Musculoskeletal pain and reported workplace assault: a prospective study of clinical staff in nursing homes

Hum Factors. 2014 Feb;56(1):215-27. doi: 10.1177/0018720813508778.


Objective: This study examined prospectively the effect of workplace violence on musculoskeletal symptoms among nursing home workers.

Background: Previously we reported a cross-sectional relationship between physical assaults at work and musculoskeletal pain. This follow-up provides stronger evidence of the effect of workplace violence on musculoskeletal outcomes within the same workforce over two years.

Method: Nursing home workers who responded to three consecutive annual surveys formed the study cohort (n = 344). The outcomes were any musculoskeletal pain, widespread pain, pain intensity, pain interference with work and sleep, and co-occurring pain with depression. The main predictor was self-reported physical assault at work during the 3 months preceding each survey. Prevalence ratios (PRs) were assessed with log-binomial regression, adjusting for other workplace and individual factors.

Results: Every fourth nursing home worker, and 34% of nursing aides, reported persistent workplace assault over the 2 years. Among respondents assaulted frequently, two thirds experienced moderate to extreme musculoskeletal pain, and more than 50% had pain interfering with work and/or sleep. Baseline exposure to assault predicted pain outcomes 1 year later. Repeated exposure was associated with a linear increase over 2 years in the risks of pain intensity, interference with work, and interference with sleep; co-occurring pain and depression had an adjusted PR of 3.6 (95% CI = 1.7-7.9).

Conclusion: Workplace assault, especially when repeated over time, increases the risk of pain that may jeopardize workers' ability to remain employed.

Application: More effective assault prevention would protect and support the workforce needed to care for our increasing elderly and disabled population.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Pain / epidemiology*
  • Musculoskeletal Pain / etiology*
  • Musculoskeletal Pain / psychology
  • Nursing Homes*
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / etiology*
  • Occupational Diseases / psychology
  • Pain Measurement
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • United States / epidemiology
  • Violence*
  • Workplace