Physically demanding workloads and the risks of musculoskeletal disorders in homecare workers in the USA

Abstract

Although musculoskeletal disorders (MSDs) are prevalent among homecare workers, little is known about the MSD risk factors. This study investigated whether physically demanding workloads among homecare workers are related to MSDs, especially in neck, shoulder and back pain. Data were taken from two waves of a random sample (June to December 2003 and December 2003 to February 2004). The sample included 1643 homecare workers at Wave 1 and 1198 homecare workers at Wave 2, respectively. A basic telephone interview and 30 minutes computer-assisted interview were performed for homecare workers in Wave 1 and Wave 2. The prevalence of neck, shoulder and back MSDs was assessed at Wave 1 and Wave 2 using the Nordic questionnaire of musculoskeletal symptoms. The incidence of MSDs at 6 months was estimated at Wave 2 using only those who were in the asymptomatic reference group at Wave 1 as the denominator. At Wave 1, back MSDs were the most prevalent (10.2%), followed by neck (9.6%) and shoulder (7.1%) MSDs. After 6 months, the incidence of neck MSDs was the highest (7.0%), followed by back (6.4%) and shoulder (4.8%) MSDs. Physical demands of work were assessed using items developed from focus groups of workers. When compared with asymptomatic workers, those with MSDs showed a dose-response effect for physical job demands. After controlling for age, psychosocial demands and social support on-the-job, physical demands among homecare workers were significantly associated with an excessive odds of neck, shoulder and back MSDs incident at 6 months (odds ratios of 1.14-1.17 for each unit increase on a physical demand scale). Our study shows that the physical demands of work are a significant risk factor for MSDs among homecare workers. Considering the high physical demands among homecare workers, the finding in this study clearly indicates that practical intervention strategies should be implemented to protect homecare workers from exposure to MSD risk factors.

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“…However, the use of relatives as paid providers may bring up unintended complications regarding the actual delivery of care, because of the well-documented risk of occupational injury and musculoskeletal disorders (MSDs) among PAS providers [7,8] . Musculoskeletal disorders (MSDs) are defined as "injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and disorders of the nerves, tendons, muscles and supporting structures of the upper and lower limbs, neck, and lower back that are caused, precipitated or exacerbated by sudden exertion or prolonged exposure to physical factors such as repetition, force, vibration, or awkward posture" [9] .…”

“…In the United States, the rate of MSDs among PAS workers exceeded that among construction, mining and manufacturing workers [14] . Recently, Kim et al [7] investigated this MSD risk prospectively, using a random sample of over 1600 paid providers. Study results indicated that providers' physical demands providing care are a significant risk factor for MSDs.…”

“…Even if the MSD was not directly caused by home care work, it could easily become a work-related injury if physical strain from performing the home care work prevented healing and led to the condition becoming chronic. An ergonomic work environment in home care has been shown to be an important factor in preventing occupational injury and MSD [7,12] . This study documents that most respondents reported hallways or doorways wide enough for wheelchair or walker, but about half indicated recipients' homes did not have ramps or street level entrances.…”

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“…This suggests that a combination of tasks that require bending may increase the risk of musculoskeletal problems for PAS providers. Similarly, Kim and colleagues found a modest increase in risk (OR=1.14; CI=1.08-1.19) for physical demands among PAS providers (Kim et al, 2010). Other studies of care providers have also found challenges in identifying the role of physical risk factors in WRMSDs or related disability (Ando et al, 2000;Simon et al, 2008), or determining the most problematic physical risk factor in home care (Cheung et al, 2006;Ono et al, 1995).…”

“…With upwards of 44% of low back pain patients in the general working population reporting a recurrence within one year (Woolf & Pfleger, 2003), multiple episodes or chronicity among home care providers also needs to be considered. Although several studies have documented rates among home health nurses and aides, only a few have focused on paid PAS workers in the home (Kim et al, 2010;Meyer & Muntaner, 1999;Ono et al, 1995).…”