Applied Ergonomics 112 (2023) 104053

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

Psychosocial hazards play a key role in differentiating MSD risk levels of

workers in high-risk occupations
Jodi Oakman *, Wendy A. Macdonald, Kate McCredie
Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Australia

A R T I C L E I N F O A B S T R A C T

Key terms: Objectives: Workplace management practices targeting risk of musculoskeletal disorders (MSDs) fail to reflect
Musculoskeletal disorders evidence that risk is affected by psychosocial as well as physical hazards. To promote improved practices in
Workplace risk management occupations where MSD risk is highest, better information is needed on how psychosocial hazards, combined
APHIRM toolkit
with physical hazards, affect risk of workers in these occupations.
Latent profile analysis
Methods: Survey ratings of physical and psychosocial hazards by 2329 Australian workers in occupations with
high MSD risk were subjected to Principal Components Analysis. Latent Profile Analysis of hazard factor scores
identified different combinations of hazards to which latent subgroups of workers were typically exposed. Survey
ratings of frequency and severity of musculoskeletal discomfort or pain (MSP) generated a pre-validated MSP
score and its relationship with subgroup membership was analysed. Demographic variables associated with
group membership were investigated using regression modelling and descriptive statistics.
Results: Analyses identified three physical and seven psychosocial hazard factors and three participant subgroups
with differing hazard profiles. Profile group differences were greater for psychosocial than physical hazards, and
MSP scores out of 60 ranged from 6.7 for the low hazard profile (29% of participants) to 17.5 for the high hazard
profile (21%). Differences between occupations in hazard profiles were not large.
Conclusions: Both physical and psychosocial hazards affect MSD risk of workers in high-risk occupations. In
workplaces such as this large Australian sample where risk management has focused on physical hazards, actions
targeting psychosocial hazards may now be the most effective way to reduce risk further.

1. Introduction
There is robust evidence that work-related psychosocial hazards can
have substantial effects on workers’ risk of musculoskeletal disorders
(MSD) (Eatough et al., 2012; Gerr et al., 2014; Lang et al., 2012; Marras
et al., 2009; National Research Council & Institute of Medicine Board,
2001; Hauke et al., 2011). However, current regulatory guidance,
workplace management policies and practices targeting MSD risk
continue to focus on physical hazards that arise from the biomechanical
demands of work task performance, with little if any attention to
assessing and controlling MSD risk from psychosocial hazards (Mac­
donald and Oakman, 2015; Roman-Liu, 2014; Takala et al., 2010a;
Barrero et al., 2009; David, 2005a; Oakman and Bartram, 2017; Oakman
et al., 2019a). Inadequate attention to risk from psychosocial hazards is
also evident in the MSD risk management tools currently used by er­
gonomists and other occupational health and safety (OHS) professionals.
(Macdonald and Oakman, 2015; Roman-Liu, 2014; David, 2005b;
Takala et al., 2010b; Whysall et al., 2004; Oakman et al., 2021; Mac­
donald and Evans, 2006).
To achieve more effective translation of research evidence to work­
place MSD risk management practices, it will be important to convince
workplace managers and OHS professionals that it is necessary to con­
trol MSD risk from psychosocial as well as physical hazards. This pre­
sents a challenge for researchers. Many MSD hazards interact with each
other in their effects on risk (National Research Council, 2001; Marras
et al., 2000; Widanarko et al., 2015), but most research in this field has
focused on identifying variance in MSD risk indicators that is attribut­
able uniquely to each separate hazard. It has been pointed out that: “The
typical, real-life impact of co-occurring work factors may be obscured
when they are studied separately or mutually adjusted. If a factor is
typically a part of a factor complex with a substantial net impact on pain,
studying that factor separately may conceal its contribution.” (Chris­
tensen et al., 2018).
Addressing this issue, Christensen and colleagues (Christensen et al.,

* Corresponding author.
E-mail address: J.oakman@latrobe.edu.au (J. Oakman).

https://doi.org/10.1016/j.apergo.2023.104053
Received 16 January 2023; Received in revised form 18 April 2023; Accepted 21 May 2023
Available online 2 June 2023
0003-6870/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
J. Oakman et al.
2018) used Latent Profile Analysis (LPA) to identify subgroups of
workers who typically shared particular combinations of psychosocial
hazard levels, describing these hazard combinations as representing
typical ‘work situations’. They identified four such subgroups within
their large Norwegian workforce sample, and found that group mem­
bership was a significant predictor of musculoskeletal pain (MSP) level.
Similarly, research using a large Canadian database (Shahidi et al.,
2021) applied LPA to identify subgroups of Canadian workers on the
basis of their psychosocial hazard exposures and found relationships
between MSP levels and profile membership.
It appears that LPA analysis of MSD-related hazards has not yet
included coverage of physical hazard exposures. This is an important
omission because physical hazards certainly have a major effect on MSD
risk. Until quite recently, occupational health and safety regulators have
focused largely or entirely on these physical hazards so awareness at
workplace level of the need to control MSD risk from psychosocial
hazards is very low, even among occupational health professionals and
practitioners (Oakman et al., 2019b). In this workplace context, results
from research concerning the importance of psychosocial hazards that
did not also encompass the role of physical hazards would lack credi­
bility, presenting a barrier to translating such evidence into improved
workplace risk management practices. Credibility among workplace
stakeholders is important because control of risk from psychosocial
hazards cannot be achieved without the active involvement of line
managers, supported by senior management. To achieve this, results
from LPA analysis of both physical and psychosocial hazard levels spe­
cific to the occupations and industry sectors where MSD risk is highest would
be particularly helpful. The clear relevance of such information for
workplace managers in high-risk sectors would facilitate communica­
tion to them of the need to control MSD risk from psychosocial as well as
physical hazards.
Another potential benefit of LPA analysis of a comprehensive range
of both psychosocial and physical hazards is that it might identify
occupation-based latent subgroups of workers. If the hazard configura­
tions of identified groups were found to be sufficiently different, it could
warrant customisation of risk management practices for particular
groups so that participation by workers in risk assessment and control
procedures would require less time, thereby enhancing efficiency and
reducing another barrier to improvement of workplace risk management
practices.
Various barriers to changing these workplace practices have been
identified (Macdonald and Oakman, 2015, 2022; David, 2005b; Whysall
et al., 2004). In addition to credibility issues related to psychosocial
hazards, the inadequacies of MSD risk management tools have presented
a major difficulty. The APHIRM Toolkit (Oakman and Macdonald, 2019)
was designed to address this problem and is now freely available for
routine use by workplace users. It is unique in providing participative
online procedures, including automated data analysis and reporting
modules, for both assessing and controlling MSD risk from a compre­
hensive range of both physical and psychosocial hazards. The research
reported here entailed analysis of data available from APHIRM Toolkit
users, so has the advantage of representing occupations where MSD risk
is a primary concern of workplace risk managers.
In summary, data from a newly available survey, designed to assess
both physical and psychosocial hazards in occupations where MSD risk
is problematic, will be used in exploratory research with the following
aims:
1. Determine and evaluate the factor structure of the APHIRM survey’s
hazard assessment items
2. Use LPA to identify sub-groups of workers characterised by different
profiles of physical and psychosocial hazards
3. Evaluate validity of the APHIRM survey as a means of assessing MSD
risk by determining associations between workers’ hazard exposures,
as reflected in identified LPA sub-group scores, and their levels of
musculoskeletal discomfort and pain (MSP)
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Applied Ergonomics 112 (2023) 104053
4. Explore the possibility of occupation-related differences of a kind
that might support customisation of risk management procedures to
particular sub-groups.
2. Method
2.1. Data source: APHIRM toolkit database
The APHIRM toolkit has been available online since 2019 for inde­
pendent use by workplaces as part of their own MSD risk management
programs. In registering to use the toolkit, organisations must agree to
its Terms of Use as approved by the La Trobe University Human Ethics
Committee, which include privacy protection provisions and ensure La
Trobe University’s access to de-identified information for use in
research. Registration is free; attending training in the use of APHIRM is
highly recommended but not mandatory.
The toolkit includes a survey that requires workers to rate their ex­
posures to physical and psychosocial hazards and their own musculo­
skeletal discomfort or pain levels. From August 2021 to April 2022, 33
registered organisations administered a total of 2847 surveys to em­
ployees working in jobs that are routinely performed by at least 10 in­
dividuals. Employees complete the survey anonymously during paid
working hours, typically using their own smart phone. They are
informed that they will be invited to provide feedback on survey results
and to suggest future risk control actions, and that actions will be
implemented to the fullest extent that is reasonably practicable.
2.2. Current sample
The sample of participants for the current analysis was restricted to
respondents who had completed: at least 90 percent of questions about
their hazard exposures; all questions required to generate an MSP score;
and all demographic questions (age, gender, weekly working hours,
duration of employment at that workplace). These restrictions resulted
in a final sample comprising 2329 employees from 33 organisations.
Separately from the survey, participating organisations provided infor­
mation enabling identification of respondents’ occupational categories
and industry sectors.
2.3. Survey hazard measurement items
Survey items and response scales are available at www.aphirm.org.
au. They include:
• 12 items assessing work-related physical (biomechanical) hazards
arising from the frequency or severity of awkward or static postures,
exertion of high forces, repetitive or precise actions
• 40 items assessing work-related psychosocial hazards (see supple­
mentary materials Table S1)
• 10 items assessing musculoskeletal discomfort or pain (MSP) – see
Outcome measure, below.
Research developing the 12 physical hazard items found that worker
ratings had greater criterion validity as indicators of MSD risk than
various observation-based ‘ergonomics’ assessments of the tasks per­
formed by workers (Macdonald et al., 2008), which is consistent with
accepted validity requirements for MSD risk assessment (Macdonald and
Oakman, 2022). The 40 psychosocial hazards were drawn initially from
a variety of sources, particularly the Copenhagen Psychosocial Ques­
tionnaire (COPSOQ) (Burr et al., 2019) and the Work Environment
Assessment Questionnaire (WOAQ) (Griffiths et al., 2006). COPSOQ
provides broad coverage of psychosocial hazard constructs (Kop et al.,
2016). WOAQ was developed for use in mainly ‘blue collar’ occupations
within manufacturing industry. It therefore uses simple wording, and its
hazard constructs include physical equipment and environmental fac­
tors that are absent from COPSOQ; both these features are important in
J. Oakman et al.
the present context.
Drawing on items from COPSOQ and WOAQ, and on feedback from
extensive trialling in industry sectors and occupations where MSD risk is
high, wording has been adapted where necessary to facilitate under­
standing by workers with limited English literacy. Supplementary
Table S1 shows numbers of APHIRM psychosocial hazard items in
relation to both COPSOQ scales and WOAQ factor labels.
2.4. Outcome measure: MSP score
The survey includes 10 items requiring respondents to rate the fre­
quency (out of 4) and severity (out of 3) of their musculoskeletal
discomfort and pain over the last six months for each of 5 body regions
(neck/shoulders, hands/fingers, arms, middle to lower back, and hips/
bottom/legs/feet), which generates an MSP score out of 60.
2.5. Analyses
Aim 1. Exploratory factor analysis of survey responses for both
physical and psychosocial hazards was performed using SPSS v.27
Principal Axis Factoring. After orthogonal varimax rotation of factor
loadings, factor structure was adjusted based on the salience of factor
loadings, simplicity of structure configuration and theoretical mean­
ingfulness (Costello and Osborne, 2005), giving consideration to inter­
pretability of factors in relation to existing scales such as those in
COPSOQ (Burr et al., 2019).
Aim 2. Latent profile analysis (LPA) in Stata SE 17.0 was used to
investigate possible groupings of workers with similar configurations of
the hazard factors identified in the previous step. Item scores within
each factor were combined and re-scaled where necessary so that higher
scores indicated potentially more harmful hazard exposures. Models
with one to eight profiles were run and initial assessment of solutions
was based on Akaike Information Criteria (AIC), Bayesian Information
Criteria (BIC) and minimum profile size (Nylund et al., 2007). Final
model selection prioritised interpretability in relation to MSP scores.
Analyses of variance (ANOVAs) and descriptive statistics quantified
each hazard’s contribution to profile membership and relationship with
MSP.
Aim 3. Regression modelling determined the association between
latent profiles and MSP score, with the level modelled as a count vari­
able using a negative binomial distribution to allow for estimation of
overdispersion. An initial model used posterior probabilities of profile
membership as a categorial independent variable, followed by a second
model that also included demographic variables to account for residual
effects of these that had not been encompassed within profile mem­
bership. In the second model, multicollinearity was checked using the
Variance Inflation Factor (VIF). Rate ratios, representing the ratio of
each profile’s MSP score to the reference group, were reported to assist
interpretability.
Aim 4. Multivariate logistic regression in Stata SE 17.0 examined as­
sociations between profile membership and the following de­
mographics: employee age, gender, hours worked per week, and
employment duration. Three models were run to test the likelihood of
each demographic group’s membership in a profile compared to other
profiles, again using VIF values to check for multicollinearity. Further
logistic regression analysis investigated associations between profile
membership and occupation. Differences in hazard factor and MSP
scores between occupations, and between workgroups within occupa­
tions, were explored using descriptive statistics.
3. Results
Characteristics of the sample are shown in supplementary materials
Table S2. Compared to the Australian working population they were
more likely to work in the mining sector (25.2% versus 2.1%) or
transport, postal & warehousing (13.9% versus 5.0%). The most highly
3
Applied Ergonomics 112 (2023) 104053
represented occupations were labourers (28.3% versus 8.7%) and ma­
chinery operators and drivers (26.3% versus 6.3%). As shown in the
table, workers in these Australian industry sectors and occupations have
among the highest rates of MSD-related insurance claims as a proportion
of all serious injury claims for that sector or occupation (Oakman et al.,
2019a).
3.1. Hazard factors identified by Principal Components Analysis (PCA)
Data available from 2329 survey respondents were confirmed as
highly suitable for factor analysis (KMO = 0.956; Bartlett’s Test of
Sphericity p = .000) and nine factors were initially extracted. The first
factor included 21 items and interpretation of its meaning was some­
what problematic, but the other eight factors were clearly understand­
able in relation to existing physical or psychosocial hazard constructs.
The ninth factor included only one item (prolonged sitting) but was
retained because of its potentially important effect on MSD risk (Coenen
et al., 2018).
Further inspection of the 21 items in Factor 1 found that one item
(Clear work goals and responsibilities) also loaded quite highly on
Factor 5 (0.46 on Factor 5 versus 0.47 on Factor 1). Since it was a better
conceptual fit in Factor 5, it was moved there. For the same reasons,
three other items (Work stations and work space; Equipment, tools;
Health and Safety) were moved from Factor 1 to Factor 6 where their
loadings were 0.49, 0.42 and 0.41 respectively. Inspection of the 17
items remaining in Factor 1 suggested two separate factors, and a further
PCA (KMO = 0.955; Bartlett’s Test of Sphericity p = .000) with varimax
rotation identified Factor 1A (10 items) and Factor 1B (7 items), which
were clearly separate and meaningful. In Factor 1B the last item (‘in­
fluence’) had a low loading (0.33) but was a good conceptual fit there
and it represents a theoretically important construct so was retained.
Details of the resultant ten factors are shown in supplementary ma­
terials Table S3. For items with an equivalent WOAQ item, numbers in
the WOAQ column refer to the corresponding WOAQ factors (Griffiths
et al., 2006). It can be seen in Table S3 that APHIRM factors 1B, 3, 6 and
8 corresponded closely with four of the five WOAQ factors; these are:
Reward and recognition; Workload issues; Quality of physical environment;
and Quality of relationships with colleagues. Items from the other WOAQ
factor Quality of relationships with management were mainly in APHIRM
factor 1A Quality of supervision and leadership (5 items); the other three of
these WOAQ factor items were in APHIRM factor 1 and 5. This spread of
items from one WOAQ factor across three APHIRM factors is not sur­
prising because of the presence also of COPSOQ items from 19 scales, 5
of which are not represented in WOAQ.
3.2. Identification of latent profiles based on individual hazard exposure
patterns
Addressing Aim 2, LPA was used to identify sub-groups of partici­
pants characterised by similar configurations of the ten factors identified
above – that is, to identify hazard profiles that differ between latent sub-
groups of participants. Values of AIC and BIC decreased with increasing
profile numbers, but sample sizes in models with more than five profiles
became too small (<5% of total sample). Data were therefore assessed
for the three-, four- and five-profile solutions, which are presented along
with model fit criteria for one-to eight-profile solutions in supplemen­
tary materials Table S4 and Fig. S1.
Inspection of the three, four and five profile solutions indicated quite
similar within-profile hazard configurations in all three solutions. The
three-profile solution in Fig. 1 was therefore chosen as most suitable for
the present purpose as it differentiates differences in hazard levels most
clearly, which facilitates interpretation of potential relationships with
MSD risk. Profile 1 accounts for 29% of participants and its scores for all
factors are the most favourable (lowest). Profile 3 accounts for 21% of
participants and has the least favourable scores across all factors.
To quantify the inter-profile differences apparent in Fig. 1, statistical
J. Oakman et al.
Fig. 1. Estimated scores for hazard factors: PTDWB Physical Task Demands
Whole Body, PTDHF Physical Task Demands Hands/fingers, PS Prolonged
sitting, QSL Quality of Supervision & Leadership, JDO Job Development Op­
portunities, WQP Workload Quantity & Pace, RCED Role Conflicts & Emotional
Demands, MCSW Meaningful & Clearly Specified Work, PE Physical Environ­
ment, CR Co-worker Relationships.
significance and effect size (Eta-squared) for each hazard factor as a
determinant of profile membership were calculated. ANOVA results are
shown in Table 1. Post-hoc tests between pairs of the three profiles were
all highly significant; it can be seen that effect sizes, indicated by Eta-Sq,
are greater for psychosocial than physical factors.
To provide a broader context for interpretating these results in
relation to MSP risk, supplementary materials Table S5 shows the
bivariate correlation matrix for MSP and hazard scores. Comparing re­
sults in Table 1 and S5, it can be seen that physical hazards are more
strongly linked to MSP score than to profile membership. MSP was most
strongly correlated with PTDWB (Physical Task Demands – Whole
Body), followed by RCED (Role Conflicts & Emotional Demands).
Importantly, many correlations between hazards were substantial.
3.3. Personal demographics of profile groups
Table 2 reports results from multivariate logistic regression analysis,
showing associations between profile membership and participants’ age,
gender, hours worked per week and duration of employment at their
current workplace; all VIF values were less than 2, indicating little risk of
multicollinearity. It can be seen that membership of Profile 3 was
associated with longer employment duration (although not higher age)
and with working more than 30 h per week. Gender was also relevant:
compared with men, women were more likely to be in Profile 1 and less
likely to be in Profile 3, while those identifying as ‘other’ (n = 33) were
over-represented in Profile 3.
3.4. Relationship between profile membership and MSP scores
Addressing Aim 3, it was found that mean MSP scores for each profile
group were substantially different; for Profiles 1 to 3 respectively, mean
(SD) values, scored out of 60, were: 6.69 (7.24), 10.74 (9.31) and 17.46
(11.8). That is, the mean MSP score of people in Profile 3 was almost 11
points higher than that of people in Profile 1. Table 3 shows results from
negative binomial regression analysis with MSP score as a count mea­
sure and the posterior probabilities of profile membership as categorical
independent variables, confirming that differences in MSP score be­
tween profile groups were highly significant.
Model 1 included only the latent profile groups; Model 2 also
included personal demographics, hours worked per week, employment
duration and occupation; VIF values indicated little risk of multi­
collinearity. Inclusion of the additional independent variables in Model
Table 1
ANOVA results showing extent of differences between latent profile groups for each hazard factor.
PTDWB PTDHF PS QSL
F 184.0 94.1 37.8 2801.9
Sig <.001 <.001 <.001 .000
Eta-Sq .137 .075 .031 .707
Applied Ergonomics 112 (2023) 104053
2 explained relatively little additional variance in MSP score. This is
probably because estimation of such models “minimizes covariances
between items within profile groups so that differences between in­
dividuals are mainly accounted for by their group membership”(22).
Therefore, to the extent that demographic variables are associated with
hazard scores, their effects on MSP are subsumed within profile
membership.
3.5. Occupation-related differences in profile group membership, hazard
levels and MSP score
Aim 4 was to explore the possibility of occupation-related differences
of a kind that might support customisation of risk management pro­
cedures to particular sub-groups. Initial exploration of the data found
many interrelationships between profile membership, demographic
variables, hazard levels and MSP scores, but here we report only results
that are most relevant to this aim.
Mean MSP scores (out of 60) for the five occupations with the largest
number of survey respondents (see Table S2) ranged from 9.9 to 12.4 as
shown in supplementary materials Table S6. Although statistically sig­
nificant (F = 5.64, p < .001), these differences in MSP were not large in
absolute terms. Table S6 also reports results from regression analysis
showing associations between occupational groups and profile mem­
bership. Compared with Machinery operators & drivers, Professionals are
more likely to be in Profile 3, while Community and personal service
workers, Technicians and trades workers and Labourers were more likely to
be in Profile 1.
Hazard factor scores separately for each occupational groups are
shown in Fig. 2, and it can be seen that their configurations are quite
similar. The largest difference between occupations was in Prolonged
Sitting (PS), which was highest for Machinery operators and drivers and
lowest for Community and personal service workers. Further investigation
found that the range of variation in hazard levels between the largest
work groups within some occupations was comparable with the variation
between occupations. For example, Supplementary Fig. S1 depicts this
variability for the three largest workgroups within two of the five
occupational groups: Professionals, where variability was greatest, and
Labourers where it was lowest.
In summary, there are differences between occupations in profile
group membership, in hazard levels and in MSP scores. However, vari­
ability in the configuration of hazards between workgroups within
occupational groups is similar to variability between occupations. Also,
variability in MSP score between occupations was not large – much less
than between profile groups.
4. Discussion
This study used a newly available database of survey responses from
workers in 33 self-selected organisations that had chosen to implement
the APHIRM Toolkit as part of their own workplace MSD risk manage­
ment procedures. The first research aim was to determine the factor
structure of hazard assessment items in the APHIRM survey. This was a
necessary first step in order to achieve the project’s subsequent research
aims. It is worth noting, however, that when the survey is used for its
intended purpose as a workplace risk management tool, its factor
structure is not relevant because the toolkit’s online algorithm operates
at the level of individual items to identify the ‘top 10’ hazards to be
prioritised for risk control action. Surveyed workers are asked to provide
JDO WQP RCED MCSW PE CR
1974.2 325.7 777.1 699.5 1594.6 339.8
.000 <.001 <.001 <.001 .000 <.001
.629 .219 .401 .376 .578 .226
4
J. Oakman et al. Applied Ergonomics 112 (2023) 104053

Table 2
Associations between personal demographic characteristics and profile membership.
Profile 1 (lowest MSP) Profile 2 Profile 3 (highest MSP)

OR 95% CI OR 95% CI OR 95% CI

Age 18–24 years Ref. - Ref. - Ref. -

25–34 years 0.8 0.5–1.2 1.0 0.7–1.5 1.5 0.8–2.6
35–44 years 0.7 0.5–1.1 1.3 0.9–1.9 1.0 0.6–1.8
45–54 years 0.8 0.6–1.3 1.0 0.7–1.5 1.3 0.7–2.2
55–64 years 0.9 0.6–1.3 1.3 0.9–2.0 0.9 0.5–1.6
65+years 1.7 0.9–3.2 1.1 0.6–2.1 0.4 0.2–1.1
Gender Male Ref. - Ref. - Ref. -
Female 1.3* 1.1–1.6 1.0 0.8–1.2 0.7* 0.6–1.0
Other 0.1** 0.0–0.5 1.0 0.5–2.1 3.4** 1.7–7.0
Hours worked per week <20 Ref. - Ref. - Ref. -
21–30 0.9 0.5–1.3 1.0 0.6–1.5 1.8 0.8–3.9
31–40 0.7 0.5–1.1 0.9 0.6–1.3 2.6** 1.3–5.4
>40 0.6* 0.4–0.9 1.0 0.7–1.5 2.6* 1.3–5.3
Employment duration <6 months Ref. - Ref. - Ref. -
6 months–2 years 0.8 0.6–1.1 1.1 0.8–1.5 1.4 0.8–2.4
2–5 years 0.5*** 0.4–0.7 1.1 0.8–1.6 2.6*** 1.6–4.2
5–10 years 0.4*** 0.3–0.6 1.3 0.9–1.7 2.8*** 1.7–4.6
>10 years 0.3*** 0.2–0.5 1.2 0.9–1.7 3.5*** 2.1–5.8

developed for workers in similar occupations to those in the present

Table 3
Association between profile membership and MSP score.
Model 1 Model 2 (demographics added)
RR 95% CI RR 95% CI
Profile 1 Reference - Reference - relevant concept for such workers is “having a say” (Macdonald, 2000),
Profile 2 1.60*** 1.47–1.75 1.65*** 1.52–1.80
Profile 3 2.61*** 2.35–2.90 2.79*** 2.50–3.10
***Significant at 0.000 level.
Fig. 2. Mean hazard factor scores for each occupational group (excluding
managers and clerical & administrative workers due to small sample sizes).
PTDWB Physical Task Demands Whole Body, PTDHF Physical Task Demands
Hands/fingers, PS Prolonged sitting, QSL Quality of Supervision & Leadership,
JDO Job Development Opportunities, WQP Workload: Quantity & Pace, RCED
Role Conflicts & Emotional Demands, MCSW Meaningful & Clearly Specified
Work, PE Physical Environment, CR Co-worker Relationships.
feedback on the likely sources or causes of each of these hazards, which
requires that hazards are identified in words that are clearly interpret­
able in relation to potential risk control actions. Labels given to factors
representing groups of survey items are necessarily much broader in
meaning and too imprecise for this purpose, whereas the wording of
individual hazard items is sufficiently specific to elicit useful feedback.
As indicated in Table S3, 11 items of the APHIRM survey’s 52 items
fell into two Physical Task Demands factors unique to APHIRM, and 40
fell into one of seven psychosocial factors. The remaining item (pro­
longed sitting) was accepted as a tenth (single-item) factor since there is
ample evidence that lack of physical activity can negatively affect
health, including MSD risk (Coenen et al., 2018). The only item with an
unusually low factor loading (0.33) was ‘influence’ in Factor 1B Job
Development Opportunities. Such an item is not part of WOAQ, which was
study; items for that questionnaire were selected based on discussions
with stakeholders “to test their current relevance to the manufacturing
industry”(29). Our previous research with ‘blue collar’ workers per­
forming highly repetitive, externally paced work suggested that a more
which might align more closely with Factor 1A Quality of Supervision &
Leadership. Overall, however, the factor structure of the APHIRM survey
was found to have good construct validity and provided a sound basis for
addressing Aims 2 and 3.
LPA revealed three sub-groups of workers characterised by different
hazard configurations that differed consistently in hazard severity but
varied relatively little in the configuration of hazards within each pro­
file. As would be expected, MSP scores and hence MSD risk were highest
for people in Profile 3 where hazard levels were highest. Differences
between profile groups in mean MSP score were very substantial,
ranging from 6.7 (out of 60) for Profile 1 to 17.5 for Profile 3, confirming
validity of the APHIRM survey as an MSD risk assessment tool.
In light of the large range of MSP values and the recognised impor­
tance of physical task demands as MSD hazards, it might be surprising
that differences between the three profiles were less for physical task
demands than for psychosocial hazards. The hazard factors that
contributed most to differentiating latent profile membership were
Quality of Supervision and Leadership (QSL Eta-Sq. = 0.707) and Job
Development Opportunities (JDO Eta-Sq. = 0.629), compared with Phys­
ical Task Demands Whole Body (PTDWB) and Physical Task Demands
Hands and Fingers (PTDHF) for which Eta-Squared values were 0.137
and 0.075 respectively.
Those results do not reflect the strength of association between MSP
levels and hazard factors when considered separately for each hazard in
terms of Pearson bivariate correlations, which were 0.319, 0.277, 0.487
and 0.348 for QSL, JDO, PTDWB and PTDHF respectively (Table S5).
However, variation between profile groups in physical task demands
(PTDWB, PTDHF) was much less than variation in psychosocial hazards,
and in Profile 1, psychosocial hazard scores were lower than physical
demand scores whereas in Profile 3, psychosocial and physical hazards
were at a similar level. It is these patterns that explain the greater effect
of psychosocial hazards on profile membership.
One reason for less variation in physical than psychosocial hazard
levels might be the nature of the present sample. All 33 organisations
operate in Australian jurisdictions where OHS regulators have for many
years emphasised the importance of reducing MSD risk from physical
task demands. Further, these organisations were motivated to imple­
ment the APHIRM toolkit as a means of addressing risk from

5
J. Oakman et al.
psychosocial as well as physical MSD hazards, so they might already
have implemented extensive risk control actions targeting physical
hazards, which could have reduced their variability between organisa­
tions. In contrast, legislation and associated Codes of Practice that spe­
cifically mandate control of psychosocial hazards are only now being
introduced in Australian jurisdictions (Safe Work Australia, 2022).
The much higher MSP levels of Profile 3 members is consistent with
other evidence that MSD risk is highest when both types of hazard are
high (Widanarko et al., 2015; Devereux et al., 2002) whether due to
their synergistic or simply additive effects. Another possible contributor
might be effects of high psychosocial hazard exposures on individual
behaviours that increase MSD risk. For example, van den Berge and
colleagues (van den Berge et al., 2021) reported that clustering of
multiple work-related physical and psychosocial hazards, as in Profile 3
here, was associated with ‘unhealthy lifestyle’ factors such as smoking
and being physically inactive, particularly among workers with low
levels of education.
Profile membership is determined by the similarity of people’s haz­
ard profiles, but these profiles can be associated with differences in
personal characteristics such as age or gender: for example, if women
tended to be employed in jobs with lower hazard levels than those of
men. Analyses to investigate differences between latent profile groups in
personal characteristics found that women were indeed over-
represented in Profile 1. Of the 742 women in the sample, a dispro­
portionate number (34%) were in Community and personal services
occupations where most hazard levels were lowest (Fig. 2). Probability
of Profile 3 membership increased markedly with increasing durations
of employment in the current workplace, and was also higher for those
working more than 30 h per week. This might be explained if, as seems
likely, people employed for more years and working longer hours per
week are in more senior positions such as ‘leading hand’ or supervisor
and if such roles increase exposures to some psychosocial hazards.
As noted above, occupational differences can affect profile mem­
bership. Aim 4 was to explore the possibility of occupation-related dif­
ferences of a kind that might support customisation of risk management
procedures to particular sub-groups. There is evidence that psychosocial
hazard profiles vary somewhat between different occupations, particu­
larly between blue- and white-collar workers (Berthelsen et al., 2020;
Metzler and Bellingrath, 2017). In the present study, differences were
found between occupations in profile group membership, hazard levels
and in MSP scores. However, these differences were not large relative to
differences between latent profile groups, and variability in hazard
configuration between workgroups within occupations was similar to
variability between occupations (Table S6, Fig. S1). Overall, there was
little evidence that clearly identifiable subgroups of workers differed
sufficiently to warrant customisation of workplace risk management
strategies to match their particular characteristics. Across all groups, a
wide range of both physical and psychosocial hazards are likely to
require management.
4.1. Study limitations
The data utilised is cross-sectional so causality cannot be inferred
and there is a potential for reverse causality whereby those with higher
MSD risk may report higher hazard levels. Most psychosocial hazards
can only be measured validly through self-report; it is sometimes
possible to cross-validate in relation to other criteria, but this was not
possible in the present case. Further analysis of longitudinal data would
strengthen conclusions, and this is expected to be possible as APHIRM
Toolkit users repeat the survey as part of ongoing risk management
cycles.
The present very large sample represents Australian occupations and
sectors where MSD risk is problematic, which is advantageous in the
context of promoting improved risk management in these sectors.
However generalisability of present findings is limited by the nature and
operating environment of participating organisations. They were self-
6
Applied Ergonomics 112 (2023) 104053
selected users of the APHIRM toolkit so were highly motivated to
reduce MSD risk, and they operate within Australian jurisdictions where
there has long been a major focus on legal requirements to control MSD
risk from ‘manual handling’ hazards. It therefore seems likely that
physical hazard levels might already have been reduced as far as
reasonably practicable; if so, this would probably reduce both the
impact of physical hazards on risk and the likelihood of variation in
hazard profiles configurations in the present data set, relative to data
from a random sample of workplaces.
5. Conclusions
In summary, the exploratory research reported here concluded that:
• APHIRM survey hazard items provide good construct validity for use
in MSD risk assessment, based on relationships between APHIRM
and WOAQ factor scores and coverage of COPSOQ scales.
• Three latent sub-groups of workers were identified, differing in their
physical and psychosocial hazard profiles; these groups differed
more in hazard severity than in hazard configurations within each
profile.
• Psychosocial hazards played a stronger role than physical hazards in
differentiating sub-group membership.
• Sub-group membership was a strong predictor of musculoskeletal
discomfort and pain levels and therefore of MSD risk, demonstrating
that the APHIRM survey has criterion validity as a tool for assessing
MSD risk.
• Occupation-related differences were not sufficient to justify cus­
tomisation of risk management procedures to particular sub-groups.
These findings highlight the need for workplaces to manage MSD risk
from psychosocial as well as physical hazards in occupations and sectors
where MSD risk is the main OHS problem. In organisations where major
efforts have already been made to control MSD risk from physical haz­
ards, actions to reduce risk from psychosocial hazards may be the most
effective way to achieve further reductions in risk.
Author statement
JO and WAM conceptualized the study. KM performed the statistical
analysis. All authors were involved in interpretation of the results. All
authors were involved in drafting the manuscript. All authors read and
approved the final version of the manuscript as submitted.
Declaration of competing interest
The authors declare this paper has not been published elsewhere and
they have no conflicts of interest to report.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.apergo.2023.104053.
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