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

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  • This article was downloaded by: [Northeastern University]On: 19 November 2014, At: 04:17Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

    Theoretical Issues in ErgonomicsSciencePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/ttie20

    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

    To link to this article: http://dx.doi.org/10.1080/14639220500090760

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    http://www.tandfonline.com/page/terms-and-conditionshttp://www.tandfonline.com/page/terms-and-conditions

  • Psychosocial factors and musculoskeletal disorders in theconstruction 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 individualsusual 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, MayJune 2006, 329344

    *Corresponding author. Email: sobeihtk@email.uc.edu

    Theoretical Issues in Ergonomics ScienceISSN 1463922X print/ISSN 1464536X 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 firms 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 02 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.

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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 15. 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 prospecti...

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