Effort-reward imbalance and one-year change in neck-shoulder and upper-extremity pain among call center computer operators

Dr N Krause, University of California at San Francisco University of California Berkeley Richmond Field Station, Richmond, CA 94804, USA.
Scandinavian Journal of Work, Environment & Health (Impact Factor: 3.45). 12/2009; 36(1):42-53. DOI: 10.2307/40967828
Source: PubMed


The literature on psychosocial job factors and musculoskeletal pain is inconclusive in part due to insufficient control for confounding by biomechanical factors. The aim of this study was to investigate prospectively the independent effects of effort-reward imbalance (ERI) at work on regional musculoskeletal pain of the neck and upper extremities of call center operators after controlling for (i) duration of computer use both at work and at home, (ii) ergonomic workstation design, (iii) physical activities during leisure time, and (iv) other individual worker characteristics.
This was a one-year prospective study among 165 call center operators who participated in a randomized ergonomic intervention trial that has been described previously. Over an approximate four-week period, we measured ERI and 28 potential confounders via a questionnaire at baseline. Regional upper-body pain and computer use was measured by weekly surveys for up to 12 months following the implementation of ergonomic interventions. Regional pain change scores were calculated as the difference between average weekly pain scores pre- and post intervention.
A significant relationship was found between high average ERI ratios and one-year increases in right upper-extremity pain after adjustment for pre-intervention regional mean pain score, current and past physical workload, ergonomic workstation design, and anthropometric, sociodemographic, and behavioral risk factors. No significant associations were found with change in neck-shoulder or left upper-extremity pain.
This study suggests that ERI predicts regional upper-extremity pain in -computer operators working >or=20 hours per week. Control for physical workload and ergonomic workstation design was essential for identifying ERI as a risk factor.

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    • "Furthermore, excessive use of scripts has been criticized because of reducing the skills of agents and their need to think (Wilson, 2006), and its positive relation to emotional exhaustion (Holman, 2003a,b). In a recent study, Krause et al. (2010) found a significant relation between effort-reward imbalance in call centers with musculoskeletal disorders among employees controlling for duration of computer use, ergonomic workstation design, physical activities during leisure time and other individual worker characteristics. In recent years, however, studies have suggested physical activities (e.g., training programs) to be an efficient treatment for work-related health issues. "
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    ABSTRACT: Background: Performance monitoring might have an adverse influence on call center agents’ well-being. We investigate how performance, over a six-month period, is related to agents’ perceptions of their learning climate, character strengths, well-being (subjective and psychological), and physical activity. Method: Agents (N = 135) self-reported perception of the learning climate (Learning Climate Questionnaire), character strengths (Values In Action Inventory Short Version), well-being (Positive Affect, Negative Affect Schedule, Satisfaction With Life Scale, Psychological Well-Being Scales Short Version), and how often/intensively they engaged in physical activity. Performance, “time on the phone”, was monitored for six consecutive months by the same system handling the calls. Results: Performance was positively related to having opportunities to develop, the character strengths clusters of Wisdom and Knowledge (e.g., curiosity for learning, perspective) and Temperance (e.g., having self-control, being prudent, humble, and modest), and exercise frequency. Performance was negatively related to the sense of autonomy and responsibility, contentedness, the character strengths clusters of Humanity and Love (e.g., helping others, cooperation) and Justice (e.g., affiliation, fairness, leadership), positive affect, life satisfaction and exercise Intensity. Conclusion: Call centers may need to create opportunities to develop to increase agents’ performance and focus on individual differences in the recruitment and selection of agents to prevent future shortcomings or worker dissatisfaction. Nevertheless, performance measurement in call centers may need to include other aspects that are more attuned with different character strengths. After all, allowing individuals to put their strengths at work should empower the individual and at the end the organization itself. Finally, physical activity enhancement programs might offer considerable positive work outcomes.
    Full-text · Article · Jun 2014 · Frontiers in Psychology
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    • "Furthermore, Krause et al. observed negative confounding for physical work-related stress [38]. This means that the association between ERI and musculoskeletal pain is concealed by confounding and only becomes clear after adjustment [52]. "
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    ABSTRACT: Musculoskeletal pain may be triggered by physical strains and psychosocial risk factors. The effort-reward imbalance model (ERI model) is a stress model which measures psychosocial factors in the working world. The question is whether workers with an effort-reward imbalance report musculoskeletal pain more frequently than those with no effort-reward imbalance. A systematic review using a best evidence synthesis approach was conducted to answer this question. A literature search was conducted for the period from 1996 to 2012, using three databases (Pubmed, Embase and PsycINFO). The research criteria related to psychosocial, work-related stress as per the ERI model and to musculoskeletal pain. A quality score was developed using various quality criteria to assess the standard of the studies. The level of evidence was graded as in (Am J Ind Med 39:180-193, 2001). After applying the inclusion criteria, a total of 19 studies were included in the review: 15 cross-sectional studies, three prospective studies and one case-control study. 74% of all studies exhibited good methodological quality, 53% collected data using the original ERI questionnaire, and in 42% of the studies, there was adequate control for physical working conditions. Furthermore, different cut-off points were used to classify exposed and non-exposed individuals. On the basis of 13 studies with a positive, statistically significant association, a moderate level of evidence was inferred for the association between effort-reward imbalance and musculoskeletal pain. The evidence for a role of over-commitment and for its interaction with effort-reward imbalance was rated as inconclusive - on the basis of eight and five studies, respectively. On the basis of the available evidence, no reliable conclusion may be drawn about any association between the psychosocial factors ascertained using the ERI model and musculoskeletal pain. Before a reliable statement can be made on the association between ERI and musculoskeletal pain, additional longitudinal studies must be performed - with a standardised method for recording and classifying exposure, as well as control of physical confounders. Appropriate preventive measures can then be specified.
    Full-text · Article · Jan 2014 · BMC Public Health
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    • "Work-related stress is one of the leading causes of workers' ill health in developed countries [1], where it has considerable effects on sickness absence and disability [2]. Epidemiological investigations document significant associations of stressful work with coronary heart disease [3] [4] [5], depression [6] [7] [8], musculoskeletal disorders [9] [10], and other stressrelated health problems [11]. In recent years, specific theoretical concepts and their measurement in terms of psychometrically validated standardized questionnaires has led to progress in identifying psychosocial working conditions that produce adverse health effects. "
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    ABSTRACT: Purpose: To perform a parsimonious measurement of workplace psychosocial stress in routine occupational health surveillance, this study tests the psychometric properties of a short version of the original Italian effort-reward imbalance (ERI) questionnaire. Methods: 1,803 employees (63 percent women) from 19 service companies in the Italian region of Latium participated in a cross-sectional survey containing the short version of the ERI questionnaire (16 items) and questions related to self-reported health, musculoskeletal complaints and job satisfaction. Exploratory factor analysis, internal consistency of scales and criterion validity were utilized. Results: The internal consistency of scales was satisfactory. Principal component analysis enabled to identify the model's main factors. Significant associations with health and job satisfaction in the majority of cases support the notion of criterion validity. A high score on the effort-reward ratio was associated with an elevated odds ratio (OR = 2.71; 95% CI 1.86-3.95) of musculoskeletal complaints in the upper arm. Conclusions: The short form of the Italian ERI questionnaire provides a psychometrically useful tool for routine occupational health surveillance, although further validation is recommended.
    Full-text · Article · Aug 2012 · The Scientific World Journal
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