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The incremental effect of psychosocial workplace factors on the development of neck and shoulder disorders: a systematic review of longitudinal studies

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To systematically analyse evidence on the incremental effect of work-related psychosocial risk factors on the development of neck and shoulder disorders, as reported in longitudinal studies.


A systematic literature search was conducted in three data bases (MEDLINE, EMBASE, and PsychINFO) until May 2009. The quality assessment leading to a methodological quality score of the included studies was conducted by two independent reviewers using a standardised checklist. Criteria for the evaluation of evidence were established. Heterogeneity analyses were conducted.


Altogether 18 prospective longitudinal studies were included in the analysis. Potential psychosocial risk factors were mainly based on the job demand control (support) model by Karasek (1998). Study results were too heterogeneous to deduce pooled risk estimates. But the weight of evidence was strong for an incremental effect of job demands, job control, social support, and job strain, on the development of neck and/or shoulder disorders.


While we found evidence for an incremental effect of different psychosocial work factors (in addition to the effect of physical job factors), these results have to be interpreted carefully in order to support the notion that psychological factors can have an independent causal influence on the development of musculoskeletal disorders. Nevertheless, our findings are important for the development of preventive strategies, as they stress the need for preventive approaches that tackle both physical and psychosocial factors. Future research is warranted to consolidate and strengthen the results of this review.

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This review was conducted as a by-product of another study, sponsored by the German Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV). The authors would like to thank Dr. Rolf Ellegast for his support during this study.

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The authors declare that they have no competing interest.

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Correspondence to Elke Ochsmann.



Explanation of the methodological criteria from Table 1


Positive if at least two demographic factors out of age, gender, profession are clearly defined


Positive if either inclusion or exclusion criteria for the baseline population are presented


Positive if the total number of participants was ≥60% on the last point of follow-up compared to the number of participants at baseline


Positive if demographic/clinical information (patient/disease characteristics such as age, sex and other potential prognostic predictors) was presented for those lost to follow-up/drop-outs


Positive if the follow-up period was at least 3 months


Positive if clinical diagnosis was assessed


Positive if standardised questionnaires at baseline and at follow-up were applied for outcome measurement


Positive if objective outcome measurements are applied (clinical examination, clinical tests, X-ray)


Positive if standardised questionnaires at baseline and at follow-up were applied for psychosocial risk factors


Positive if standardised questionnaires at baseline and follow-up were applied for physical risk factors


Positive if objective assessment of physical exposure is conducted (video analysis, weight definition)


Positive if the data presentation fits to the stated method


Positive if univariate/multivariate models are presented by means of relative risks, rate ratios, odds ratios or hazard ratios

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Kraatz, S., Lang, J., Kraus, T. et al. The incremental effect of psychosocial workplace factors on the development of neck and shoulder disorders: a systematic review of longitudinal studies. Int Arch Occup Environ Health 86, 375–395 (2013).

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