Effort‐reward Imbalance and Low Back Pain among Eldercare Workers in Nursing Homes: A Cross‐sectional Study in Kagawa Prefecture, Japan

Abstract

Low back pain (LBP) represents a major global burden and the top cause in the years lived with disability 1) . In Japan, workers' compensation claims for LBP among eldercare workers in nursing homes has increased more than twofold over the past decade, while LBP among many other occupational groups has decreased 2) . Given that the population is rapidly aging in Japan as well as in other highly developed countries, a detailed and comprehensive understanding of LBP among eldercare workers is important. Existing literature indicates that the risk factors of LBP among hospital workers include not only physical work load, including person transfer, but also work stress 3−6) . The study subjects, however, were not eldercare workers in nursing homes, and the work stress experienced by eldercare workers is poorly understood.There are two models to explain work stress that have been validated in many empirical studies, translated in various languages and widely used in the world. One of them is the job demand-control model 7) , and the other is the effort-reward imbalance model 8) . In contrast to the job demand-control model, which emphasizes task-level control, the effort-reward imbalance model emphasizes the rewards given to employees. Human service work can be quite rewarding, for instance, when patients recover or cheer up because of the professional's efforts. However, the relationship between caregivers and care recipients may also be stressful, for instance, when difficult and demanding recipients are not appreciative of a caregiver's efforts. Considering that human service work involves such broad contexts beyond the scope of task-level control, the effort-reward imbalance (ERI) stress model is valid for demonstrating a stress- To clarify effortreward imbalance among eldercare workers in nursing homes and to examine the association between the effort-reward imbalance (ERI) and low back pain (LBP) among them. Methods: A total of 549 questionnaires were distributed to a random sample comprising 23% of the 79 special elderly nursing homes in Kagawa in 2013. A total of 467 eldercare workers (response rate 85%) participated in this study. Of the 467 eligible respondents, 372 (80%) completed all items of the ERI questionnaire. Complete data were available for 342 (73%) eldercare workers. Results: Of the 342 respondents, 215 (63%) had LBP at the time of the study, and 291 (85%) showed a critical "high cost/low gain" condition as determined by an effort-reward ratio >1. Multiple logistic regression analyses adjusted for age, gender, previous LBP experience, high-risk work and K6 score showed that eldercare workers with a high ERI had a higher risk for LBP than workers with a low ERI (OR, 1.96; 95% CI, 1.02−3.77). Conclusions: Most eldercare workers have a high ERI, and their LBP is associated with their ERI. Balancing effort and reward may be an important factor for improving LBP among eldercare workers in nursing homes. (J Occup Health 2014; 56: 197-204)

Association between pain‐related fear and presenteeism among eldercare workers with low back pain

“…A higher pain-related fear was significantly associated with higher presenteeism among eldercare workers with LBP. A previous study reported the association between negative belief about LBP (measured by Fear-Avoidance Beliefs Questionnaire [FABQ]; (Waddell, Newton, Henderson, Somerville, & Main, 1993) and presenteeism (Mannion et al, 2009). In that study, the FABQ work was significantly associated with presenteeism.…”

“…Additionally, eldercare work is a physically demanding work. Low back pain (LBP) is a prevalent and challenging problem (Davis & Kotowski, ; Yokoyama, Hirao, Yoda, Yoshioka, & Shirakami, ), which impacts early retirement and absenteeism among eldercare workers (d'Errico et al, ; The Ministry of Health, Labour and Welfare, ). In Japan, LBP accounted for 62% of causes of sick leave longer than 4 days.…”

Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

“…In the model, stress is an outcome of an imbalance between the efforts paid by the employee (job demands, obligations, critical coping, and need for control) and the rewards received from the employer and society (money, esteem, status, job security) [67]. Workplace factors such as psychosocial job demands, work organization, and workplace attitudes have been identified and studied through the ERI model [77–79]Effort-reward imbalance as a risk factor for disability pension: the Finnish Public Sector Study [77]Effort-reward imbalance at work and general health of Las Vegas hotel room cleaners [78]Case-management ecological model [80]This model provides an operational paradigm to guide case-management operations or to detect various systems on the disability process [80]. It was not developed to explain the factors leading to work disability, but rather to identify the systems and stakeholders involved in the work disability process.…”

A cross-sectional study of the association between effort-reward imbalance and psychologic distress among Japanese dietitians

“…In previous surveys, the mean ER ratios for other occupations were reported to be 0.5 for 1000 female office employees, 29 0.7 for 2208 female specialists, 29 0.8 for 348 nurses, 7 0.93 for 1210 childcare workers, 4 and 1.38 for 342 eldercare workers 8 in Japan. Compared with other occupations, we found the mean ER ratio of dietitians to be higher than that of female office employees and specialists, 29 lower than that of childcare 4 and eldercare workers, 8 and comparable to nurses. 7 However, this comparison was not adjusted for gender, age, and other covariates.…”

“…Various surveys have been conducted for occupational stress. [4][5][6][7][8][9][10][11][12] However, only a few studies have explored this for dietitians. [13][14][15][16] Most of these surveys have been conducted with dietitians working in hospitals or social welfare facilities.…”