Hum Factors. 2014 Feb;56(1):178-90. doi: 10.1177/0018720813487201.
The aim of this study was to characterize associations between psychosocial and work organizational risk factors and upper-extremity musculoskeletal symptoms and disorders.
Methodological limitations of previous studies of psychosocial and work organizational risk factors and musculoskeletal outcomes have produced inconsistent associations.
In this prospective epidemiologic study of 386 workers, questionnaires to assess decision latitude ("control") and psychological job demands ("demand") were administered to study participants and were used to classify them into job strain "quadrants". Measures of job stress and job change were collected during each week of follow-up. Incident hand/arm and neck/shoulder symptoms and disorders were ascertained weekly. Associations between exposure measures and musculoskeletal outcomes were estimated with proportional hazard methods.
When compared to the low-demand/high-control job strain referent category, large increases in risk of hand/arm disorders were observed for both high-demand/high-control (hazard ratio [HR] = 4.49, 95% confidence interval [CI] = [1.23, 16.4]) and high-demand/low-control job strain categories (HR = 5.18,95% CI = [1.39, 19.4]). Similar associations were observed for hand/arm symptoms. A strong association was also observed between the low-demand/low-control job strain category and neck/shoulder disorders (HR = 6.46, 95% CI = [1.46, 28.6]). Statistically significant associations were also observed between weekly stress level and weekly job change and several musculoskeletal outcomes.
Associations between psychosocial risk factors and work organizational factors and musculoskeletal outcomes were large and in the hypothesized direction.
Prevention of occupational musculoskeletal disorders may require attention to psychosocial and work organizational factors in addition to physical factors. Methods to control adverse effects of psychosocial and work organizational risk factors should be explored.
本研究旨在描述心理社会和工作组织风险因素与上肢肌肉骨骼症状和疾病之间的关联。
先前研究心理社会和工作组织风险因素与肌肉骨骼结果的方法学局限性导致关联结果不一致。
在这项针对 386 名工人的前瞻性流行病学研究中，向研究参与者发放了评估决策自主权（“控制”）和心理工作要求（“需求”）的问卷，并将他们分为工作紧张“象限”。在随访的每一周收集工作压力和工作变化的测量值。每周确定手部/手臂和颈部/肩部症状和疾病的发生情况。使用比例风险方法估计暴露测量值与肌肉骨骼结果之间的关联。
与低需求/高控制的工作紧张参照类别相比，高需求/高控制（危险比 [HR] = 4.49，95%置信区间 [CI] = [1.23, 16.4]）和高需求/低控制工作紧张类别（HR = 5.18，95% CI = [1.39, 19.4]）的手部/手臂疾病风险显著增加。手部/手臂症状也存在类似的关联。低需求/低控制工作紧张类别与颈部/肩部疾病也存在很强的关联（HR = 6.46，95% CI = [1.46, 28.6]）。每周压力水平和每周工作变化与几种肌肉骨骼结果之间也存在显著关联。
心理社会风险因素和工作组织因素与肌肉骨骼结果之间的关联很大，且与假设方向一致。
除了物理因素外，职业肌肉骨骼疾病的预防可能还需要关注心理社会和工作组织因素。应探索控制心理社会和工作组织风险因素不良影响的方法。
