Volume 29, Issue 1 (Winter 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(1): 23-34 | Back to browse issues page

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Sahraei M M, Molavi Verdanjani M, Soltanian A, Khatiban M. The Relationship Between Musculoskeletal Injuries and Stress Load in Emergency Medical Staff of Hamadan Province in 2019. Avicenna J Nurs Midwifery Care 2021; 29 (1) :23-34
URL: http://nmj.umsha.ac.ir/article-1-2120-en.html
1- M.Sc. Student, Department of Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Instructor, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
3- Professor, Department of Biostatistics and Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
4- Professor, Mother and Child Care Research Centre, Dept. of Ethics Education in Medical Sciences, and Dept. of Medical-Surgical Nursing, School of Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran , mahnaz.khatiban@gmail.com
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✅ There was a significant relationship only between stress and musculoskeletal damage. By modifying and eliminating stressors in emergency personnel’s routines, by holding workshops on ergonomic principles as well as stress reduction principles, it is possible to reduce the physical disorders of emergency personnel.

Extended Abstract:   (926 Views)

Emergency medical staff who are at the forefront of health care delivery face many occupational stresses that have psychological, physical, behavioral, and organizational consequences for them, including musculoskeletal disorders. The purpose of this study was to investigate the correlation between musculoskeletal injuries and stress load tolerance among medical emergency staffs in Hamedan province.


Materials and Methods

In this descriptive-correlational study, conducted in 2019, 76 (40%) of urban and 114 (60%) of employees of road bases were selected from among emergency medical staff of Hamadan, Iran. Data were collected using Nordic Musculoskeletal Injury Questionnaire and Occupational Stress Questionnaire. Data were analyzed by SPSS 23 (SPSS Inc., Chicago, Ill., USA) using descriptive statistics, t-test and Spearman correlation coefficient.



The mean age of the participants was 34.05 (± 8.11) years and the work experience was 123.42 (±84.22) months. The majority (77%) were married, 57.3% had undergraduate degrees and 46.9% had formal employment. Employee stress burden was 503.3 (161.23%) out of 1050 points. Persons who had musculoskeletal disorder due to their job had reported more stress than others; hoever, this difference was not significant (P<0.05). People with musculoskeletal disorders in neck reported higher stress load (P<0.05) than others which was not significant. There was a significant relationship between type of employment, work experience, and type of exercise with musculoskeletal disorders (P<0.05).

Table 1. How to distribute quantitative demographic variables of the research units
Variable N Minimum Maximum Mean Standard Deviation
Age (years) 176 20 60 34.05 8.11
Height (cm) 179 160 195 170.69 6.01
Weight (kg) 177 58 105 78.69 10.36
Work experience (months) 179 26 343 123.42 84.22
Number of working hours per month 171 12 280 175.33 16.82
Number of overtime hours per month 164 0 350 143.21 49.13
Duration of leave in the last year due to musculoskeletal pain or discomfort (days) 41 1 80 15.56 20.24
How long ago was the leave due to pain or discomfort? (Month) 36 1 120 22.25 26.19
Table 2. Distribution of absolute and relative frequencies of the studied units in terms of demographic variables
Variable Variable levels N %
Marital status
Single 41 23
Married 137 77
Number of children
0 70 51.1
1 40 29.2
2 20 14.6
3 and 4 7 5.1
Education rate
Associate degree 58 32.6
Bachelor’s degree 102 57.3
Master and above 18 10.2
Employment status
Design 21 12
Official 82 46.9
Project-based 49 28
Contractual 23 13.1
Yes 15 9
No 163 91
Doing exercise
Yes - regular 30 16.9
Yes- Irregular 119 67.2
No 28 15.8
Type of sport Aerobic 91 5/76
Anaerobic 28 5/23
Table 3. Mean and standard deviation of intensity, exposure and stress load in the studied units
Factors Intensity of exposure Exposure rate Stress load
Individual factors 4.73 ± 23.08 5.01 ± 21.03 28.15 ± 75.18
Interpersonal factors and colleagues 6.25 ± 27.69 6.25 ± 26.69 37.23 ± 90.48
Management and support factors 5.65 ± 22.62 5.35 ± 22.25 33.88 ± 78.07
Environmental and occupational conditions 8.86 ± 51.57 8.50 ± 45.64 58.45 ± 187.44
Patient-related factors 4.33 ± 23.11 4.31 ± 18.47 25.86 ± 73.20
Total 25.43 ± 148.08 25.26 ± 133.72 161.23 ± 503.03
Table 4. Comparison of the mean of quantitative demographic variables between people who had musculoskeletal pain and discomfort and people who did not have musculoskeletal pain and discomfort
Variables Musculoskeletal pain and discomfort t-test P-value
No Yes
Age (years) 30.40  ± 6.15  34.39  ± 6.15  t=-1.83 0.069
Height (cm) 176.68 ± 6.66 177.80  ± 5.95   t=-0.70 0.482
Weight (kg) 80.69 ± 8.98 78.49  ± 10.49   t=0.81 0.421
Work experience (months)  87.67 ± 65.60 135.65  ± 84.78   t=-2.20 0.029
Duration of employment (months)   82.57 ± 58.02 127.48  ± 81.05  t=-2.20 0.039
Number of working hours required   176.07 ± 4.13 175.25  ± 17.56  t=0.18 0.859
Number of overtime hours 137.67 ± 54.86 143.77  ± 48.6  t=-0.46 0.648
Exercise duration (hours) 1.32 ± 0.87 2.39  ± 9.99  t=-0.37 0.712
Table 5. Comparison of stress load in the studied units with different conditions in terms of damage to their body system
Variable Variable levels N SD ± M Test result
Musculoskeletal system damage No 49 486.57 ± 151.59 t =-0.84
Yes 130 509.24 ± 164.86 
Nervous system damage No 111 469.01 ± 148.85  t =-3.74
Yes 68 558.57 ± 166.26
Gastrointestinal damage No 115 474.83 ± 160.15 t =-3.22
Yes 64 553.70 ± 151.57
Cardiovascular system damage No 161 489.13 ± 153.28  t =-3.56
Yes 18 627.39 ± 181.25
Excretion of the excretory system No 165 494.59 ± 156.08 t =-2.44
Yes 14 602.50 ± 192.51
Damage to the skin and hair system No 149 492.29 ± 162.42 t =-2.00
Yes 30 556.37 ± 146.29
Sexual system damage No 171    500.44  ±161.11 t =-0.99
Yes 8   558.501 ±  64.48 
Table 6. Comparison of stress load in the studied units with different status in terms of pain and musculoskeletal discomfort
Variable Variable levels N The amount of stress load
M±SD Test results
Musculoskeletal pain or discomfort due to occupation Yes 163 162.47 ± 504.32 t=0.34
No 16 152.34 ± 489.94
Pain or discomfort in the neck area Yes 27 160.42 ± 562.81 t=-2.13
No 151 159.87 ± 491.79
Pain or discomfort in the arm area Yes 54 162.24 ± 531.35 t=-1.56
No 121 161.98 ± 490.09
Pain or discomfort in the legs Yes 95 146.48 ± 514.63 t=-0.97
No 81 177.69 ± 490.94
Pain or discomfort in the spine Yes 142 163.26 ± 504.68 t=-0.35
No 36 156.63 ± 494.22


Based on the obtained results, the staff stress load was 503.03 (±161.23) out of 1050 possible scores. Due to the use of different tools to measure the job stress of medical staff, including emergency personnel, comparing the prevalence of stress obtained in different studies is limited. In the obtained results, the highest average reported stress of employees in the amount and severity of stress was related to environmental and occupational conditions. In the present study, the level of job stress of employees was at the average score level. The results of the present study were consistent with the results of the study of Moshtagh et al. [8].
In the continuation of the results of this study, all employees who were associated with musculoskeletal disorders due to their jobs, expressed some more stress than others, but this difference was not significant (P <0.05). Only people with musculoskeletal disorders in the neck had a higher stress load than others (P <0.05).
The results of the present study on the relationship between work history with musculoskeletal disorders were consistent with the study of Davis and Kotowski, who examined the prevalence of musculoskeletal disorders in nurses of hospitals, long-term care centers and home health care. In this study, it was stated that with increasing work experience, the probability of musculoskeletal disorders has increased. Although the target group is different in the above study and the present study, it seems that with increasing working years and decreased physical strength, the probability of musculoskeletal disorders is higher [35].



 There was a significant relationship only between stress and musculoskeletal damage. By modifying and eliminating stressors in emergency personnel’s routines, by holding workshops on ergonomic principles as well as stress reduction principles, it is possible to reduce the physical disorders of emergency personnel.





Conflicts of Interest

The authors declared no conflict of interest.

Type of Study: Original Research | Subject: Nursing
Received: 2019/12/28 | Accepted: 2020/04/29 | Published: 2020/10/11

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