Impact of job stress on the
prevalence of musculoskeletal disorders among computer users of hospitals in Gorgan, Iran, in
2014
Taban E, MSc1, Shokri S, MSc2,
Yazdani Aval M, MSc1, Rostami Aghdam Shendi M, MSc3, Kalte
HO, MSc4*, Keshizadeh F, MSc1
1- MSc in Occupational Health
Engineering, Dept. of Occupational Health Engineering, Faculty of Medical
Sciences, Tarbiat Modares University, Tehran, Iran. 2- MSc in Occupational
Health Engineering, Dept. of Occupational Health Engineering, Faculty of
Health, Qazvin University of Medical Sciences, Qazvin, Iran.3- MSc in Occupational
Health Engineering, Dept. of Occupational Health Engineering, Faculty of
Medical Sciences, Tehran University, Tehran, Iran. 4-PhD Student in
Occupational Health Engineering, Dept. of Occupational Health Engineering,
Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Abstract Received:
May 2016, Accepted:
June
2016
Background:
Occupational
stress has physical and psychological consequences, and is a major cause of
job dissatisfaction among employees, which can reduce the quality of services
provided. This study was conducted to examine the relationship between job
stress and the prevalence of musculoskeletal disorders (MSDs) among computer
users
in hospitals
(private & governmental) of Gorgan, Iran, in 2014. Materials
and Methods: This was a cross-sectional descriptive study. The study participants
consisted of 94 hospital computer users. Data were collected using the Nordic
Musculoskeletal Questionnaire (NMQ) and Osipow’s Occupational Stress Inventory.
Data analysis was performed using SPSS software. Results: The mean score of the subjects
studied was 159±77.24. The results revealed that 6.38% of the staff had mild
stress, 68.9% mild to moderate stress, 24.47% had moderate to high stress,
and none of the employees had high occupational stress. There was no significant
relationship between job stress and MSDs of the neck, shoulders, back,
elbows, and hands and wrists, but the relationship between stress and MSDs of
the waist was significant (P=0.03). Conclusions:
The
prevalence of MSDs in the studied hospital computer users was high and stress
in the workplace can have an important role in the pathogenesis of this
disorder. |
Keywords: Stress, Occupational,
Computer,
Musculoskeletal Disease
Introduction
Human resources are the most important asset of any organization and
determine the method by which the other resources of an organization are used
to achieve its goals and objectives. As the World Health Organization (WHO) has
emphasized, the determination of the goals of health systems with respect to
quality improvement, efficiency, effectiveness, and equitable access to health
care is related to the performance of human resources (1). Despite the critical
importance of health, it is neglected internationally in terms of required
human resources (2). Stress is an inevitable part of our modern life and if it
emerges in the workplace, due to changes* in the work
environment, activities, and objectives, it will represent job stress (3). If
job stress exceeds the threshold values, it will lead to reduced efficiency
through reducing individuals’ attention, sleep disruption, increased risk of
disease, irreparable mistakes, and even harassment and violence at work, work
absences, burnout, and reduced work performance. It will also endanger one's
health through physical, psychological, and behavioral symptoms (4). Annually,
substantial losses occur due to the physical and mental health problems of
employees, reduced efficiency, turnover, and changing jobs which are caused by
job stress. Stress and its possible complications cause a
hundred lost workdays annually and an average of one million individuals refuse
to return to their work due to disorders and illnesses caused by work stress
every day.
It has been reported that about 30% of the labor forces suffer from job
stress in developed countries.
The International Labor Organization (ILO) has estimated that the cost of
job stress is about 1%-3.5% of gross domestic product (GDP), which is
increasing (2).
On the other hand, it should be noted that one of the most important
factors of productivity and quality of work, particularly among medical staff,
is job satisfaction and lack of stress (5).
Job satisfaction is a positive emotional state resulting from job quality (6). Job satisfaction is defined as the
compatibility between individuals' perception of their needs and that which
they receive from their job, it is one of the most important research variables
in organizational behavior as well as a pivotal change in organizational
research and theories (7). Studies show
that lack of job satisfaction, through having negative effects on physical and
mental health and stress among staff, increases internal conflicts,
work-related accidents, absenteeism, and staff movement, and has negative
consequences such as reduced efficiency and effectiveness of the organization (8). In addition, stress has a relationship
with job satisfaction and performance and is one of the factors affecting the
health, safety, and wellbeing of individuals. Complications of workplace
stresses and costs associated
with the disease musculoskeletal disorders have forced managers to pay
attention to this issue (9). Different countries have evaluated the rate of job
satisfaction and stress from different perspectives. The highest level of job
satisfaction has been reported in America with 41%, followed by Scotland (38%),
the UK (36%), Canada (33%), and Germany (17%). Kargar et al. conducted a study
on 5486 health staff in Ontario, Canada (10). They found that belief in
fulfilling the organization's mission, good communication, authority to decide,
the amount of salary, recognition of staff’s efforts by the organization, and
effective group work were of the most important factors in job satisfaction and
coping with stress (10). The results of
the study by Yami et al. on health workers in Ethiopia showed that 46.2% of
them were dissatisfied with their jobs and the main reasons for their
dissatisfaction were lack of motivation, low pay, and inadequate educational
status (11). Monjamed et al. found that
job satisfaction of nursing staff across the country was moderate; the highest
satisfaction was related to the variables of workplace environment and
communication with colleagues, and the least satisfaction was related to job
security, benefits, and salary (12).
Zahedi et al. showed that the majority of health care workers of Chaharmahal
and Bakhtiari, Iran, were satisfied with their supervisor, their colleagues,
and the nature of their job, and dissatisfied with promotions and salaries (13). On the relationship between psychological
factors and the incidence of musculoskeletal injuries, it can be said that
dissatisfaction with and stress from work areamong the factors that are closely
related to musculoskeletal disorders (MSDs) (14).
This study aimed to investigate the effects of job stress on MSDs among
computer users of governmental and private hospitals of Gorgan city, Iran.
Material & Methods
This cross-sectional descriptive study was conducted to
examine the relationship between job stress and MSDs among the staff of
governmental and private hospitals in Gorgan. The subjects in this study were
94 men and 4 women who were selected by census method (15). The inclusion criteria included having at least a diploma
degree and a minimum
of 1 year of work experience. The process of data collection was conducted from
July 2014 to September 2014. In the next stage, after explaining the research
objectives for the participants, assuring them of confidentiality, and
obtaining written consent forms, questionnaires were simultaneously distributed
among the participants. The questionnaires with incomplete information were
excluded from the study, and finally, questionnaires remained for further
analysis. Two questionnaires were used in this study.
Occupational Stress Inventory: The Occupational Stress Inventory was designed by Osipow
et al. in 1987 and was called the job stress measuring tool. In this study,
Osipow’s Occupational Stress Inventory was used to determine the level of
stress(16).In this questionnaire, the
severity of stress is divided into four categories of mild stress (60-119),
moderate stress (120-179), moderate to severe stress (180-239), and severe
stress (240-300)(17, 18). The
questionnaire has repeatedly been used by researchers in Iran and abroad and
its validity and reliability (α =0.89) have been approved (19).
Nordic Musculoskeletal Questionnaire: To determine the prevalence of
MSDs, the Nordic Musculoskeletal Questionnaire (NMQ) was used. The NMQ was
designed to determine the prevalence of MSDs in 1987 by Korinka et al. at the
Institute of Public Health of Scandinavian countries (20). This questionnaire examines MSDs in 9 areas of the body
including the neck, shoulders, elbows, wrists, hands, back, waist, hips/thighs,
and knees and ankles during the 3 process times of 7 days, 1 month, and 1 year
ago (21). The Statistical Package for the Social Sciences
(SPSS) (version 19, SPSS Inc., Chicago, IL, USA)was used to analyze the
gathered data.
First, Cronbach’s alpha was used to assess
there liability of measurement scales. Second, ANOVA, Pearson correlation
analysis, and descriptive statistics were used to assess the research variables
and the usefulness of the data set. Finally, a stepwise regression analysis was
used to assess the direct relationship between variables as well as to show the
causal relationship and the nature of the relationship between the variables.
All P values of less than 0.05 were considered significant. The normality of
data was verified using the Kolmogorov–Smirnov test.
Results
The results showed that the subjects had a mean age of 34.88 ± 8.20.In
addition, 4.2% of the participants were women and 95.8% were men. In terms of
education, 13 (13.8%), 13 (13.8%), 57 (60.7%), and 11 (11.7%), respectively,
had a diploma, associate's degree in education, bachelor's degree, and master's
degree. Among the studied subjects, 89 participants (94.7%) were non-smokers
and 5 (5.3%) were smokers. The mean experience of individuals was 9.56±6.69
years and the average daily working hours was 9.38 ±1.42 hours per day. Based
on data derived from the questionnaires, average stress score of participants
studied was 159±24.77. The results showed that 6.38% of the staff had mild
stress, 68.09% mild to moderate stress, 24.47% moderate to high stress, and no
one (0%) had high job stress (Table 1).
Table1: Frequency and percentage of job
stress in the subjects studied
Level of job
stress |
N |
% |
Low |
6 |
6.38 |
Medium |
64 |
68.09 |
Medium to severe |
23 |
24.47 |
Severe |
0 |
0 |
Not answered |
1 |
1.06 |
Total |
94 |
100 |
Table2:
Frequency
and percentage of musculoskeletal disorders in the past 12 months and 7 days
12 Months |
7 Days |
||||
N |
% |
N |
% |
||
Neck |
No |
43 |
45.7 |
62 |
66 |
Yes |
51 |
54.3 |
32 |
34 |
|
Shoulder |
No |
57 |
60.6 |
69 |
73.4 |
Yes (on the right
shoulder) |
13 |
13.8 |
9 |
9.6 |
|
Yes (on the left
shoulder) |
5 |
5.3 |
6 |
6.4 |
|
Yes (on both) |
18 |
19.1 |
10 |
10.6 |
|
Elbow |
No |
87 |
92.6 |
88 |
93.6 |
Yes (on the right
elbow) |
3 |
3.2 |
3 |
3.2 |
|
Yes (on the left
elbow) |
4 |
4.3 |
2 |
2.1 |
|
Yes (on both) |
0 |
0 |
1 |
1.1 |
|
Wrist and hand |
No |
61 |
64.9 |
78 |
83 |
Yes (on the right
wrist and hand) |
17 |
18.1 |
8 |
8.5 |
|
Yes (on the left
wrist and hand) |
5 |
5.3 |
2 |
2.1 |
|
Yes (on both) |
11 |
11.7 |
6 |
6.4 |
|
Back |
No |
51 |
54.3 |
69 |
73.4 |
Yes |
43 |
45.7 |
25 |
26.6 |
|
Waist |
No |
32 |
34 |
49 |
52.1 |
Yes |
62 |
66 |
45 |
47.9 |
In the subjects studied, in the past year and the past week, the highest
prevalence of MSDs was related to the waist area with values of 66% and 47.9%,
respectively (Table 2). Table 3 shows the relationship between stress and the
prevalence of MSDs in the study participants. In this study, all participants,
regardless of gender, were evaluated. No significant correlation was observed
between women and men in terms of the stress score and the prevalence of MSDs.
Table3:
Comparison
of the frequency of musculoskeletal disorders in hospital computer users in
terms of job stress scores
Segment |
Job stress score |
P |
|
|
Mean ± SD |
||
Neck |
Yes |
157.80 ± 25.72 |
0.80 |
No |
159.67 ± 24.62 |
||
Shoulders |
Yes |
156.95 ± 25.53 |
0.68 |
No |
159.93 ± 24.91 |
||
Waist |
Yes |
163.22 ± 25.76 |
0.03 |
No |
150.23 ± 21.54 |
||
Back |
Yes |
161.05 ± 30.77 |
0.61 |
No |
157.23 ± 20.87 |
||
Elbow |
Yes |
167.20 ± 19.56 |
0.43 |
No |
157.75 ± 25.94 |
||
Wrist and hand |
Yes |
159.44 ± 28.13 |
0.79 |
No |
159.45 ± 23.36 |
||
|
Discussion
Among the factors affecting the prevalence of MSDs is the degree of job
stress. Job stress in this study was an average of 159 ± 24.77 which according
to the classification of the severity of job stress in this study was in the
middle range. The results also showed that 68.09% of the subjects had moderate
and 24.47% had moderate to severe stress. Stress results achieved moderate
levels of stress. Although the overall stress level was high, the undesirable
stress level value obtained in this studywas lower compared to other studies on
staff in Iran. For example, in a study by Danesh et al. in 2006 on the stress
level in the control tower, the medium and high stress was 74%(22).
Another study that was carried out in 1994 by Putz et al. on 533 computer
users showed that work-related upper body MSDsare prevalent among individuals
(23). It was also shown that occupational and psychological factors of the
workplace have a significant relationship with the occurrence of this disorder(23). Lee Sang et al. in their study on MSDs in
different parts of the body state that stress is one of the factors that can be
effective in the occurrence of MSDs (24).
In this study, with the use of the Occupational Stress Inventory and t-test
analysis in the sample, no significant relationship was found between job
stress and MSDs of the neck, shoulders, back, elbows, and hands and
wrists.However, a relationship was observed between stress and MSDs of the
waist (P=0.03). The waist, back, and neck had the highest rate of disorders.
This study showed that the frequency of MSDs among office workers in the
past 12 months was 50.7% inthe back, 57.6%in the waist, 46.5% in the neck, and
22.1% in the right shoulder area.
. In the study by Klussmann et al. in Germany on 1065 computer terminal employees,
12-month prevalence of symptoms in the neck, shoulder, hand and wrist, elbow
and lower arm were, respectively, 55%, 38%, 21%, and 15% (25). Their results are relatively similar to
that of this study. In a study that the effects of stress factors on back pain
among nurses, the joy of work, headaches, and mood were found to have a
significant relationship with the prevalence of low back pain. According to
studies conducted by other researchers, job stress is a risk factor in the
development of MSDs (23, 26, 27). Leino
et al. also studied the relationship between MSDs and stress and found a
significant relationship between these factors (28). In their study, they
suggest that there is a significant relationship between the pleasure of
working, headache, fatigue, and low mood in the environment and low back pain(28). Luqmani et al. studied the relationship
between job satisfaction and the prevalence of MSDs among office workers (29).
In their study, they suggest that decreased job satisfaction isa predisposing
factor in the prevalence of MSDs (29).
Freemord in his study has shown that there is a significant relationship
between the prevalence of depression and stress, and back pain(30). Violante et al. found a significant
relationshipbetween low back pain and psychosocial factors and Johansson et al.
between MSDs and psychosocial factors (31, 32).
Moreover, a significant association was found between low back pain and
psychological factors such as social support at work and home and leisure time(33). Haukkal
et al. investigated psychosocial factors and stated that psychosocial factors
are predictorsofMSDs and psychological stresses are associated with MSDs (34).
Conclusion
In this study, most of the subjects complained of MSDs,
but only recognized back problems as the result of job stress
and considered other areas to be the result of other factors. According to the
results of this study, it is suggested that managers of health care
organizations attempt to reduce stress and prevent its mental and physical
effects through different strategies.This can be a step in the direction of
increasing the productivity of and the quality of services provided by health
care organizations. Holding classes for stress management and methods to deal
with it, providing entertainment and exercise facilities, at least
periodically, increasing the number of employees in the sector, and removing
forced extra work hours, modifying job descriptions of health centerpersonnel,
reducing work pressure, developing guidelines to explain and promote jobs, and
providing appropriate mental and physical environments are among the proposed
solutions to this issue.
Acknowledgements
The authors hereby express their gratitude to the hospital personnel of
Golestan University of Medical Sciences for their cooperation in conducting
this research.
Conflict of Interest: None declared
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*
Corresponding author: Haji omid Kalte, Dept. of Occupational
Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University,
Tehran, Iran.
Email: o.kalte@modares.ac.ir