The link between workplace stressors and physical injury: A systematic review and qualitative study

Background

Musculoskeletal disorders (MSDs) are a significant workplace problem with substantial impacts on individuals and society more generally. MSDs are complex, multifactorial problems which require identification and then control of all relevant hazards—physical and psychosocial—to maximise the effectiveness of prevention programs. Whilst a wide range of hazardous task identification tools exist to support work health and safety (WHS) practitioners in developing effective MSD risk management strategies, little is known about the availability of comprehensive tools which cover both physical and psychosocial hazards.

Purpose

The overarching aim of this project was to understand the barriers and facilitators to implementation of comprehensive approaches to risk management of MSDs. To address knowledge gaps in relation to barriers to the uptake of more comprehensive MSD prevention strategies, the current project aimed to:

1. Identify tools, approaches and guidance materials to support comprehensive MSD prevention
2. Explore barriers and enablers to the implementation of comprehensive MSD prevention tools in a range of industry settings
3. Using a systems approach explore the current MSD tools and strategies being used in industries
4. Develop a matrix of MSD prevention tools to assist industry stakeholders in their selection of appropriate tools.

The current project occurred in three phases: two systematic reviews followed by multiple stakeholder interviews. Systematic review 1 (SR1) aimed to identify tools, approaches, and guidance materials used to support comprehensive MSD prevention. Systematic review 2 (SR2) sought to review the barriers and enablers to the implementation of comprehensive MSD prevention tools in a range of industry settings. These reviews were used as the basis for interviews with industry stakeholders which aimed to identify which tools are currently being used in industry. A matrix of tools was then developed for dissemination to industries for use when developing MSD prevention programs.

Methods

SR1: A list of search terms was devised, based on three search concepts: MSDs/mental health outcomes, prevention tools, and work. Four electronic databases, that covered a wide range of health science and ergonomic journals, were searched: Web of Science, Medline, ProQuest Central, and PsychInfo. Studies were imported into Covidence software and all studies were screened by two authors independently for inclusion. Validated MSD risk management tools were extracted from the studies and a descriptive statistical analysis was conducted. A grey literature search was also undertaken.

SR2: A list of search terms was devised, based on four search concepts: MSD outcomes, tools, work, barriers/facilitators. Retrieved studies were loaded into Covidence software for independent screening by four authors. Data was extracted from relevant studies, and the risk of bias was assessed. Studies were grouped according to the type of intervention involved, and barriers and facilitators were analysed using a workplace systems framework.

Stakeholder interviews: Industry stakeholders (WHS professionals) were recruited through LinkedIn, direct email, snowballing sampling and contacts of Centre for WHS, SafeWork NSW, and the research team. Recruited stakeholders (n = 29) were provided with participant information and consent forms prior to their interview. All interviews were conducted via Zoom and lasted approximately one hour. Interviews were transcribed and data was extracted using thematic analysis with assistance from NVivo software.

Findings

SR1: Following the full text screening, 548 studies were assessed as relevant for inclusion; 137 reported on tools covering physical hazards, 254 on psychosocial and 228 covered comprehensive tools (both physical and psychosocial hazards). Some studies reported on more than one type of tool. These reported on 30 physical hazard tools, 35 psychosocial hazard tools, and 16 comprehensive tools. Six additional physical hazard tools were found through the grey literature search. There were 23 studies based in Australia, which represented 15 tools. An interim tool matrix for use in the stakeholder interviews was developed from this literature review.

SR2: Twenty-nine relevant studies were located through the database search. The majority of studies were qualitative in nature and had a low to moderate overall risk of bias rating. For the purposes of this report, only the 15 studies containing comprehensive tools were analysed. Studies involved tools that were implemented in at least nine industry sectors – some studies did not specify the industry sector. The most frequently reported sectors were Healthcare & Social Assistance (12 studies), Manufacturing (7 studies), and Construction (6). The articles covered a wide range of MSD risk management tools: ten studies looked at comprehensive tools (targeting both physical & psychosocial factors), 14 examined non-comprehensive tools (targeting only physical factors), and five included both types of tools (comprehensive and physical). There were no tools that only targeted psychosocial factors. Each of the reported barriers and facilitators were grouped into the relevant work-systems category: external factors, workplace environment, work organisation & job design, task & equipment, and workers’ personal characteristics. Analysis of the data revealed the work organisation & job design level as having the highest number of reported barriers. The main barriers in this level were related to lack of management commitment, counterproductive management attitudes, and high costs.

Stakeholder interviews: Twenty-nine interviews were conducted with WHS professionals from six industry sectors: manufacturing, health & social assistance, public administration, construction, agriculture, and transport/logistics/ warehousing. The majority of participants (n=27) had a formal WHS qualification. Participants reported a range of barriers to effectively managing MSD risk. The majority of barriers were located in the organisational level of the workplace system model. Most of the MSD risk management strategies currently utilised by participants were focussed at the individual and equipment/task levels of the workplace system. All participants were aware of at least one validated tool from the tool matrix (from SR1), however only nine participants were currently using a validated tool in their workplace. Reported reasons for poor uptake of validated tools were related to 1) perceived deficits of the tools, or 2) barriers to implementation (mostly organisational level barriers).

Tool matrix development: Following the stakeholder interviews, the interim tool matrix was refined (which included the addition of a psychosocial tool identified through the interviews) to include only validated tools that were accessible (online tools or downloadable & includes instructions or guidance for use) and able to be used by workplace practitioners.

Conclusion

Two literature reviews were undertaken to identify MSD risk management tools, and barriers and facilitators to the implementation of comprehensive tools. The first literature review resulted in a large number of tools being identified, however only a relatively small number were comprehensive in their focus. Of those tools identified as comprehensive, most of them did not meet the tool matrix inclusion criteria (they were either unable to be accessed or were research tools). The second literature review revealed the organisational workplace level as being the source of most barriers to successful implementation of comprehensive MSD risk management strategies. Correspondingly, the organisational workplace level was also responsible for most of the facilitators.

Tools, barriers, and facilitators were also explored from the perspective of key stakeholders, WHS professionals. The majority of stakeholders interviewed had formal WHS qualifications, were working at a managerial level, and were aware of some of the validated tools; however, most were not currently using a validated tool in workplace management of MSD risk. Reasons for poor uptake of validated tools were related to 1) perceived deficits of the tools, 2) barriers to implementation (mostly organisational level barriers), and 3) awareness and availability of tools. A matrix of tools available in Australia was compiled through the literature search and stakeholder consultation; however, many of the included tools have limitations including: a singular focus on either physical or psychosocial hazards, lack of worker participation, and overly complex. Opportunities exist for tool refinement and provision of tool implementation guidance material. In addition, awareness of tool availability and implementation needs to be improved through education and promotion activities/resources.

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