Dottorato in MALATTIE INFETTIVE, MICROBIOLOGIA E SANITA' PUBBLICA

Titolo della tesi: Towards a more comprehensive approach to risk management of work-related musculoskeletal disorders: an integrated analysis of occupational and psychosocial risk factors in a large sample of Italian workers

Background: Work-related musculoskeletal disorders (WMSDs) represent an important socio-economic burden and still pose challenges for both public and occupational health, due to the complexity of the risk factors involved as well as the limited accuracy and reliability of current risk assessment and management systems. In this regard, we conducted two different studies aimed at assessing WMSDs prevalence and identify possible associations with several socio-demographic and work-related risk factors in a large cohort representative of Italian workers in order to improve our understanding of the WMSD phenomenon and identify gaps in current evaluation strategies. Methods: Two separate studies were conducted respectively on data from the first and the second wave of INSuLa, a cross-sectional nationally representative survey of health and safety at work, developed by the Italian Workers’ Compensation Authority. In each wave of the survey, a sample of 8,000 workers was included. Multivariate logistic regression analyses were performed to evaluate the association of independent variables (sociodemographic, occupational and psychosocial risk factors) with musculoskeletal disorders (Back pain, Upper Limb pain and Lower Limb pain). Results: In both studies, the probability of experiencing WMSDs increased with age and was higher among women, workers with lower educational level and overweight/obese workers. As regard to the occupational aspects, mainly investigated in the first study, we found that workers perceiving a significant exposure to biomechanical/ergonomic risk but not included in a health surveillance program for such risk had significantly higher odds of reporting musculoskeletal disorders. Such workers were mainly in the 19–24 age range (39.9%), transportation, warehousing/information and communication sectors (38.9%) and employed in companies with more than 250 workers (35.8%). Psychosocial risks were mainly investigated in the second study revealing that those reporting moderate to very high levels of violence and harassment at work, as well as those reporting imbalance between personal efforts and rewards, were significantly more likely to experiencing WMSDs. Finally, in both studies depression was found to be significantly associated with higher odds of reporting either Back, Lower limb or Upper limb pain. Conclusions: An appropriate assessment of occupational risk factors correlated to WMSDs and the correct definition of their exposure levels is essential to adequately prevent the onset of WMSDs. At the same time, the assessment and management of biomechanical and ergonomic risks must be coordinated with psychosocial and work organisational aspects in order to develop a more integrated and comprehensive approach to manage and prevent WMSDs.