Musculoskeletal Disorders in the Workplace: An examination of the underlying causes and contributory risk factors

Introduction The incidence of musculoskeletal disorders remain the most common single condition, by incidence, affecting the working population. This remains true even though the apparent historic causation of manual handling, has reduced significantly. Back pain alone has been termed a 20thcentury medical disaster, which has reverberated into the 21stcentury, with 85% of low back pain having no clear clinical diagnosis yet individuals continue to seek a clinical solution. Understanding pain remains as complex as ever with very little evidence to suggest progress. The overall scale and cost of MSDs in the workplace are not easily identifiable as objective and accurate data are rare. Other workplace incidence and costs are either, not recorded or not published, in documents or grey literature, that are generally only accessible to individual organisations on a regular basis. Objectives The epistemology of this thesis is complexity and the extent to which this influences outcomes. The trilogy of complexity considered includes: 1. The issues facing organisations in how they prevent and manage MSDs; 2. The individual’s perspective and what they understand about possible causation, their beliefs, fears and expectations; 3. The interface with clinical and non-clinical practitioners, and whether interventions provided, are beneficial to the individual. Consideration of the multiple perspectives that arise from the various influences affecting the organisation, the employees within that organisation and the practitioners, has been possible by the metaphoric use of a “bricolage” methodology, and suggests that the current medical model is no longer appropriate. Methods A mixed method research design comprising four studies was undertaken. Firstly, a retrospective quantitative study of data (n = 21,092) from benefits provided by four organisations followed by a qualitative case example study (n = 21) of supporting documents and clinical information. These studies then informed the need for a qualitative study (n= 9) symptomatic individuals who participated in a focus group and (n= 6) face-to-face interviews and finally a qualitative study of practitioners involved in the provision of treatment services to the participating organisations. The data from each study informed the others and the data merged with the findings from the literature review and common interventions. Conclusions A disparity was found between what has been identified in literature and what actually is considered in clinical practice. The healthcare industry operates in “silos” and this separation of disciplines is reflected in organisational management. The range of underlying risk factors, evident in modern society, which are affecting or may affect an individual’s future musculoskeletal health are not being addressed by the medical model, and practitioners require training, or need to work in a multidisciplinary team, if they are to improve long-term outcomes. This thesis discusses the complexity of the multifactorial nature of musculoskeletal health, and provides a framework to challenge current practice and promote a fundamental change in the way in we assess, and treat the range of MSDs including a move towards educating individuals to take personal responsibility