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BMC Public Health

, 14:37

Environmental health


BackgroundMusculoskeletal 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.

MethodsA 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.

ResultsAfter 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.

ConclusionsOn 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.

KeywordsEffort-reward imbalance Musculoskeletal pain Psychosocial work stress Review AbbreviationsC-CCase–control

COPSOQCopenhagen Psychosocial questionnaire


ERI modelEffort-reward imbalance model


JDC modelJob-demand-control model

MSDMusculoskeletal disorder

NANot applicable

NWI-EO QuestionnaireNursing work index – Extended Organisation Questionnaire



PCProspective cohort.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-14-37 contains supplementary material, which is available to authorized users.

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Autor: Peter Koch - Anja Schablon - Ute Latza - Albert Nienhaus


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