Academic journal article Scandinavian Journal of Work, Environment & Health

Predictors of Sickness Absence Related to Musculoskeletal Pain: A Two-Year Follow-Up Study of Workers in Municipal Kitchens

Academic journal article Scandinavian Journal of Work, Environment & Health

Predictors of Sickness Absence Related to Musculoskeletal Pain: A Two-Year Follow-Up Study of Workers in Municipal Kitchens

Article excerpt

Possibilities to control long-term and repeated sickness absence (SA) are currently among the top policy priori- ties in many European countries due to the various costs involved both to society and the individual (1). The importance of SA is emphasized as it has been found to be a precursor to permanent work disability (2, 3).

Musculoskeletal (4, 5) and mental health prob- lems, especially depression (3, 6) are the dominant medical causes of SA. With regard to musculoskeletal disorders, neck pain and low-back pain have received most attention in this respect (5, 7-8). While a range of other factors, such as female gender (9), increasing age, high physical workload (9-11), poor psychoso- cial working conditions, obesity, smoking (9-11), and being physically inactive during leisure-time (12), have been implicated as risk factors for SA in general, little is known about their importance regarding SA due to musculoskeletal pain specifically.

Current epidemiological evidence suggests that mus- culoskeletal pain at several sites is more common and may be more disabling than single-site pain (13). The importance of examining factors related to SA over time has also been underlined (14). In the Finnish public sec- tor, kitchen workers are among the three occupations with the highest rates of SA (15). We have previously found that multisite pain among female municipal kitchen workers is common (16). In the current work among this occupational group, our aim was to study to what extent multisite pain and musculoskeletal diseases, as well as other somatic diseases, depressive symptoms, physical and psychosocial workload, and health-related lifestyle factors are predictive of the course of SA related to mus- culoskeletal pain during a two-year follow-up.


Study setting and participants

This two year longitudinal study was based on data derived from a cluster randomized controlled trial which the Finnish Institute of Occupational Health conducted during 2002-2005 in four large cities in Finland aimed at assessing the efficacy of a participatory ergonom- ics intervention in preventing musculoskeletal disor- ders among 504 workers of 119 municipal kitchens of schools, nurseries, nursing homes, or geriatric service centers. No systematic differences between the interven- tion and control groups were found in musculoskeletal disorders or SA due to musculoskeletal pain during the intervention or during the one-year follow-up period (17). Thus, we pooled the data for the analyses in the current work. Due to the limited number of men (N=17), the analyses were carried out among women only (N=487). The final sample comprised 386 women, based on the inclusion criterion of trajectory analysis (see below).


Data were collected by questionnaire repeatedly at nine time points: baseline (0), and thereafter at 3, 6, 9, 12, 15, 18, 21, and 24 months. The researchers distributed the questionnaires at workplaces. The questionnaires were mailed to those on vacation or sick leave with the instruction to respond within one week after return- ing to work. Non-responders were reminded by phone after two weeks. The response rates at each time point exceeded 90%.

Sickness absence due to musculoskeletal pain

The subjects were inquired at each time point about the occurrence of SA during the past three months by seven questions of the format: "Have you been on sick leave due to [body area] pain during the past three months (no/ yes)?" The sites inquired about were the neck, shoulders, forearms/hands, the low back, hips, knees, and ankles/ feet. The repeated measurements enabled us to study the course of SA over time by trajectory analysis.

Possible predictors

Musculoskeletal pain. Pain in the above-mentioned seven anatomical sites was measured by the following ques- tions modified from the validated questionnaire (18): "Have you had [body area] pain during the past three months (no/yes)? …

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