There is growing evidence in the occupational health literature that psychosocial work factors may influence the development of musculoskeletal problems, including both low back and upper extremity disorders (Bongers et al. 1993). Psychosocial work factors are defined as aspects of the work environment (such as work roles, work pressure, relationships at work) that can contribute to the experience of stress in individuals (Lim and Carayon 1994; ILO 1986). This paper provides a synopsis of the evidence and underlying mechanisms linking psychosocial work factors and musculoskeletal problems with the emphasis on studies of upper extremity disorders among office workers. Directions for future research are also discussed.
An impressive array of studies from 1985 to 1995 had linked workplace psychosocial factors to upper extremity musculoskeletal problems in the office work environment (see Moon and Sauter 1996 for an extensive review). In the United States, this relationship was first suggested in an exploratory research by the National Institute for Occupational Safety and Health (NIOSH) (Smith et al. 1981). Results of this research indicated that video display unit (VDU) operators who reported less autonomy and role clarity and greater work pressure and management control over their work processes also reported more musculoskeletal problems than their counterparts who did not work with VDUs (Smith et al. 1981).
Recent studies employing more powerful inferential statistical techniques point more strongly to an effect of psychosocial work factors on upper extremity musculoskeletal disorders among office workers. For example, Lim and Carayon (1994) used structural analysis methods to examine the relationship between psychosocial work factors and upper extremity musculoskeletal discomfort in a sample of 129 office workers. Results showed that psychosocial factors such as work pressure, task control and production quotas were important predictors of upper extremity musculoskeletal discomfort, especially in the neck and shoulder regions. Demographic factors (age, gender, tenure with employer, hours of computer use per day) and other confounding factors (self-reports of medical conditions, hobbies and keyboard use outside work) were controlled for in the study and were not related to any of these problems.
Confirmatory findings were reported by Hales et al. (1994) in a NIOSH study of musculoskeletal disorders in 533 tele-communication workers from 3 different metropolitan cities. Two types of musculoskeletal outcomes were investigated: (1) upper extremity musculoskeletal symptoms determined by questionnaire alone; and (2) potential work-related upper extremity musculoskeletal disorders which were determined by physical examination in addition to the questionnaire. Using regression techniques, the study found that factors such as work pressure and little decision-making opportunity were associated both with intensified musculoskeletal symptoms and also with increased physical evidence of disease. Similar relationships have been observed in the industrial environment, but mainly for back pain (Bongers et al. 1993).
Researchers have suggested a variety of mechanisms underlying the relationship between psychosocial factors and musculoskeletal problems (Sauter and Swanson 1996; Smith and Carayon 1996; Lim 1994; Bongers et al. 1993). These mechanisms can be classified into four categories:
It has been demonstrated that individuals subject to stressful psychosocial working conditions also exhibit increased autonomic arousal (e.g., increased catecholomine secretion, increased heart rate and blood pressure, increased muscle tension etc.) (Frankenhaeuser and Gardell 1976). This is a normal and adaptive psychophysiological response which prepares the individual for action. However, prolonged exposure to stress may have a deleterious effect on musculoskeletal function as well as on health in general. For example, stress-related muscle tension may increase the static loading of muscles, thereby accelerating muscle fatigue and associated discomfort (Westgaard and Bjorklund 1987; Grandjean 1986).
Individuals who are under stress may alter their work behaviour in a way that increases musculoskeletal strain. For example, psychological stress may result in greater application of force than necessary during typing or other manual tasks, leading to increased wear and tear on the musculoskeletal system.
Psychosocial factors may influence the physical (ergonomic) demands of the job directly. For example, an increase in time pressure is likely to lead to an increase in work pace (i.e., increased repetition) and increased strain. Alternatively, workers who are given more control over their tasks may be able to adjust their tasks in ways that lead to reduced repetitiveness (Lim and Carayon 1994).
Sauter and Swanson (1996) suggest that the relationship between biomechanical stressors (e.g., ergonomic factors) and the development of musculoskeletal problems is mediated by perceptual processes which are influenced by workplace psychosocial factors. For example, symptoms might become more evident in dull, routine jobs than in more engrossing tasks which more fully occupy the attention of the worker (Pennebaker and Hall 1982).
Additional research is needed to assess the relative importance of each of these mechanisms and their possible interactions. Further, our understanding of causal relationships between psychosocial work factors and musculoskeletal disorders would benefit from: (1) increased use of longitudinal study designs; (2) improved methods for assessing and disentangling psychosocial and physical exposures; and (3) improved measurement of musculoskeletal outcomes.
Still, the current evidence linking psychosocial factors and musculoskeletal disorders is impressive and suggests that psychosocial interventions probably play an important role in preventing musculoskeletal problems in the workplace. In this regard, several publications (NIOSH 1988; ILO 1986) provide directions for optimizing the psychosocial environment at work. As suggested by Bongers et al. (1993), special attention should be given to providing a supportive work environment, manageable workloads and increased worker autonomy. Positive effects of such variables were evident in a case study by Westin (1990) of the Federal Express Corporation. According to Westin, a programme of work reorganization to provide an “employee-supportive” work environment, improve communications and reduce work and time pressures was associated with minimal evidence of musculoskeletal health problems.