsatisfaction

Neckandshoulder

symptoms

Riskratio(R

Rand95%

CI)

adjusted

forage,

occupation,

posture,draft)for:

�Moderate/Poorvsvery

good(1.2;1.1–1.4)

�Rather

good

vs

very

good

(1.1;1.0–1.3)

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High perceived job stress was the most frequently investigated psychosocial factorby the majority of studies (six studies), some involving more than one body segment(a total of 14 investigations). Most of the studies were in the higher QS category(>70%) including one of the prospective cohort studies. With the exception of one,all investigations indicated a positive association and 43% were statisticallysignificant. More than 50% of the associations were significant in multi-variateanalyses supporting the strength of the association.

Low job control and high quantitative job demands followed a similar pattern.Both were examined by one prospective cohort and three cross-sectional studies.All investigations revealed a positive association, however, in the multi-variateanalysis the number of significant investigations dropped markedly (27% and20%, respectively) and were all cross-sectional studies.

Worry, distress and stress reactions, not primarily work-related, were inves-tigated in two cross-sectional studies and their association with MSD remainedsignificant in the multi-variate analysis. Low social support and low stimulus fromwork were both investigated in two cross-sectional studies and one prospectivecohort. Both showed positive association with MSD; however, none of the associa-tions remained significant in the univariate analysis. High qualitative job demandsshowed the same pattern over two cross-sectional studies, where the positiveassociations were not significant in the univariate analysis.

4. Discussion

The reviewed studies indicate that there is a positive association between psycho-social factors and MSD among construction workers. This evidence is based onconsistent findings from both high quality prospective and cross-sectional studies.The associations remained significant even after multi-variate analysis controlled forindividual and environmental physical factors.

Stronger evidence was found for low job satisfaction followed by highperceived job stress, while the evidence was not as strong for low job control andhigh quantitative job demands. No evidence was found for low social support,low stimulus from work or high qualitative job demands.

Table 2. Psychosocial categories and concepts included.

Psychosocial factor Concepts included

High job stress Psychological work strain, stress, exhausted at the end ofday, lifetime stress episodes

Low job control Discretion, job control, minimal schedule influenceLow job satisfaction Job satisfaction, satisfaction with own achievementsHigh quantitative job demands Quantitative demands, time pressure, poor planning, poor

management of deliveries, inadequate communication,work intensity

Low stimulus from work Understimulation, monotonous workLow social support Support, social supportHigh qualitative job demands Qualitative demandsWorry, distress and stressreactions not primarilywork related

Psychosomatic or psychic

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Table

3.

Overallquality

score

ofidentified

studies.

Cross-sectionalstudies

Prospectivecohort

studies

EAIitem

sHolm

strom

etal.

(1992a)

Holm

strom

etal.

(1992b)

LeM

asterset

al.

(1998)

Riihim

akiet

al.

(1989)

Tola

etal.

(1988)

JensenandKofoed

(2002)

Riihim

akiet

al.

(1989)

Latzaet

al.

(2002)

12

22

11

11

22

22

22

22

22

32

32

22

12

24

22

22

22

22

52

22

22

22

26

22

22

10

20

72

22

22

22

NA

82

22

22

22

29

22

00

12

02

10

NA

NA

NA

NA

NA

NA

NA

NA

11

11

11

11

11

12

11

22

21

22

13

22

22

22

22

14

11

12

11

11

15

22

22

22

22

16

22

22

22

22

17

00

20

00

00

18

NA

NA

NA

22

NA

22

19

11

21

12

2NA

20

NA

NA

NA

00

NA

00

21

22

02

12

21

22

NA

NA

NA

NA

NA

NA

NA

NA

23

NA

NA

NA

NA

NA

NA

NA

NA

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24

NA

NA

NA

NA

NA

NA

NA

NA

25

11

00

00

00

26

00

00

00

00

27

NA

NA

NA

22

NA

22

28

NA

NA

NA

NA

NA

NA

22

29

NA

NA

NA

01

NA

02

30

NA

NA

NA

22

NA

22

31

00

22

10

20

32

21

20

00

00

33

NA

NA

NA

22

NA

22

34

NA

NA

NA

00

NA

00

35

00

22

00

22

36

22

11

10

11

37

22

12

20

22

38

NA

NA

NA

NA

NA

NA

22

39

NA

NA

NA

NA

NA

NA

20

40

00

02

00

00

41

22

22

21

21

42

11

22

10

21

43

11

12

10

21

Averagescore

1.41

1.41

1.48

1.44

1.22

0.97

1.44

1.27

NA¼NotApplicable.

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Despite the limited number of studies and the inherent inability of cross-sectional studies to assess temporal associations, this review suggests that non-work-related worry and distress may be important factors in this population.

While several previously published systematic reviews investigated the relationof psychosocial factors to MSD in different body segments (i.e. lower back, upper

0.00 0.50 1.00 1.50 2.00

Riihimaki et al. (1989)

Latza et al. (2002)

Tola et al. (1988)

Riihimaki et al. (1989)

Lemasters et al. (1998)

Jensen and Kofoed (2002)

Holmstrom et al. (1992b)

Holmstrom et al. (1992a)

Prospective Cohort

Cross-sectional Studies

Figure 2. Critical appraisal of studies—subject selection quality.

0.00 0.50 1.00 1.50 2.00

Riihimaki et al. (1989)

Latza et al. (2002)

Prospective Cohort

Cross-sectional Studies

Tola et al. (1988)

Riihimaki et al. (1989)

Lemasters et al. (1998)

Jensen and Kofoed (2002)

Holmstrom et al. (1992b)

Holmstrom et al. (1992a)

Figure 1. Critical appraisal of studies—quality of reporting.

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extremities and wrist) (NIOSH 1997, Davis and Heaney 2000, Hoogendoorn et al.2000, Research Council and Institute of Medicine 2001, Bongers et al. 2002), thefocus of this review was different. Factors were evaluated based on their associationwith MSD in general and more attention was given to the target population ofconstruction workers than to the body segment affected. This review underlines

0 0.5 1 1.5 2

Riihimaki et al. (1989)

Latza et al. (2002)

Tola et al. (1988)

Riihimaki et al. (1989)

Lemasters et al. (1998)

Jensen and Kofoed (2002)

Holmstrom et al. (1992b)

Holmstrom et al. (1992a)

Prospective Cohort

Cross-sectional Studies

Figure 4. Critical appraisal of studies—data analysis quality.

0.00 0.50 1.00 1.50 2.00

Riihimaki et al. (1989)

Latza et al. (2002)

Tola et al. (1988)

Riihimaki et al. (1989)

Lemasters et al. (1998)

Jensen and Kofoed (2002)

Holmstrom et al. (1992b)

Holmstrom et al. (1992a)

Prospective Cohort

Cross-sectional Studies

Figure 3. Critical appraisal of studies—observation quality.

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the importance of psychosocial factors among construction workers as a potential

risk factor for MSD. The conclusions of this review may be limited by a number of

methodological issues. First, the number of retrieved articles was limited, even

though the database search strategy was designed and every effort was taken to

retrieve the maximum possible number of articles. Secondly, the psychosocial factors

investigated by the studies in this review were not identical. This is a common

problem in the occupational health and safety literature where the term ‘psycho-

social’ is used by many authors as a catch-all term to describe a large number of

factors (NIOSH 1997, Bongers et al. 2002). Even in studies where the factor under

investigation is the same (e.g. job satisfaction), the use of different methods/

questionnaires for assessment can greatly impact the results. While some authors

utilized simple questions to evaluate the exposure factors, others have used more

complex matrices based on factor analysis. In such conditions, the reporting of the

validity and reliability coefficients of each method becomes crucial; unfortunately

not all studies provided such data, which clearly reflected on their QS, espe-

cially in the data observation sub-domain. This lack of a standardized method for

measurement and analysis of psychosocial factors and their effects on MSD was

reported by several reviewers (NIOSH 1997, Davis and Heaney 2000,

Hoogendoorn et al. 2000, Research Council and Institute of Medicine 2001,

Bongers et al. 2002). In this review, the grouping of psychosocial factors was

based on categories suggested by Bongers et al. (2002). While the lack of a standard

classification could be a potential problem, categories were chosen for practical

reasons to allow for comparing the results of this review with others conducted on

different populations. A slightly different argument can be made for MSD. While the

definition of positive cases with MSD was not identical among studies, all authors—

with the exception of Jensen and Kofoed (2002)—stated clearly the criteria used for

0 0.5 1 1.5 2

Riihimaki et al. (1989)

Latza et al. (2002)

Tola et al. (1988)

Riihimaki et al. (1989)

Lemasters et al. (1998)

Jensen and Kofoed (2002)

Holmstrom et al. (1992b)

Holmstrom et al. (1992a)

Prospective Cohort

Cross-sectional Studies

Figure 5. Critical appraisal of studies—generalization of results quality.

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their case definition and reported some validity and/or reliability indices of themethods used.

Finally, different risk estimates and measures of association were reported bydifferent investigators. Risk estimates above ‘1’ for different psychosocial factorswere reported in this review; however, they were only considered when statisticallysignificant. The association was further weighted by the results of multi-variateanalysis and the QS of the study. While this systematic approach minimizes bias,care should be taken when assessing causality and comparing the results of thisreview with other reports on psychosocial factors. The approach adopted here isintended to provide the reader with insight into the process of critical appraisaland assessment of evidence. While the conclusions are limited by the smallnumber of studies and the methodological issues discussed above, the reader isencouraged to follow a similar approach when newer studies emerge.

Table 4. Description of evidence.

Positive findingsin univariate

analysis

Significant findingsin univariate

analysis

Significant findingsin multi-variate

analysis

(1) High perceived job stressAll studies 13/14¼ 93% 6/14¼ 43% 3/14¼ 21%QS>70% 11/12¼ 92% 5/12¼ 42% 3/12¼ 25%QS<70% 2/2¼ 100% 1/2¼ 50% 0/2

(2) Low job controlAll studies 11/11¼ 100% 5/11¼ 46% 3/11¼ 27%QS>70% 10/10¼ 100% 5/10¼ 50% 3/10¼ 30%QS<70% 1/1¼ 100% 0/1 0/1

(3) High quantitative job demandsAll studies 5/5¼ 100% 3/5¼ 60% 1/5¼ 20%QS>70% 2/2¼ 100% 2/2¼ 100% 1/2¼ 50%QS<70% 3/3¼ 100% 1/3¼ 33% 0/3

(4) Low job satisfactionAll studies 4/4¼ 100% 4/4¼ 100% 4/4¼ 100%QS>70% 2/2¼ 100% 2/2¼ 100% 2/2¼ 100%QS<70% 2/2¼ 100% 2/2¼ 100% 2/2¼ 100%

(5) Worry, distress,stress reactions non-workAll studies 2/2¼ 100% 2/2¼ 100% 2/2¼ 100%QS>70% 2/2¼ 100% 2/2¼ 100% 2/2¼ 100%QS<70% — — —

(6) Low social supportAll studies 2/3¼ 67% 0/3 0/3QS>70% 1/2¼ 50% 0/2 0/2QS<70% 1/1¼ 100% 0/1 0/1

(7) Low stimulus from workAll studies 2/3¼ 67% 0/3 0/3QS>70% 1/2¼ 50% 0/2 0/2QS<70% 1/1¼ 100% 0/1 0/1

(8) High qualitative job demandsAll studies 2/2¼ 100% 0/2 0/2QS>70% 2/2¼ 100% 0/2 0/2QS<70% — — —

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5. Conclusions

There is evidence that psychosocial factors are independently associated with mus-culoskeletal disorders among construction workers. Low job satisfaction appearsto be the most important factor followed by high perceived job stress. More studiesare needed to determine the effect of psychosocial factors among blue collar workersand how they interact with other environmental exposures to affect MSD. There isstill a need for developing a standardized instrument capable of reliably evaluatingpsychosocial factors.

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About the authors

Tarek Sobeih, MD, MSc is an Assistant Lecturer of Industrial Medicine andOccupational Diseases at Cairo University. He is currently pursuing a PhD degreein Occupational Safety and Ergonomics at the University of Cincinnati. His researchfocuses on prevention of musculoskeletal disorders in the workplace and occupa-tional lung diseases.

Nancy M. Daraiseh is a research assistant professor at the University of Cincinnatiin the Department of Industrial and Manufacturing Engineering. She received herPhD in Industrial Engineering with a focus on occupational safety/ergonomics fromthe University of Cincinnati. Dr Daraiseh holds a BS in Electrical Engineering from

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The Jordan University of Science & Technology and an MS in IndustrialEngineering from the University of Cincinnati. Her research interests include: work-place assessment focusing on the identification of risk factors (physical, psychologi-cal and organizational) impacting various outcomes (musculoskeletal symptoms/injuries, ageing, stress, performance, job satisfaction/dissatisfaction) as well asintervention studies.

Ash M. Genaidy holds degrees in engineering (BS, MS, PhD) and epidemiology(PhD). He is an Associate Professor of Industrial & Manufacturing Engineeringand Environmental Health and is the Deputy Director of the Safety & HealthEngineering programme in the NIOSH-Sponsored Cincinnati Education andResearch Center, all at the University of Cincinnati. Dr Genaidy’s teaching andresearch focus on ergonomics, safety and health engineering, statistics, epidemiologyand engineering economy and entrepreneurship. Dr Genaidy is the author orco-author of over 80 peer-reviewed papers published in international journalsincluding Ergonomics, Human Factors, Applied Ergonomics, Theoretical Issues inErgonomics Sciences, American Journal of Industrial Medicine, Journal of Occupa-tional Medicine, Spine, Occupational and Environmental Medicine and Journal ofSafety Research. He is an Associate Editor for Theoretical Issues in ErgonomicsSciences, has edited a book on ‘Computer-Aided Ergonomics’ and is the recipientof the ‘Outstanding Young Engineer of the Year’ by the Engineering Society ofDetroit.

O. Salem’s main research interests are in transportation and construction health andsafety, lean construction and infrastructure systems. He serves as a faculty memberwith the Civil and Environmental Engineering Department at the University ofCincinnati. Dr Salem has more than 30 refereed publications. His work has beenpresented to and published by several national and international professional orga-nizations including the Transportation Research Board (TRB), American Society forCivil Engineers, Canadian Society of Civil Engineering and the United Nations. Hereceived several research awards and grants from many domestic and national orga-nizations including the National Science Foundation, National Institute forOccupational Safety and Health, Construction Industry Institute, Federal HighwayAdministration and Ohio Department of Transportation. Dr Salem earned his PhDDegree from the University of Alberta in 1998. He served on the Board of Directors ofthe American Road and Transportation Builders Association (ARTBA) with theResearch and Education Committee. He is active with the Transportation ResearchBoard (TRB) and serves on a number of technical committees. In addition to hisacademic experience, Dr Salem has more than 10 years of industry work experience;he is a registered Professional Engineer and a Certified Professional Constructor.

Richard Shell holds degrees in engineering (BS, MS and PhD). He is a professorof industrial and manufacturing engineering and environmental health engineeringat the University of Cincinnati. Dr Shell’s teaching and research focus on safetyand health engineering and work measurement. Dr Shell is the author or co-authorof over 100 peer-reviewed papers published in international journals, includingTheoretical Issues in Ergonomics Science, Ergonomics and Applied Ergonomics.He was the recipient of the ‘Phil Carroll Award’ for outstanding achievement inwork measurement and methods engineering by the American Institute of IndustrialEngineers.

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