Physical and psychosocial prerequisites of functioning in relation to working ability and general...

7/29/2019 Physical and psychosocial prerequisites of functioning in relation to working ability and general subjective well-bei

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Working ability and well-being among office workers 1

Physical and psychosocial prerequisites of functioning in relation to working ability andgeneral subjective well-being among office workers

Tuulikki Sjgren-Rnk, M.Sc., Department of Health Sciences, University of Jyvskyl, FinlandPostal address: Jyvskyln yliopisto, terveystieteiden laitos

PL 35 40351 JyvskylTelefax number: Fax. (014) 2602011e-mail address: [email protected],

Markku T. Ojanen, PhD, Professor, Department of Psychology, University of Tampere, FinlandEsko K. Leskinen, PhD, Professor, Department of Statistics, University of Jyvskyl, FinlandSirpa T. Mustalampi, M.Sc., Department of Health Sciences, University of Jyvskyl, FinlandEsko A. Mlki, PhD, Professor, Department of Health Sciences, University of Jyvskyl, Finland

Physical and psychosocial prerequisites of functioning in relation to working ability andgeneral subjective well-being among office workers

ABSTRACTObjectives The purpose of the study was to investigate the physical and psychological prerequisitesof functioning as well as social environment at work and personal factors in relation to working abilityand general subjective well-being in a group of office workers.

Methods The study was a descriptive cross-sectional study of office workers using path analysis. Thestudy comprised 88 volunteers, 64 women and 24 men from the same workplace (mean age 45,78,6). The measurement of the independent variables was done using psychosocial and physicalquestionnaires and physical measurements. The first dependent variable, working ability, wasmeasured by a work ability index. The second dependent variable, general subjective well-being, wasassessed by life satisfaction and meaning of life. The variables were structured according to amodified version of the ICF.

Results Forward flexion of the spine, intensity of musculoskeletal symptoms, self-confidence andmental stress at work explained 58% of working ability and had indirect effects on general subjectivewell-being. Self-confidence, mood and working ability had a direct effect on general subjective well-being. The model developed explained 68% of general subjective well-being. Age played a significantrole in this study population.

Conclusion The prerequisites of physical functioning are important in maintaining working ability,particularly in aging workers, and psychological prerequisites of functioning are of even greaterimportance in maintaining general subjective well-being.

Key terms Factors of work ability, functioning, ICF in research, physically light work, quality of life, riskfactors
mailto:[email protected]:[email protected]


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INTRODUCTION

About 9% of the Finnish working-age population currently receives a disability pension. The two mainreasons for this are mental disturbances and musculoskeletal diseases. These problems have beenexacerbated by the aging of the labour force during the latter half of the past decade. Maintaining

working ability and increasing the effectiveness of rehabilitation are challenges facing the health careand rehabilitation system, as well as employers (1,2). Working ability is a complex of interactionsinvolving health, the physical, psychological and social prerequisites of functioning, and personal andenvironmental factors.

In Finnish non-experimental epidemiological studies of municipal employees, associations have beenfound between working ability and leisure-time physical activity, possibilities for development at work(3,4), work and life satisfaction, and basic education (5). Work disability has been associated withmusculoskeletal and mental symptoms, aging, being overweight, smoking (5,3,6,7) and physicalperformance (7,8). Factors in the physical or social working environment which impaired the ability towork were poor working posture, repetitive movements, high physical demands, physically disturbingworking conditions, lack of freedom, decrease in recognition and esteem at work, role ambiguity atwork and dissatisfaction with supervisor`s attitude (5,3,4,6). Irrespective of diseases, work stressors

and stress symptoms have shown a correlation with working ability (5). Strong inter correlations havebeen found among health, life-style, working ability and life satisfaction (9). However there is also aneed for studies to explore the direct and indirect associations and causal links to working ability andwell-being in different occupations.

The International Classification of Functioning, Disability and Health (ICF) prompts us to considerhuman functioning in both the individual and social context. The body functions and structurecomponent of the ICF model concern the physiological and psychological prerequisites of anindividual`s functioning. The activity and participation components involve both individual and socialperspectives. Personal factors refer to background factors in the individual`s life, for example age,gender and education. Finally environmental factors concern the physical, social and attitudinalenvironment in which people live or work. The physiological and psychological prerequisites offunctioning enter into a dynamic interaction with the state of health, functioning and personal and

environmental factors. The information derived from this so doing can be used as a clinical,educational, rehabilitation and social policy tool (10).

The purpose of the present study was to investigate the physical and psychological prerequisites offunctioning as well as social environment at work and personal factors in relation to (i) working abilityand (ii) general subjective well-being in a group of office workers.


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SUBJECTS AND METHODS

This study was a descriptive cross-sectional study of a group of office workers, and forms part oflarger experimental active rehabilitation trial. The goal of the study was to examine the effect of aphysical exercise program developed to counterbalance sedentary work and to help recovery frommonotonous and fixed working positions. The source population consisted of 123 local government

employees from the same workplace. All the subjects` occupations were physically light, consistingmostly of mental work using a computer.

Questionnaires were sent to all members of the source population asking about their musculoskeletalsymptoms, aerobic capacity, physical activity and working ability. Those who vonunteed to take part inthe experimental rehabilitation study, underwent further physical tests and answered psychosocialquestionnaires. The final study group consisted of 88 individuals, 64 women and 24 men (mean age45,7 8,6). Their education of level was mainly college or university (86%), and on average they hadspent 13 years in their present workplace.

The criterion to inclusion in this study was physically light work. The volunteers` state of health wasassessed in collaboration with an occupational health physician, and was based on the answers givento the working ability questionnaire and the intensity of pain or discomfort experienced during the past

7 days. Telephone contact (n=28) was used to confirm the time of an accident, possible degree ofdisability and the factors underlying pain or discomfort (Borg CR10 scale 5). Two volunteers wereadvised to contact to their physician personally. None of the subjects met the exclusion criteria, whichwere as follows: difficult or neglected diseases, acute injury, post operative state, inflammation, orneurological signs.

Details on the subjects` musculoskeletal symptoms, psychosocial functioning and working ability atthe baseline measurement have been published previously (11). In both sexes the prerequisites ofpsychosocial functioning were similar to those found earlier in a large sample of Finnish employees(12,13). The musculoskeletal symptoms as well as the physical functioning and working abilityvariables corresponded to the average levels found in previous studies among participants matched tooccupation, gender and age (14,15,16,17). No gender difference was found in the working abilityindex, but compared to the older subject ( 46 years) the younger subjects ( 45 years) had a better

(p=0,000) work ability index (43 vs. 39) (11). Their prognosis of their own work ability after two yearswas also better (p=0.004) than that of their older counterparts. Further information about the workability index is presented in table 1. In hand grip strength in both sexes (18) and in intensity of leisuretime activity (LTA) among the men the results were little above the average (19).


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Item Scale Explanation Median

(n= 88)

Subjective estimation of present work ability compared

with the lifetime best

0-10 0= very poor, 10= very good 9

Subjective work ability in relation to physical demands of

the work


Subjective work ability in relation to mental demands of

the work


Number of diagnosed diseases 1-7 1= 5 or more diseases, 2= 4 diseases, 3= 3diseases,

4= 2 diseases, 5= 1 diseases, 7= no diseases 5

Subjective estimation of work impairment due to diseases 1-6 1= fully impairment, 6= no impairment 5,5

Sickness absence during past year 1-5 1= 100 days or more, 2= 25-99 days,

3= 10-24 days, 4= 1-9days, 5= 0 days 4

Own prognosis of work ability after two years (*)

(*)There was a statigtically significant difference between

the 45 and 46 years of age groups, but the median was

the same.

1,4,7 1= hardly able to work, 4= not sure, 7= fairly sure 7

Psychological resources (enjoying daily tasks, activity and

life spirit, optimistic about the future)


Work ability index (

45 years /

46 years ) 7-49 7-27= poor, 28-38= moderate, 37-43= good, 44-49= excellent 43/40

Table 1. Work ability index among office workers (n=88).

MeasurementsThe independent physical variables were percentage body fat, spine forward flexion, hand gripstrength, aerobic capacity, intensity of musculoskeletal symptoms, musculoskeletal disability and time-weighted intensity of leisure time activity (LTA). Body fat was measured using bioelectrical impedancewith the manufacturer`s equations (Spectrum II, RJL Systems, Detroit, MI USA) (20), spine forwardflexion was measured with a Myrin goniometer (21,22), hand grip strength was measured in the sitting

position with an anatomically adjusted strength gauge (23,18), and aerobic capacity was measured bya non-exercise test (24). Musculoskeletal pain or discomfort experienced during the previous 7 dayswas measured on the Borg CR10 scale (25). Restrictions on participation in daily activities (0-4)because of musculoskeletal symptoms experienced during the last 12 months, was measured by amodified version of the Standardised Nordic questionnaire (26,27). Musculoskeletal pain or discomfortand restriction on participation in daily activities were assessed in 10 different anatomical areas,forming two sum indexes, which we labeled intensity of musculoskeletal symptoms and disability,respectively. Physical activity was measured by the one-month all-time recall questionnaire andconverted to MET values (metabolic equivalent) by a specific computer program (MetPro) (28,29).Time-weighted intensity of leisure time activity (LTA) was used as significant age and genderdifferences in LTA were found in this study population.

The independent psychological variables were self-confidence, anxiety, somatic symptoms and mood.

Somatic symptoms and mood were assessed in relation to work and leisure. The independentvariables relating to the social environment at work were mental stress at work and the workingatmosphere. One-year recall of psychological functioning and the social environment at work was


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measured by descriptive visual rating scales (12,13). On the scale 0 represented the worst and 100the best possible situation. In this study we used the label psychosocial variables to refer to thepsychological and social environment at work variables.

The dependent variables were working ability and general subjective well-being. Working ability wasmeasured by the work ability index (30,17). The work ability index consisted of assessments of the

physical and mental demands of the individual`s work, diagnosed diseases, effect of diseases onworking ability, sick leave, work ability prognosis, and psychological resources. General subjectivewell-being was defined according to life satisfaction and meaning of life (average), which weremeasured by descriptive visual rating scales (12,13). The hypothetical model and variables used inthis study are described in figure 1.

Figure 1. Interactions between the components of the modified version of the InternationalClassification of Functioning, Disability and Health (ICF) (3) and the hypothetical model and variablesused in this study.

Consistency of measurementsIntraclass correlations coefficient (ICC) was used to calculate consistency. Measurements conductedamong a similar sedentary occupation population (n= 14-16, unpublished study) matched the resultsof previous studies. Questionnaire test- retest ICC values were between 0.61 and 0.95 and intraobserver consistency between 0.75 and 0.97 (appendix 1). Test-retest percentage agreement in themodified Standardised Nordic questionnaires was 73-93%.

Statistical analysesThese statistical analysis were carried out by SPSS 9.0. (31). Path analyses were carried out by thePRELIS 2.30 and LISREL 8.30 programs (32).

The path analysis was performed as follows: first the physical prerequisites of functioning wereinserted into the model as independent variables, second the psychological prerequisites offunctioning and the social environment at work variables were added into the model. Third, age andgender were included in the adjustment analysis as independent variables in both final models.

RESULTS

The association between the physical prerequisites of functioning variables and working ability andgeneral subjective well-being

The physical prerequisites of functioning variables, which related to a good work ability index were lowintensity of musculoskeletal symptoms, good flexibility in spine forward flexion and good aerobic


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capacity. These independent variables indirectly affected general subjective well-being throughworking ability, and working ability directly affected general subjective well-being. This modelexplained 52% of working ability and 18% of general subjective well-being (Figure 2).

Figure 2. Physical prerequisites of functioning variables associated with working ability and generalsubjective well-being in office workers (n= 88).

In the adjustment analysis, when we added age and gender as independent variables into the finalmodel, gender was not significant. Age displaced aerobic capacity and spine forward flexion as apredictor of working ability. Age and intensity of musculoskeletal symptoms explained 51% of workingability, and this model explained 18% of general subjective well-being. Intensity of musculoskeletalsymptoms and age had a negative effect on working ability.The associations between the physical and psychosocial prerequisites of functioning variables andworking ability and general subjective well-being

The physical and psychosocial prerequisites of functioning variables which related directly to workingability were high self-confidence, low mental stress at work, good spine forward flexion and lowintensity of musculoskeletal symptoms. These independent variables had indirect effects on generalsubjective well-being through working ability. Good mood, self-confidence and working ability had

direct effects on general subjective well-being. This model explained 58% of working ability and 68%of general subjective well-being (Figure 3).

Figure 3. Physical and psychosocial prerequisites of functioning variables associated with workingability and general subjective well-being in office workers (n= 88).

In the adjustment analysis, when we added age and gender as independent variables in the finalmodel, gender was not significant. Age displaced spine forward flexion and mental stress at work as apredictor of the working ability. Mood, self-confidence and working ability had direct and unchangingeffects on general subjective well-being. Age, intensity of musculoskelatal symptoms and self-

confidence explained 58% of working ability, and the whole model explained 68% of generalsubjective well-being.


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DISCUSSION

Measuring working ability and subjective well-being is a complex task. Working ability assessmentsneed to be based on both objective findings and on workers` subjective evaluations of their resourcesin relation to work and life demands. In this study we used a work ability index, which was constructedin the Finnish Institute of Occupational Health. The validity of the work ability index has been

examined in previous Finnish studies. In previous studies the index had associations with health (33)and a poor work ability index was a good predictor of work disability (34,7). In the present studysubjective well-being consisted of two general questions on life satisfaction and meaning of life. Theassessments were not directed at specific areas as they are in studies of social indicators or insatisfaction, emotional or good life approaches (35,36,37,38). In this study the participants were freeto emphasis whatever aspects of life they wished.

We limited ourselves in this study to examine social environmental factors related to work, ignoringnon-work-related social factors. Also, we did not analyze factors relating to the physical workingenvironment, as the work done across the group was very similar, consisting of physically light, mostlycomputer-based mental work. Of course, personal working styles and routines can vary considerably,and this may have some influence on our results.

In this study the consistency of the measurements varied between high and fair (>.80 high, .80-.61fair and .60-.40 poor) on the intraclass correlation scale (39). The consistency of the measurementsrelating to the physical prerequisites of functioning and working ability variables was similar to thatreported in previous studies (16,29,40,41). The consistency of the measurements of the psychologicalprerequisites of functioning and general subjective well-being was slightly better than that obtained inprevious studies (12,13). There were no previous consistency measures for the mental stress atwork or working atmosphere questions.

Of this office worker population, 72.4% participated in both the physical examination and self-administered questionnaires (79.3% of women and 58.5% of the men). The rate of participation washigher among the women (p=0.019). There were no other differences in the personal factors, e.g. inage or education, between those who volunteed to take part in the experimental rehabilitation studyand those who refused to participate. In the physical and working ability measurements the only

difference was in aerobic capacity, which was reported as slightly better among those who refused toparticipate in (n=21) in experimental rehabilitation study (p=0.012). Because the sample was small(n=88), the results can be read as tentative only.

High intensity of musculoskeletal symptoms and age had the greatest negative effect on workingability. The individual components of the physical function variables (intensity of musculoskeletalsymptoms, spine forward flexion and aerobic capacity) explained 52% of the work ability index. Whenwe added the psychosocial variables into the model the degree of explanation increased slightly to58%. Self-confidence and mental stress at work emerged as significant together with intensity ofmusculoskeletal symptoms and spine forward flexion. Self-confidence is one of the components of thepsychological function variables and mental stress at work is a component of the social environmentat work variable. Stress at work included responsibility at work, working tempo and mental stress atwork. When age and gender were incorporated in the models by adjustment analysis, the explanatory

powers of working ability did not increase, because age displaced the independent variables.Tomaintain working ability and improve the effectiveness of rehabilitation it is important aside form ageand gender, to identify all the independent variables, which can have effected in the workplace.

Only 18% of general subjective well-being was explained by the physical prerequisites of functioningand working ability variables. This increased to 68% when the psychosocial variables were enteredinto the model. Self-confidence (functions component), mood (activity component) and working ability(participation component) affected directly general subjective well-being. According to thesimultaneous model path analysis, working ability explained general subjective well-being better thanvice versa. To the best of our knowledge, this is the first time the interactions of between the physicaland psychosocial prerequisites of functioning, working ability and general subjective well-being havebeen studied in the framework of a modified version of the ICF.

Our study work ability index results are mostly in agreement with those of previous epidemiologicalstudies of municipal workers. Musculoskeletal and psychological symptoms (5,6), and age (3,6) had a


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negative effect on the work ability index, and the social environment at work has been shown to beimportant in terms of factors such asfreedom, recognition, esteem at work, division of labour andsupervisor`s attitude (5,3,4,6). Leisure time physical activity has previously been associated with thework ability index(3,4), but this was not the case in either the present study, or that by Pohjonen(2001) study. Correlations have been found between the work ability index and both aerobic capacityand muscular strength in previous studies (7,8). Our results differ with respect to muscular strength,

as we found no correlations between the latter and the work ability index. Comparing the present withprevious studies was problematic on allows of differences in the study populations and work demands(3,4,5,6,7,8). No previous studies explaining work ability index factors among the physically lightworkers have been published.

It can be concluded that office workers, like manual workers, face the challenges of musculoskeletaland mental symptoms in seeking to maintain their working ability and general subjective well-being.The physical prerequisites of functioning are among of the most important factors in maintainingworking ability. High intensity of musculoskeletal symptoms had the greatest negative effect onworking ability in the present as in earlier studies. The psychological prerequisites of functioninghowever turned out to be more important in maintaining general subjective well-being. Self-confidence, mood and working ability directly affected general subjective well-being. Of theenvironmental factors mental stress at work had an association with working ability, but the effects of

these factors were not as significant as those of the physical and psychological prerequisites offunctioning. In this study population gender did not play a significant role. When planning interventionsto maintain working ability and general subjective well-being, factors which directly and indirectlysupport these variables should be taken into consideration, particularly among aging workers.


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ACKNOWLEDGMENTSWe would like to thank Seija Talo, for her advice on to how handle the interactions between thecomponents of the modified International Classification of Functioning, Disability and Health. We thankMr. Michael Freeman for checking the language of the manuscript.


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Appendix 1. Consistency of questionnaires and measurements (n=14-16) assessed twice within aweek, measured by the intraclass correlation coefficient (ICC).

Measure ICC

Spine forward flexion, intra observer 0.75Hand grip strength, intra observer 0.95 - 0.97

Aerobic capacity, non-exercise test 0.95

Time weighted intensity of leisure time

activity (METs)

0.62

Psychological functions, descriptive visual

rating scales

0.61 - 0.85

Environmental factors, descriptive visual

rating scales

0.79 - 0.92

Work ability index 0.94

General subjective well-being 0.87 0.95

ICC= Intraclass correlation coefficient

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