4Musculoskeletal health in the workplace
Introduction
Musculoskeletal (MSK) problems remain the main reason why individuals are absent from work globally. This includes MSK problems associated with work, where associations have been found between poor workplace ergonomics and physical exposures at work or psychosocial risks at work, and usually referred to as work-related musculoskeletal disorders (WRMSDs or MSDs) and MSK problems related to lifestyle behaviours, disease and injuries outside the workplace that individuals come to work with [1,2]. Across the EU, data from EU-28 identifies that from the labour force survey, self-reporting of MSDs was at 54.2% in 2007 rising to 60.1% in 2013; no further data are available at this point [3]. In the US and Canada, MSDs have the most impact on organisations’ overall health care costs (53%), followed by cancer (47%), diabetes (44%) and cardiovascular disease/heart disease (32%) [4]. In the US, MSDs comprise about 40% of all lost-time workplace injuries [5]. In Canada and Ontario (2018), WRMSDs is the number one type of lost-time work injury, accounting for 40% and 38% of all lost-time claims, respectively [6,7]. Each year in Canada, MSDs alone create an economic burden of $25.6 billion, of which, $13.9 billion is due to productivity losses [8]. According to the Government of Ontario, MSDs cost Ontario workplaces hundreds of millions of dollars due to worker absence and lost productivity. Additional indirect costs, when a worker has suffered from an MSD, include overtime and replacement wages, workstation and equipment modifications, administration costs, training costs for replacement workers and reduced quality of outputs. The Global Burden of Disease study [9] estimated that MSK conditions were the second highest contributor to global disability and that 20%–33% of people across the globe live with a painful MSK condition. In Europe alone, there are an estimated 120 million people with a chronic MSK condition [10].
For the purposes of this chapter, chronic MSK conditions are defined as ‘those that last more than 12 weeks, including chronic back pain or chronic upper limb disorders, as well as rheumatic diseases, degenerative conditions such as osteoarthritis or osteoporosis or non-specific pain syndromes categorised as chronic’ [11]. Thus, while the term chronic MSK conditions covers a variety of symptoms in the body as well as different disease outcomes, there are also common symptoms, including pain, fatigue, functional limitations and tiredness. Additional health issues, that is, co-morbidities and multimorbidity also often occur in people with MSK conditions, including cardiovascular disease, diabetes and depression [12]. This all impacts on quality of life in individuals as well as in societies where economic consequences could be as high as 2% of gross domestic product across the EU [13].
Having a chronic MSK condition has a pervasive impact on individuals that include fear and worry, social withdrawal and loss of social roles, family strain, and loss of income [14] and while many people want to continue to work there are a number of barriers and facilitators in making this happen. The aims of this chapter are to:
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Consider what has changed in the workplace and the workforce since 2000 and its impact on MSK conditions;
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To understand how work impacts on chronic MSK conditions and the prevention measures that can be taken in the workplace;
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To gain knowledge on how we can support individuals with MSK conditions to stay at or return to work.
Section snippets
The evidence base for MSK conditions
Since the year 2000, there have been several different changes in the world of work which are likely to have had an impact on occurrence of MSK conditions and disability for those working with MSK conditions. This includes an increase in knowledge about the workplace, lifestyle and individual factors that are implicated in the development of MSK conditions including [1,2]:
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Workplace Factors
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Heavy physical work
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Sedentarism
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Repetitive work
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Poor and/or awkward postures
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Exposure to psychosocial risks
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Prevention measures that can be taken in the workplace
Globally, employers face several challenges in developing a sustainable, healthy and productive workforce. Workplace injury rates and their economic and societal costs are excessively high. MSD risk factors are depicted in the human factors and ergonomics (HFE) systems model [26], as factors related to the individual/person, the work task and the work environment domains. Not surprisingly, some of these individual-level outcomes are related to reduced organisational performance, such as product
How to enable people with MSK problems to remain in work
Having safe and healthy working conditions is a key component of retaining workers with chronic diseases and disabilities and making work sustainable across the life course. While work should not exacerbate existing health conditions, a broader objective is that work should promote health and wellbeing for all workers.
Facilitators and challenges in enabling worker retention
MSKs are associated with high rates of worker retention across Europe, North America and Australasia [10,84,85]. Individuals with MSK conditions experience reduced productivity [86] and increased absenteeism and presenteeism rates in the workplace. Levels of worker retention vary by job type, for example, people with MSK conditions performing dextrous or laborious manual tasks are at an increased risk of early workforce exit than those in a more inactive and/or flexible environment [87].
For
What works in practice?
While the evidence base in this area of research is still growing, the following section describes eight case studies and the workplace interventions that enabled retention of the worker. The aim of the cases was to examine the journey to either return-to-work or stay at work with a chronic MSD [121].
Interviews were carried out with the eight individuals who had the following MSK health issues:Retail worker Chondromalacia ICT worker Knee osteoarthritis University lecturer Osteoporosis Researcher Upper
Funding statement
Part of the paper was funded by EU OSHA and this is coming out as a separate report from them. No other funding has been received.
Summary
While the workplace and workforce have changed since 2000, these changes highlight that exposure to risks for MSDs do not appear to be well managed. Combined with increasing numbers of vulnerable workers including young workers, older workers, women workers and migrant workers and people with other MSK conditions, work disability caused by MSK problems may increase in coming decades. Current recommendations in retaining workers with chronic MSK conditions is to ensure that safety and health
Declaration of competing interest
No other conflicts of interest were reported.
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This is part of a series prepared on behalf of the Global Alliance for Musculoskeletal Health to provide the background for developing global and national policies and strategies to address the enormous and growing burden of musculoskeletal conditions and to promote musculoskeletal health for all