Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses Fatores de risco físico e psicossocial para distúrbios musculoesqueléticos em enfermeiras brasileiras e italianas

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload. Nursing Staff; Cross-cultural Comparison; Musculoskeletal Diseases; Absenteeism Introduction Musculoskeletal disorders are an important cause of morbidity in Western countries 1 where they have been a major focus for research. Moreover, in the last decade the body of evidence on musculoskeletal disorders has extended to also include epidemiological investigations conducted the so called “developing” countries 2,3,4. Many studies have highlighted the important role of stressful physical activities in the generation and progression of musculoskeletal disorders. At the same time, psychosocial risk factors, such as job satisfaction, somatizing tendency and mood, are receiving growing attention as determinants of musculoskeletal disorders, and appear at least equally important 5,6,7,8. In addition, some studies have started to explore the role of culturally determined health beliefs in generating and maintaining musculoskeletal symptoms. These studies have suggested marked variations in the prevalence of common musculoskeletal complaints and associated disability among workers carrying out similar jobs but in dissimilar settings (different countries) 9,10. It is hypothesized that in many cases, chronic musculoskeletal symptoms and disability may be “psychologically mediated responses to triggering exposures” 11 (p. 281) conditioned by individual characteristics and cultural circumstances. Nurses employed in hospitals are particularly liable to work-related musculoskeletal disorders: 1632 ARTIGO ARTICLE RISK FACTORS FOR MUSCULOSKELETAL DISORDERS IN NURSES 1633 Cad. Saúde Pública, Rio de Janeiro, 28(9):1632-1642, set, 2012 their work frequently involves heavy lifting, often in awkward postures, and sometimes entails forceful movements of the upper limbs. Low back, neck and shoulder pain have been shown to be highly prevalent among nurses 12. In order to study the psychosocial and cultural influences on musculoskeletal disorders, we recruited two populations of Brazilian and Italian nurses and nursing technicians (called nurses as a whole), as part of the international CUPID (Cultural and Psychosocial Influences on Disability) study. Our aim was to compare the prevalence of musculoskeletal disorders among nurses in the two locations, and their association with physical and psychosocial risk factors.