Relations between work and upper extremity musculoskeletal problems (UEMSP) and the moderating role of psychosocial work factors on the relation between computer work and UEMSP

  • Nektaria Nicolakakis
  • Susan R. Stock
  • Michal Abrahamowicz
  • Rex Kline
  • Karen Messing
Original Article



Computer work has been identified as a risk factor for upper extremity musculoskeletal problems (UEMSP). But few studies have investigated how psychosocial and organizational work factors affect this relation. Nor have gender differences in the relation between UEMSP and these work factors  been studied. We sought to estimate: (1) the association between UEMSP and a range of physical, psychosocial and organizational work exposures, including the duration of computer work, and (2) the moderating effect of psychosocial work exposures on the relation between computer work and UEMSP.


Using 2007–2008 Québec survey data on 2478 workers, we carried out gender-stratified multivariable logistic regression modeling and two-way interaction analyses.


In both genders, odds of UEMSP were higher with exposure to high physical work demands and emotionally demanding work. Additionally among women, UEMSP were associated with duration of occupational computer exposure, sexual harassment, tense situations when dealing with clients, high quantitative demands and lack of prospects for promotion, and among men, with low coworker support, episodes of unemployment, low job security and contradictory work demands. Among women, the effect of computer work on UEMSP was considerably increased in the presence of emotionally demanding work, and may also be moderated by low recognition at work, contradictory work demands, and low supervisor support.


These results suggest that the relations between UEMSP and computer work are moderated by psychosocial work exposures and that the relations between working conditions and UEMSP are somewhat different for each gender, highlighting the complexity of these relations and the importance of considering gender.


Work-related upper extremity musculoskeletal disorders Computer work Psychosocial work demands Moderating effects 



This study is part of a series conducted by the Scientific Group on Work-related Musculoskeletal Disorders of the Quebec Institute of Public Health. We thank members of the Scientific Group for insightful discussions and input throughout various stages of this work.

Compliance with ethical standards

Conflict of interest

None of the authors have any competing interests to disclose.


This study was funded by the Canadian Institutes of Health Research (Grant #245412) at the University of Montreal Hospital Research Centre and through a postdoctoral fellowship from the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (the Québec Occupational Health and Safety Research Institute) for N Nicolakakis. The funding sources did not influence any aspect of this study, including its design, analysis, the interpretation of findings or conclusions.

Ethical approval

The Research Ethics Committee of the University of Montreal Hospital Centre approved this study (Project registration no. 11.145, Approved September 15, 2011).

Supplementary material

420_2017_1236_MOESM1_ESM.pdf (45 kb)
Supplementary material 1 (PDF 45 kb)
420_2017_1236_MOESM2_ESM.pdf (56 kb)
Supplementary material 2 (PDF 55 kb)
420_2017_1236_MOESM3_ESM.pdf (74 kb)
Supplementary material 3 (PDF 74 kb)


  1. Andersen JH, Thomsen JF, Overgaard E et al (2003) Computer use and carpal tunnel syndrome: a 1-year follow-up study. JAMA 289:2963–2969CrossRefGoogle Scholar
  2. Andersen JH, Harhoff M, Grimstrup S et al (2008) Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder. Occup Environ Med 65:126–131CrossRefGoogle Scholar
  3. Andersen JH, Fallentin N, Thomsen JF, Mikkelsen S (2011) Risk factors for neck and upper extremity disorders among computers users and the effect of interventions: an overview of systematic reviews. PLoS One 6:e19691CrossRefGoogle Scholar
  4. Arcand R, Labrèche F, Stock S, Messing K, Tissot F (2000) Travail et santé [Work and health]. In: Daveluy C, Pica L, Audet N, Courtemanche R, Lapointe F (eds) Enquête sociale et de santé 1998 [1998 Québec Health and Social Survey], 2nd edn. Institut de la Statistique du Québec, QuébecGoogle Scholar
  5. Arvidsson I, Arvidsson M, Axmon A, Hansson G-Å, Johansson CR, Skerfving S (2006) Musculoskeletal disorders among female and male air traffic controllers performing identical and demanding computer work. Ergonomics 49:1052–1067CrossRefGoogle Scholar
  6. Bongers PM, IJmker S, van den Heuvel S, Blatter BM (2006) Epidemiology of work-related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioral perspective (part II). J Occup Rehabil 16:279–302CrossRefGoogle Scholar
  7. Bruno Garza JL, Eijckelhof BHW, Huysmans MA (2013) The effect of over-commitment and reward on trapezius muscle activity and shoulder, head, neck, and torso postures during computer use in the field. Am J Ind Med 56:1190–1200CrossRefGoogle Scholar
  8. Chang CH, Amick BCR, Menendez CC et al (2007) Daily computer usage correlated with undergraduate students’ musculoskeletal symptoms. Am J Ind Med 50:481–488CrossRefGoogle Scholar
  9. da Costa BR, Vieira ER (2010) Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med 53:285–323Google Scholar
  10. Eijckelhof BHW, Bruno Garza JL, Huysmans MA et al (2013a) The effect of overcommitment and reward on muscle activity, posture, and forces in the arm-wrist-hand region–a field study among computer workers. Scand J Work Environ Health 39:379–389CrossRefGoogle Scholar
  11. Eijckelhof BHW, Huysmans MA, Bruno Garza JL et al (2013b) The effects of workplace stressors on muscle activity in the neck-shoulder and forearm muscles during computer work: a systematic review and meta-analysis. Eur J Appl Physiol 113:2897–2912CrossRefGoogle Scholar
  12. Ekman A, Andersson A, Hagberg M, Hjelm EW (2000) Gender differences in musculoskeletal health of computer and mouse users in the Swedish workforce. Occup Med 50:608–613CrossRefGoogle Scholar
  13. Gerr F, Marcus M, Ensor C et al (2002) A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders. Am J Ind Med 41:221–235CrossRefGoogle Scholar
  14. Hauke A, Flintrop J, Brun E, Rugulies R (2011) The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress 25:243–256CrossRefGoogle Scholar
  15. Herin F, Vézina M, Thaon I, Soulat J-M, Paris C, ESTEV group (2014) Predictive risk factors for chronic regional and multiple body sites musculoskeletal pain: a 5-year prospective study in a working population. Pain 155:937–943CrossRefGoogle Scholar
  16. Homan MM, Armstrong TJ (2003) Evaluation of three methodologies for assessing work activity during computer use. AIHA J 64:48–55CrossRefGoogle Scholar
  17. Huysmans MA, IJmker S, Blatter B et al (2012) The relative contribution of work exposure, leisure time exposure, and individual characteristics in the onset of arm-wrist-hand and neck-shoulder symptoms among office workers. Int Arch Occup Environ Health 85:651–666CrossRefGoogle Scholar
  18. IJmker S, Huysmans MA, Blatter BM, van der Beek AJ, van Mechelen W, Bongers PM (2007) Should office workers spend fewer hours at their computer? A systematic review of the literature. Occup Environ Med 64:211–222CrossRefGoogle Scholar
  19. IJmker S, Huysmans MA, van der Beek AJ et al (2011) Software-recorded and self-reported duration of computer use in relation to the onset of severe arm-wrist-hand pain and neck-shoulder pain. Occup Environ Med 68:502–509CrossRefGoogle Scholar
  20. Jaccard J (2001) Interaction effects in logistic regression. Sage University Paper Series on Quantitative Applications in the Social Sciences, Series no. 07-135. Sage Publications Inc, Thousand OaksGoogle Scholar
  21. Jensen C, Ryholt CU, Burr H, Villadsen E, Christensen H (2002) Work-related psychosocial, physical and individual factors associated with musculoskeletal symptoms in computer users. Work Stress 16:107–120CrossRefGoogle Scholar
  22. Karasek RA (1985) Job content questionnaire and user’s guide. University of Massachusetts, LowellGoogle Scholar
  23. Karlqvist L, Tornqvist EW, Hagberg M, Hagman M, Toomingas A (2002) Self-reported working conditions of VDU operators and associations with musculoskeletal symptoms: a cross-sectional study focussing on gender differences. Int J Ind Ergon 30:277–294CrossRefGoogle Scholar
  24. Kristensen TS, Smith-Hansen L, Jansen N (2005) The Copenhagen Psychosocial Questionnaire—a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health 31:438–449CrossRefGoogle Scholar
  25. Kryger AI, Andersen JH, Lassen CF et al (2003) Does computer use pose an occupational hazard for forearm pain; from the NUDATA study. Occup Environ Med 60:e14CrossRefGoogle Scholar
  26. Kuorinka I, Jonsson B, Kilbom A et al (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233–237CrossRefGoogle Scholar
  27. Lapointe J, Dionne C, Brisson C, Montreuil S (2009) Interaction between postural risk factors and job strain on self-reported musculoskeletal symptoms among users of video display units: a three-year prospective study. Scand J Work Environ Health 35:134–144CrossRefGoogle Scholar
  28. Marcus M, Gerr F, Monteilh C et al (2002) A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders. Am J Ind Med 41:236–249CrossRefGoogle Scholar
  29. Martin L, Omrani N (2015) An assessment of trends in technology use, innovative work practices and employees’ attitudes in Europe. Appl Econ 47:623–638CrossRefGoogle Scholar
  30. Messing K, Stock SR, Tissot F (2009) Should studies of risk factors for musculoskeletal disorders be stratified by gender? Lessons from the 1998 Québec Health and Social Survey. Scand J Work Environ Health 35:96–112CrossRefGoogle Scholar
  31. National Research Council and Institute of Medicine (2001) Musculoskeletal disorders and the workplace: low back and upper extremities. Panel on musculoskeletal disorders and the workplace. Commission on Behavioral and Social Sciences and Education. National Academies Press, Washington, DCGoogle Scholar
  32. Rao JNK, Scott AJ (1981) The analysis of categorical data from complex sample surveys: chi-squared tests for goodness of fit and independence in two-way tables. J Am Stat Assoc 76:221–230CrossRefGoogle Scholar
  33. Sauter SL, Swanson NG (1996) An ecological model of musculoskeletal disorders in office work. In: Moon SD, Sauter SL (eds) Beyond biomechanics: psychosocial aspects of musculoskeletal disorders in office work. Taylor & Francis Ltd, LondonGoogle Scholar
  34. Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1:27–41CrossRefGoogle Scholar
  35. Silverstein B, Fan ZJ, Smith CK et al (2009) Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk? Scand J Work Environ Health 35:113–126CrossRefGoogle Scholar
  36. Stock SR, Fernandes R, Delisle A, Vézina N (2005) A systematic review of reproducibility and validity of workers’ self-reports of physical work demands. Scand J Work Environ Health 31:409–437CrossRefGoogle Scholar
  37. Stock S, Nicolakakis N, Messing K, Turcot A, Raïq H (2013) Quelle est la relation entre les troubles musculo-squelettiques (TMS) liés au travail et les facteurs psychosociaux? Perspectives interdisciplinaires sur le travail et la santé 15-2.
  38. Stock S, Nicolakakis N, Raïq H, Messing K, Lippel K, Turcot A (2014) Underreporting work absences for nontraumatic work-related musculoskeletal disorders to workers’ compensation: results of a 2007–2008 survey of the Québec working population. Am J Public Health 104:e94–e101CrossRefGoogle Scholar
  39. Tornqvist EW, Kilbom A, Vingård E et al (2001) The influence on seeking care because of neck and shoulder disorders from work-related exposures. Epidemiology 12:537–545CrossRefGoogle Scholar
  40. Tornqvist EW, Hagberg M, Hagman M, Risberg EH, Toomingas A (2009) The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users. Int Arch Occup Environ Health 82:689–702CrossRefGoogle Scholar
  41. Van den Heuvel SG, van der Beek AJ, Blatter BM, Bongers PM (2006) Do work-related factors predict neck and upper limb symptoms in office workers? Int Arch Occup Environ Health 79:585–592CrossRefGoogle Scholar
  42. Vézina M, Cloutier E, Stock S, Lippel K, Fortin E, Delisle A, St-Vincent M, Funes A, Duguay P, Vézina S, Prud’homme P (2011) Enquête québécoise sur des conditions de travail, d’emploi, de santé et de sécurité du travail (EQCOTESST) [Québec Survey on Working and Employment Conditions and Occupational Health and Safety]. Institut de recherche Robert-Sauvé en santé et sécurité du travail (IRSST), Institut national de santé publique du Québec (INSPQ), Institut de la statistique du Québec (ISQ). Québec. Report R-691Google Scholar
  43. Wahlström J, Hagberg M, Toomingas A, Tornqvist EW (2004) Perceived muscular tension, job strain, physical exposure, and associations with neck pain among VDU users; a prospective cohort study. Occup Environ Med 61:523–528CrossRefGoogle Scholar
  44. Won EJ, Johnson PW, Punnett L, Dennerlein JT (2009) Upper extremity biomechanics in computer tasks differ by gender. J Electromyogr Kinesiol 19:428–436CrossRefGoogle Scholar
  45. World Health Organization Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium (2003) The burden of musculoskeletal conditions at the start of the new millennium. Technical Report Series 919. World Health Organization. GenevaGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Scientific Group on Work-related Musculoskeletal DisordersInstitut national de santé publique du QuébecMontrealCanada
  2. 2.Department of Social and Preventive MedicineUniversity of Montreal School of Public HealthMontrealCanada
  3. 3.University of Montreal Hospital Research Centre (CRCHUM)MontrealCanada
  4. 4.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
  5. 5.Department of PsychologyConcordia UniversityMontrealCanada
  6. 6.Interdisciplinary Research Centre on Well-Being, Health, Society and Environment (CINBIOSE)University of Quebec in Montreal (UQAM)MontrealCanada

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