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  • Department of Public Health

    University of Helsinki

    Musculoskeletal disorders and psychosocial factors at work

    Effects of a participatory ergonomics intervention in a

    cluster randomized controlled trial

    Eija Haukka

    ACADEMIC DISSERTATION

    To be presented by permission of the Faculty of Medicine of the University of Helsinki,

    for public examination in the Auditorium of the Finnish Institute of Occupational Health,

    Haartmaninkatu 1 A (3rd floor), Helsinki, on Friday 5th November 2010, at 12 noon

    Publications of Public Health M206:2010

  • ISSN 0355-7979

    ISBN 978-952-10-4867-8 (paperback)

    ISBN 978-952-10-4868-5 (pdf)

    http://ethesis.helsinki.fi

    Helsinki University Print

    Helsinki 2010

  • Author's address: Finnish Institute of Occupational Health

    Topeliuksenkatu 41 a A

    FI-00250 Helsinki, Finland

    E-mail:eija.haukka@ttl.fi

    Supervisors: Docent Päivi Leino-Arjas

    Finnish Institute of Occupational Health

    Helsinki, Finland

    Professor (emerita) Hilkka Riihimäki

    Finnish Institute of Occupational Health

    Helsinki, Finland

    Reviewers: Professor Clas-Håkan Nygård

    University of Tampere

    Tampere, Finland

    Docent Simo Taimela

    University of Helsinki

    Helsinki, Finland

    Opponent: Professor Allard van der Beek

    EMGO Institute, VU University Medical Centre

    Amsterdam, The Netherlands

  • CONTENTS

    ABSTRACT .........................................................................................................................................7

    LIST OF ORIGINAL PUBLICATIONS ...........................................................................................10

    ABBREVIATIONS............................................................................................................................11

    1. INTRODUCTION..........................................................................................................................12

    2. REVIEW OF THE LITERATURE ................................................................................................14

    2.1. Burden of musculoskeletal disorders...........................................................................................14

    2.2. Risk factors for musculoskeletal disorders..................................................................................16

    2.2.1. Physical workload...............................................................................................................18

    2.2.2. Psychosocial factors at work...............................................................................................21

    2.2.3. Health-related lifestyle........................................................................................................22

    2.2.4. Individual factors ................................................................................................................24

    2.3. Ergonomics intervention studies .................................................................................................28

    2.3.1. Study designs ......................................................................................................................28

    2.3.2. Methodological issues.........................................................................................................30

    2.3.3. Challenges encountered in workplace intervention studies ................................................32

    2.3.4. The participatory approach .................................................................................................33

    2.4. Evidence of the effectiveness of ergonomics interventions in preventing

    musculoskeletal disorders...................................................................................................................35

    2.4.1. Overview.............................................................................................................................35

    2.4.2. Behavioural and physical interventions ..............................................................................36

    2.4.3. Organizational interventions...............................................................................................37

    2.4.4. Participatory ergonomics interventions ..............................................................................38

    2.5. Kitchen work as a target of an ergonomics intervention.............................................................50

    3. THEORETICAL FRAMEWORK OF THE STUDY ....................................................................52

    4. AIMS OF THE STUDY.................................................................................................................54

  • 5. MATERIALS AND METHODS ...................................................................................................55

    5.1. General description of the study..................................................................................................55

    5.2. Study designs and subjects ..........................................................................................................56

    5.3. Sample size, randomization and blinding....................................................................................57

    5.4. Data collection, worker turnover and loss to follow-up ..............................................................58

    5.5. The participatory ergonomics intervention .................................................................................59

    5.6. Measures......................................................................................................................................62

    5.6.1. Musculoskeletal disorders and multiple-site musculoskeletal pain....................................62

    5.6.2. Psychosocial factors at work and mental stress ..................................................................63

    5.6.3. Perceived physical workload ..............................................................................................64

    5.6.4. Covariates ...........................................................................................................................64

    5.7. Statistical analyses.......................................................................................................................66

    5.7.1. Effects of the participatory ergonomics intervention on musculoskeletal

    disorders and psychosocial factors at work ..................................................................................66

    5.7.2. Multiple-site musculoskeletal pain and reciprocal associations with psychosocial

    factors at work ..............................................................................................................................67

    6. RESULTS.......................................................................................................................................68

    6.1. Effects of the participatory ergonomics intervention in the prevention of

    musculoskeletal disorders (I)..............................................................................................................68

    6.1.1. Baseline characteristics.......................................................................................................68

    6.1.2. Changes in ergonomics.......................................................................................................70

    6.1.3. Effects on health outcomes .................................................................................................71

    6.1.4. Effects on perceived physical workload .............................................................................74

    6.2. Effects of the participatory ergonomics intervention on psychosocial factors at work

    (II).......................................................................................................................................................74

    6.3. Occurrence of multiple-site musculoskeletal pain (III)...............................................................77

    6.4. Reciprocal associations of multiple-site musculoskeletal pain with psychosocial

    factors at work (IV) ............................................................................................................................79

    6.4.1. Time-lagged associations....................................................................................................79

    6.4.2. Trajectories of multiple-site musculoskeletal pain and psychosocial factors at

    work ..............................................................................................................................................80

  • 6.4.3. Associations of psychosocial factors at baseline with multiple-site

    musculoskeletal pain trajectories ..................................................................................................82

    6.4.4. Association of multiple-site musculoskeletal pain at baseline with psychosocial

    work factor trajectories .................................................................................................................83

    6.4.5. Psychosocial work factor trajectories in relation to multiple-site pain trajectories ............84

    7. DISCUSSION..........................................................................................