Journal of Occupational Rehabilitation

, Volume 23, Issue 4, pp 585–596 | Cite as

Pain-Related Work Interference is a Key Factor in a Worker/Workplace Model of Work Absence Duration Due to Musculoskeletal Conditions in Canadian Nurses

  • Eleanor Murray
  • Renée-Louise FrancheEmail author
  • Selahadin Ibrahim
  • Peter Smith
  • Nancy Carnide
  • Pierre Côté
  • Jane Gibson
  • Jaime Guzman
  • Mieke Koehoorn
  • Cameron Mustard


Objective To examine the role of pain experiences in relation to work absence, within the context of other worker health factors and workplace factors among Canadian nurses with work-related musculoskeletal (MSK) injury. Methods Structural equation modeling was used on a sample of 941 employed, female, direct care nurses with at least one day of work absence due to a work-related MSK injury, from the cross-sectional 2005 National Survey of the Work and Health of Nurses. Results The final model suggests that pain severity and pain-related work interference mediate the impact of the following worker health and workplace factors on work absence duration: depression, back problems, age, unionization, workplace physical demands and low job control. The model accounted for 14 % of the variance in work absence duration and 46.6 % of the variance in pain-related work interference. Conclusions Our findings support a key role for pain severity and pain-related work interference in mediating the effects of workplace factors and worker health factors on work absence duration. Future interventions should explore reducing pain-related work interference through addressing workplace issues, such as providing modified work, reducing physical demands, and increasing job control.


Work absence Musculoskeletal injuries Pain Multimorbidity Healthcare workers Depression 



This project was funded by a research grant provided by the Workplace Safety and Insurance Board (Ontario). While the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada. Peter Smith is supported by a New Investigator Award from the Canadian Institutes of Health Research. Nancy Carnide is supported by a Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research.

Supplementary material

10926_2012_9408_MOESM1_ESM.pdf (48 kb)
Supplementary Figure 1: Initial theoretical model of worker factors associated with work absence duration due to work-related musculoskeletal injuries. (PDF 48 kb)
10926_2012_9408_MOESM2_ESM.pdf (78 kb)
Supplementary Figure 2: Final theoretical model of worker and workplace factors with significant pathways in model-building phase. (PDF 78 kb)
10926_2012_9408_MOESM3_ESM.doc (46 kb)
Supplementary Table 1: Survey items for work absence, worker health factors and workplace factors from the 2005 National Survey of Work and Health of Nurses (DOC 46 kb)
10926_2012_9408_MOESM4_ESM.doc (92 kb)
Supplementary Table 2: Survey item distributions across levels of work absence duration. Proportional distribution by work absence duration, and Chi squared p-values for univariate associations are presented with total sample size for each predictor variable category. (DOC 92 kb)


  1. 1.
    NIOSH. State of the Sector|Healthcare and Social Assistance. Identification of research opportunities for the next decade of NORA: Department of Health and Human Services (National Institute of Occupational Safety and Health [NIOSH]) 2009. Report No.: Report No.: 2009-139.Google Scholar
  2. 2.
    Frank J, Cullen K; the IWH Ad Hoc Working Group. Preventing injury, illness and disability at work: a view from Canada. A discussion paper for the occupational health and safety community. Scan J Work Environ Health. 2006;32(2):160–7.Google Scholar
  3. 3.
    Loisel P. Intervention for return to work—what is really effective? Scand J Work Environ Health. 2005;31(4):245–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Franche RL, Krause N. Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors. J Occup Rehabil. 2002;12(4):233–56.PubMedCrossRefGoogle Scholar
  5. 5.
    Schultz IZ, Crook JM, Berkowitz J, Meloche GR, Milner R, Zuberbier OA, et al. Biopsychosocial multivariate predictive model of occupational low back disability. Spine. 2002;27(23):2720–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Franche RL, Murray E, Ibrahim S, Smith P, Carnide N, Côté P, et al. Examining the impact of worker and workplace factors for prolonged work absences among Canadian nurses. J Occup Environ Med. 2011;53(8):919–27.PubMedCrossRefGoogle Scholar
  7. 7.
    Shaw WS, Linton SJ, Pransky G. Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors? J Occup Rehabil. 2006;16:591–605.PubMedCrossRefGoogle Scholar
  8. 8.
    Gheldof ELM, Vinck J, Vlaeyen JWS, Hidding A, Crombez G. The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings. Pain. 2005;113:71–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Allen H, Hubbard D, Sullivan S. The burden of pain on employee health and productivity at a major provider of business services. J Occup Environ Med. 2005;47:658–70.PubMedCrossRefGoogle Scholar
  10. 10.
    World Health Organization. International classification of functioning, disability and health. 2001.
  11. 11.
    Collins JJ, Baase CM, Sharda CE, Ozminkowski RJ, Nicholson S, Billotti GM, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005;47(6):547–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Kessler RC, Barber C, Birnbaum HG, Frank RG, Greenberg PE, Rose RM, et al. Depression in the workplace: effects on short-term disability. Health Aff. 1999;18(5):163–71.CrossRefGoogle Scholar
  13. 13.
    Kessler RC, Greenberg PE, Mickelson KD, Meneades LM, Wang PS. The effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med. 2001;43(3):218–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Nordin M, Hiebert R, Pietrek M, Alexander M, Crane M, Lewis S. Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations. J Occup Environ Med. 2002;44(7):677–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Shaw WS, Pranksy G, Fitzgerald TE. Early prognosis for low back disability: intervention strategies for health care providers. Disabil Rehabil. 2001;23:815–28.PubMedCrossRefGoogle Scholar
  16. 16.
    Steenstra IA, Verbeek JH, Heymans MW, Bongers PM. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med. 2004;62:851–60.CrossRefGoogle Scholar
  17. 17.
    Franche RL, Carnide N, Hogg-Johnson S, Côté P, Breslin FC, Bültmann U, et al. Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study. Can J Psych. 2009;54(8):534–46.Google Scholar
  18. 18.
    Tompa E, Scott-Marshall H, Dolinschi R, Trevithick S, Bhattacharyya S. Precarious employment experiences and their health consequences: towards a theoretical framework. Work. 2007;28:209–24.PubMedGoogle Scholar
  19. 19.
    Alexopoulos EC, Burdorf A, Kalokerinou A. Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals. Int Arch Occup Environ Health. 2003;76(4):289–94. doi: 10.1007/s00420-003-0442-9.PubMedGoogle Scholar
  20. 20.
    Bourbonnais R, Mondor M. Job strain and sickness absence among nurses in the province of Quebec. Am J Ind Med. 2001;39(2):194–202.PubMedCrossRefGoogle Scholar
  21. 21.
    Koehoorn M, Demers PA, Hertzman C, Village J, Kennedy SM. Work organization and musculoskeletal injuries among a cohort of health care workers. Scand J Work Environ Health. 2006;32(4):285–93. doi: 10.5271/sjweh.1012.PubMedCrossRefGoogle Scholar
  22. 22.
    Seago JA. Work group culture, stress, and hostility. Correlations with organizational outcomes. J Nurs Adm. 1996;26(6):39–47.PubMedCrossRefGoogle Scholar
  23. 23.
    Verhaeghe R, Mak R, Van Maele G, Kornitzer M, De Backer G. Job stress among middle-aged health care workers and its relation to sickness absence. Stress Health. 2003;19:265–74.CrossRefGoogle Scholar
  24. 24.
    Shields M, Wilkins K, Statistics C, Health C, Canadian Institute for Health I. Findings from the 2005 National Survey of the Work and Health of Nurses. Ottawa: Statistic Canada; 2006.Google Scholar
  25. 25.
    Crook J, Milner R, Schultz IZ, Stringer B. Determinants of occupational disability following a low back injury: a critical review of the literature. J Occupat Rehab. 2002;12(4):277–95.CrossRefGoogle Scholar
  26. 26.
    van der Hulst M, Vollenbroek-Hutten MMR, Ijzerman MJ. A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation—or, back school treatment outcome in patients with chronic low back pain. Spine. 2005;30(7):813–25.PubMedCrossRefGoogle Scholar
  27. 27.
    Côté P, Hogg-Johnson S, Cassidy D, Carroll L, Frank JW. The association between neck pain intensity, physical functioning, depressive symptomatology and time-to-claim closure after whiplash. J Clin Epidemiol. 2001;54:275–86.Google Scholar
  28. 28.
    Schade V, Semmer N, Main CJ, Hora J, Boos N. The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain. 1999;80(1–2):239–49.PubMedCrossRefGoogle Scholar
  29. 29.
    Ash P, Goldstein SI. Predictors of returning to work. Bull Am Acad Psychiatr Law. 1995;23(2):205–10.Google Scholar
  30. 30.
    Shields M, Wilkins K. Technical Appendix. Findings from the 2005 National Survey of the Work and Health of Nurses. Ottawa, Canada: Statistics Canada; 2006.Google Scholar
  31. 31.
    Campbell MJ, Julious SA, Altman DG. Estimating sample sizes for binary, ordered categorical, and continuous outcomes in two group comparisons. BMJ. 1995;311:1145–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Labour Statistics Division. Work Absence Rates, 2009. Ottawa, ON: Statistics Canada; 2010.Google Scholar
  33. 33.
    Labour Statistics Division. Work Absence Rates, 2008. Ottawa, ON: Statistics Canada; 2009.Google Scholar
  34. 34.
    Kessler RC, Wittchen H-U, Abelson JM, McGonagle KA, Schwarz N, Kendler KS, et al. Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US National Comorbidity Survey. Int J Meth Psychitr Res. 1998;7(1):33–55.CrossRefGoogle Scholar
  35. 35.
    Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q. 1979;24:285–305.CrossRefGoogle Scholar
  36. 36.
    Siegrist J, Klein D, Voigt KH. Linking sociological with physiological data: the model of effort-reward imbalance at work. [Review] [14 refs]. Acta Physiologica Scandinavica. 1997; 640(Supplementum):112–6.Google Scholar
  37. 37.
    Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998;3(4):322–55.Google Scholar
  38. 38.
    MacCallum RC, Austin JT. Applications of structural equation modeling in psychological research. Annu Rev Psychol. 2000;51:201–26.PubMedCrossRefGoogle Scholar
  39. 39.
    Gorman E, Yu S, Alamgir H. When healthcare workers get sick: exploring sickness absenteeism in British Columbia, Canada. Work. 2010;35(2):117–23.PubMedGoogle Scholar
  40. 40.
    Buhi ER, Goodson P, Neilands TB. Structural equation modeling: a primer for health behavior researchers. Am J Health Behav. 2007;31(1):74–85.PubMedCrossRefGoogle Scholar
  41. 41.
    Muthen LK, Muthen BO. Mplus user’s guide. Los Angeles, CA: Muthen & Muthen; 2004.Google Scholar
  42. 42.
    Morneau Sobecco. Recommendations for experience rating: For discussion with stakeholders: Morneau Sobeco, 2008.Google Scholar
  43. 43.
    Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. 2002;92(1):105–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Alamgir H, Yu S, Fast C, Hennessy S, Kidd C, Yassi A. Efficiency of overhead ceiling lifts in reducing musculoskeletal injury among carers working in long-term care institutions. Injury. 2008;39(5):570–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Schechter J, Green LW, Olsen L, Kruse K, Cargo M. Application of Karasek’s demand/control model to a Canadian occupational setting including shift workers during a period of reorganization and downsizing. Am J Health Promot. 1997;11(6):394–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Labriola M, Lund T, Burr H. Prospective study of physical and psychosocial risk factors for sickness absence. Occup Med (Lond). 2006;56(7):469–74. doi: 10.1093/occmed/kql058.PubMedCrossRefGoogle Scholar
  47. 47.
    Smulders PGW, Nijhuis FJN. The job demands-job control model and absence behaviour: results of a 3-year longitudinal study. Work Stress. 1999;13(2):115–31.CrossRefGoogle Scholar
  48. 48.
    Brouwer S, Franche RL, Hogg-Johnson S, Lee H, Krause N, Shaw WS. Return-to-work self-efficacy: development and validation of a scale in claimants with musculoskeletal disorders. J Occup Rehabil. 2011;21(2):244–58. doi: 10.1007/s10926-010-9262-4.Google Scholar
  49. 49.
    Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.PubMedCrossRefGoogle Scholar
  50. 50.
    Costa LdCM, Maher CG, McAuley JH, Hancock MJ. Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain. 2010;15:213–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Eleanor Murray
    • 1
    • 2
  • Renée-Louise Franche
    • 2
    • 3
    • 4
    • 8
    Email author
  • Selahadin Ibrahim
    • 2
    • 8
  • Peter Smith
    • 2
    • 5
    • 8
  • Nancy Carnide
    • 2
    • 8
  • Pierre Côté
    • 6
    • 8
    • 10
  • Jane Gibson
    • 2
    • 9
  • Jaime Guzman
    • 7
  • Mieke Koehoorn
    • 3
  • Cameron Mustard
    • 2
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Institute for Work & HealthTorontoCanada
  3. 3.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  4. 4.Faculty of Health SciencesSimon Fraser UniversitySurreyCanada
  5. 5.School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  6. 6.Faculty of Health SciencesUniversity of Ontario Institute of TechnologyOshawaCanada
  7. 7.Division of Physical Medicine & RehabilitationUniversity of British ColumbiaVancouverCanada
  8. 8.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  9. 9.Knowledge Transfer & Exchange ConsultantTorontoCanada
  10. 10.UOIT-CMCC Centre for the Study of Disability Prevention and RehabilitationUniversity of Ontario Institute of TechnologyOshawaCanada

Personalised recommendations