A comparative analysis on musculoskeletal disorders between Greek and Dutch nursing personnel

  • Evangelos C. Alexopoulos
  • Alex Burdorf
  • Athena Kalokerinou
Short Communication


Objective: To analyse cross-cultural differences between Greek and Dutch nursing personnel in association with the risk factors and occurrence and consequences (absenteeism and medical care seeking) of musculoskeletal disorders. Methods: This study was based on questionnaire surveys among 393 nurses and caregivers in nursing homes and homes for the elderly in The Netherlands and among 351 nurses in general hospitals in Athens, Greece. Logistic regression analysis was used to analyse associations between physical and psychosocial workload, need for recovery, perceived general health and (1) the occurrence of musculoskeletal complaints in the past 12 months, (2) chronic complaints during at least 3 months, and (3) complaints which led to sickness absence and medical care seeking. Results: Greek nurses reported significantly more back complaints in the past 12 months (75 vs. 62%) than the Dutch workers, but chronicity (11 vs. 12%) and sickness absence (17 vs. 15%) of these complaints did not differ. Similar differences were observed for neck complaints but not for shoulder complaints. Most Greek nurses with back complaints visited a medical specialist (40%) while Dutch nurses and caregivers sought care through a general practitioner (33%). Multivariate analyses showed that in both countries strenuous back postures (ORs 1.9 and 1.9) and especially a moderate general health (ORs 4.3 and 2.9) were the significant risk factors for back pain. Conclusions: In both countries similar risk factors were associated with the occurrence of low-back pain. Cross-national differences were less important for the risk factors and musculoskeletal complaints than for the consequences of these complaints and for medical care seeking.


Musculoskeletal complaints Low-back pain Nurses Sickness absence Medical care seeking Greece The Netherlands 


  1. Andersson GBJ (1999) Epidemiologic features of chronic low back pain. Lancet 354:581–585PubMedCrossRefGoogle Scholar
  2. Borg G (1990) Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health 16(Suppl):55–58PubMedGoogle Scholar
  3. Burdorf A, Sorock G (1997) Positive and negative evidence for risk factors of work-related back disorders. Scand J Work Environ Health 23:243–256PubMedGoogle Scholar
  4. Elders LAM, Burdorf A (2001) Interrelationships of risk factors and low back pain in scaffolders. Occup Environ Med 58:597–603PubMedCrossRefGoogle Scholar
  5. Engels JA, Gulden JWJ, Senden TF, Hof B (1996) Work related risk factors for musculoskeletal complaints in the nursing profession: results of a questionnaire survey. Occup Environ Med 53:636–641PubMedGoogle Scholar
  6. Greenberg J, Baron R (1997) Behaviour in organizations, 6th edn. Prentice Hall, Englewood CliffsGoogle Scholar
  7. Hartvigsen J, Lings S, Leboeuf-Y de C, Bakketeig L (2004) Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective studies. Occup Environ Med 61:e2PubMedGoogle Scholar
  8. Jansen JP, Morgenstern H, Burdorf A (2004) Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low-back pain. Occup Environ Med 61:972–979PubMedCrossRefGoogle Scholar
  9. Josephson M, Lagerstrom M, Hagberg M, Wigaeus Hjelm E (1997) Musculoskeletal symptoms and job strain among nursing personnel: a study over a three year period. Occup Environ Med 54:681–685PubMedGoogle Scholar
  10. Karasek R, Theorell T (1990) Healthy work: Stress, productivity, and the reconstruction of working life. Basic Books, Inc., Publishers, New YorkGoogle Scholar
  11. Karasek RA, Baker D, Marxer F (1981) Job decision latitude, job demands and cardiovascular disease: a prospective study among Swedish men. Am J Public Health 71:694–705PubMedGoogle Scholar
  12. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B (1998) The job content questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 3(4):322–355CrossRefPubMedGoogle Scholar
  13. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, Jorgensen K (1987) Standard Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergonom 18:233–237CrossRefGoogle Scholar
  14. Lagerström M, Wenemark M, Hagberg M, Wigaeus Hjelm E (1995) Occupational and individual factors related to musculoskeletal symptoms in five body regions among Swedish nursing personnel. Int Arch Occup Environ Health 68:27–35CrossRefPubMedGoogle Scholar
  15. Ono Y, Shimaoka M, Hiruta S, Hattori Y, Hori F, Takeuchi Y (2000) Associations of self estimated workloads with musculoskeletal symptoms among hospital nurses. Occup Environ Med 57:211–216CrossRefPubMedGoogle Scholar
  16. Paoli P, Merllié D (2001) Third European survey on working conditions 2000. European Foundation for the Improvement of Living and Working Conditions, DublinGoogle Scholar
  17. Sjoberg L (1997) Explaining risk perception: An empirical evaluation of cultural theory. Risk Decis Policy 2(2):113–130CrossRefGoogle Scholar
  18. Sluiter JK, van der Beek AJ, Frings-Dresen MHW (1999) The influence of work characteristics on the need for recovery and experienced health: a study on coach drivers. Ergonomics 42:573–583CrossRefPubMedGoogle Scholar
  19. Smedley J, Egger P, Cooper C, Coggon D (1995) Manual handling activities and risk of low back pain in nurses. Occup Environ Med 52:160–163PubMedCrossRefGoogle Scholar
  20. Smedley J, Egger P, Cooper C, Coggon D (1997) Prospective cohort study of predictors of incident low back pain in nurses. BMJ 314:1225–1228PubMedGoogle Scholar
  21. Tveito TH, Hysing M, Eriksen HR (2004) Low back pain interventions at the workplace: a systematic literature review. Occup Med 54:3–13CrossRefGoogle Scholar
  22. Van Sonsbeek JLA (1990) De Voeg: a list of subjective health complaints (Statistical reports M37). SDU/ publishers, The HagueGoogle Scholar
  23. Veldhoven van M, Broersen S (2003) Measurement quality and validity of the ‘need for recovery scale’. Occup Environ Med 60:3–9CrossRefPubMedGoogle Scholar
  24. Waxman R, Tennant A, Helliwell P (1998) Community survey of factors associated with consultation for low back pain. BMJ 317:1564–1567PubMedGoogle Scholar
  25. Weber UE, Lee KC (2000) Culture and individual judgement and decision making. Appl Psychol 49(1):32–61CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Evangelos C. Alexopoulos
    • 1
  • Alex Burdorf
    • 1
  • Athena Kalokerinou
    • 2
  1. 1.Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
  2. 2.Nursing School Athens UniversityAthensGreece

Personalised recommendations