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Abstract: The role of psychosocial and physical factors in the development of shoulder pain has now been clearly demonstrated. However, only a few studies have analyzed these associations over time. The main goal of this study was to evaluate the predictive value of work-related psychological and mechanical factors on chronic shoulder pain. A total of 12,714 subjects (65% men) born in 1938, 1943, 1948, and 1953 participating in a French prospective longitudinal epidemiological investigation in 1990 to 1995 Enquête Santé Travail Et Vieillissement (ESTEV) were included. Clinical examination was performed by 400 trained occupational physicians. Personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between chronic shoulder pain and personal and occupational factors were analyzed using logistic regression modeling. A total of 1706 subjects experienced chronic shoulder pain in 1990, and 2089 experienced chronic shoulder pain in 1995. The incidence of chronic shoulder pain in 1995 was 11% (n=1355). Forceful effort (odds ratio [OR]=1.24 95% CI [1.05–1.44], awkward posture (OR=1.34 95% CI [1.19–1.52]), decision latitude (OR=1.19 [1.04 to 1.35]), and psychological demand (OR=1.19 95% CI [1.06–1.32]) in 1990 were significantly associated with chronic shoulder pain in 1995, even after adjustment for personal factors and previous shoulder pain status. Awkward posture (OR=1.43 [1.25 to 1.63]), psychological demand (OR=1.24 [1.09 to 1.40]), and decision latitude (OR=1.21 [1.04 to 1.41] work-related factors in 1990 were associated with the development of chronic shoulder pain between 1990 and 1995. These results suggest that awkward posture, forceful effort, job demand, and decision control are predictors of chronic shoulder pain at work. Interventions designed to reduce the incidence of chronic shoulder pain must include both mechanical and psychological factors. [Copyright &y& Elsevier]

Abstract: The role of psychosocial factors in the development of upper limb musculoskeletal disorders has now been clearly demonstrated. However, only a few studies have analysed the association between the organisational work environment and musculoskeletal disorders in health care workers. The main goal of this study was to test the hypothesis that some specific organisational constraints may be related to upper limb musculoskeletal symptoms experienced by registered nurses, independently of the effort/reward imbalance model and major confounding factors. In 2006, 2194 female registered nurses in 7 French teaching hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded to valid self-report questionnaires (ERI [effort–reward imbalance], Nordic-style questionnaire). The organisational work environment was assessed by the self-rated Nursing Work Index—Extended Organisation scale. Multilevel models were used for analyses. We found that 2 organisational health care constraints: low level of shared values about work between members in the unit and lack of support from the administration were significantly associated with upper limb symptoms, independently of ERI perceptions. This study identified and quantified specific health care organisational factors that have an impact on nurses’ upper limb symptoms, sometimes independently of ERI perception. A prospective study is needed to clarify the causal role of psychosocial and organisational work factors in upper limb injury in nurses. Organisational approaches may be more effective in improving health at work and may also have a longer-lasting impact than individual approaches. Specific health care organisational factors measured by a new tool (Nursing Work Index—Extended Organisation) have an effect on nurses’ upper limb symptoms, independently of effort–reward imbalance perception. [Copyright &y& Elsevier]