Sick leave due to musculoskeletal disorders: A prospective cohort study.

Background: In Norway, home care workers experience particularly high levels of medically-certified sick leave. A substantial percentage of sick leave is due to musculoskeletal disorders, which may be attributed to risk factors at work. Due to limited knowledge of the impact of working conditions on sick leave in this sector, an improved understanding of occupation-specific risk factors is needed. Objective: To examine the impact of psychosocial and mechanical work factors on subsequent sick leave due to musculoskeletal disorders. Design: Prospective cohort study. Setting: A probability sample of 130 Norwegian municipalities and their respective home care services. Participants: 1819 home care workers. Methods: Participants were surveyed on work environment factors and followed for 26 months between 2019 and 2021 using registry data on sick leave from the Norwegian Labour and Welfare Administration. Registry data comprised complete registrations of all medically-certified sick leave, including the relevant diagnostic codes of the International Classification of Primary Care system. Incidence risk ratios and 95 % confidence intervals were calculated using negative binomial regression with robust standard deviations. Population attributable risk and population preventable fractions were calculated to estimate the contribution of the significant work factors to sick leave in the sample. Results: The following factors were associated with excessive risk of sick leave due to musculoskeletal disorders: Lifting or supporting the patient between bed and chair or wheelchair, heavy physical exertion without aids or assistance, heavy physical exertion despite aids or assistance, walking/standing, forward bending of the upper body, squatting/kneeling, and experiencing the work as physically demanding. Control over work pacing, fair leadership, empowering leadership, and support from immediate supervisor were associated with reduced risk of sick leave. Conclusions: Preventive efforts to reduce sick leave due to musculoskeletal disorders among home care workers should adopt a multifactorial approach, including both psychosocial and mechanical work factors and the context in which they occur. There may be considerable potential for risk reduction by targeting awkward postures and heavy physical exertions, facilitating control over work pacing, and developing relationship-oriented leadership skills. Registration: Clinical Trials - NCT03855163.