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Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

Commentary

Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants


Jong-Yu Chyuan Chia-Yen Sher Chung-Yi Li 3 3 Chih-Yong Chen Li-Wen Liu
1 2 3

Department of Restaurant, Hotel & Institutional Management, Fu-Jen Catholic University Department of Health Care Management, National Taipei College of Nursing Division of Occupational Health, Institute of Occupational Safety and Health, Council of Labor Affairs, Executive Yuen

Abstract
The purposes of this study were to explore the prevalence of work-related musculoskeletal discomfort (MSD), sleep disorder, and the quality of life (QOL) among hotel room attendants. Four hundred and ninety-five convenient samples were obtained from 30 hotels in Taiwan. Method: Using cross-sectional research design, a structured questionnaire was designed from the Nordic Musculoskeletal Disorders questionnaire and the WHOQOL-BRIEF Taiwan version questionnaire. Result: Multivariate regression analysis revealed that monthly work hours was significantly associated with MSD at the neck, upper back, and elbow, and it was also significantly associated with both environmental domain QOL and odds of difficulty in initiating sleep(DIS). In addition, the length of life-time employment was significantly associated with leg and ankle discomfort, and it was also significantly associated with the QOL score of social domain. Moreover, taking a break during work was significantly and positively associated with physiological domain QOL, while doing housework after work was significantly and positively associated with upper arm discomfort. The attendants with neck discomfort were associated with a significantly higher risk for DIS (odds ratio (OR)=2.24) and early morning waking(EMA) (OR=2.01). Waist (OR=1.58) and ankle/foot (OR=1.96) discomfort were both significantly associated with higher odds of DIS. On the other hand, thigh discomfort was associated with a significantly reduced OR (0.45) of DIS, and the subjects with upper arm discomfort had significantly reduced OR of EMA (OR=0.49). The study participants with neck, waist, or ankle/foot discomfort all had significantly lower overall QOL. Conclusion: the restaurant / hotel industry should pay more attention to those room attendants MSD

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problem. Through the appropriate arrangement of working hours and the provision of adequate rest, it can effectively reduce the occurrence of MSD and enhance their overall work-related QOL. Keywords: Room attendant, Musculoskeletal discomfort, Sleep disorder, Quality of life

Accepted 8 June, 2011 Correspondence to: Jong-Yu Chyuan, Department of Restaurant,Hotel & Institutional Management, Fu-jen Catholic University, E-mail: 002477@mail.fju.edu.tw

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Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

Preface
In the hotel industry, room attendants are in charge of the cleaning and maintenance of the entire room. No one knows the habits and routines of the customer better than them, and they are the most basic and most essential roles [1]. However, room attendants are always the first to be blamed, and the last to be thanked [2]. Most room attendants think their job is hard work, tiring, lowpaid, highly repetitive, complicated and detailed; and some think that their job is boring, lonely, humble, and often have to deal with difficult customers, and even almost half of the room attendants think they do dirty work [3].
1. The job content of room attendants

2. The musculoskeletal discomfort of room attendants

The frequent sheet and blanket cover changing and bathroom equipment cleaning that room attendants do will lead to the body over stretching and long-term unnatural knee bending and further increase the risk of occupational musculoskeletal discomfort. The occupational injuries of employees may result in money and time loss for the company. The hidden cost is about 2~3 times that of the actual payment [7]. The perception of this phenomenon of the room attendants is generally insufficient. In addition to discomfort or delay in work efficiency, it is even easier to reduce the staff morale or impact family life, which cannot be underestimated [8]. Most room attendants indicate that there are the following three features during their work. They are respectively the same repeated hand movement (48.5%), pushing/pulling the cleaning storage cart (39.4%) and frequent bending of wrist under a great amount of force (35.0%). In the recent half-year, most room attendants have shown shoulder and neck musculoskeletal discomfort (78.8%), followed by wrist/finger (66.2%) and lower back (62.6%). The respondents said that the possible factors for the lower back discomfort may be bending over to make the bed (58.1%), bending over to work (33.9%) and moving and lifting heavy objects (33.1%) [9].
3. Peoples sleep disorder issue

Room attendants must replace the sheets and blanket covers, clean the bathroom equipment, position the tables and chairs, perform housekeeping and confirm the conditions of all appliances or objects in a short period of time. Especially, they must complete the 13 to 14-room cleaning within a limited time, their work nature and work amount is way beyond most peoples imagination [4,5]. However, these cleaning jobs will also lead to safety concerns, such as that the chemical composition of the detergent may cause inhalation hazards, cleaning glassware may result in cutting their hands, and pushing the heavy carts may easily lead to back pain [3]. Therefore, repetitive bending of their waists to wash the sink, bathroom walls, toilets, floor, bathtubs, lifting the mattresses, and making the sheets are all risk factors that will lead to musculoskeletal discomfort [6]. 375

It is found in the industrial hygiene and

Journal of Occupational Safety and Health 19: 373-388 (2011)

occupational medical field that psychological factors, physical pain, work stress and social support are all closely related to sleep conditions. Normal sleep needs will vary according to age. As long as you feel that your physical strength is back in the morning, and you are not sleepy and tired, it means you have had enough sleep. Longterm insufficient sleep may accelerate the aging of nerve cells, organ dysfunction and metabolic disorders; therefore, poor quality of sleep has been regarded as one of the causes of disease [10]. The 4000-person insomnia survey of the Medical Center of NCKU showed that the insomnia prevalence for people in Taiwan is about 28% (male: 24.8%, and female: 31.2%), which ranked the first in the Asia-Pacific region, and the second of the world [11,12]. Lu [13] found that people who have insufficient sleep accounted for 9.3%. Chen [11] found that peoples sleep disorders include: difficulty getting to sleep (37.5%), difficulty getting to sleep again after waking up during sleep (17.7%), able to sleep again after waking up during sleep (10.6%) and waking up earlier than the scheduled time (4.9%).
4. Factors that impact the quality of life

significantly at the end of the 1980s [14]. The definition for quality of life given by WHO: The perception level for the goal expectation, standard, and concern of an individual in his/her cultural value system, including personal physiological health, mental state, independence degree, social relationship and environment [14]. According to literature, the more frequent or stronger the pain and discomfort appears, the lower the degree the quality of life will be [15]. Work stress is closely related to quality of life [16,17], and psychological factor and health condition will impact quality of life [18,19]. Low degree work autonomy will impact the workplace health of the worker, and environmental and social support is also closely related to labor health [20,21].

Material and Methodology


1. Study purpose

The study explores the musculoskeletal discomfort prevalence, sleep disorder, quality of life and other related factors (demographic variables and work status) of room attendants. The purpose is to understand the musculoskeletal discomfort degree, appearance time and handling method of room attendants, and also to understand the relationship between the work features, sleep disorder and quality of life of room attendants.
2. Study method

Along with the progress of time and the improvement of medical standard, peoples attention for health has risen from the physiological level to the requirements of social stability, quality of life and the workplace environment. It is found from the database commonly used in the medical and psychological industry that there are more and more studies that use quality of life as the subject, starting from the mid-1970s, and increased 376

The cross-sectional study applied the questionnaire survey method for data collection between July and October 2008, the study object is the room attendants of the hotels listed by

Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

the Tourism Bureau, Taiwan [22], including international hotels (a total of 63 hotels, with 13 hotels willing to participate and sign the consent form); general hotels (a total of 31 hotels, with five participating hotels); and hotels and B&Bs (a total of 5,274 hotels and B&Bs, with 12 participating hotels). Due to being limited to the availability, time and research funding, the study has 495 effective questionnaires, and the recycle rate is 98.4%.
3. Study tool

the criterion-related validity being between 0.88 and 1.00 [23,24]. The re-test reliability data of the questionnaire indicates that Cronbachs is 0.85, which is a good measuring tool. For sleep disorder, the study used the Likert scale [25], self-evaluation method, and the previous one month as the reference time point. In the question, sleep disorder is divided into difficulty getting to sleep (need to lie in bed for more than 30 minutes before falling asleep), sleep disruption (night sleep reduced or interrupted for more than 1 hour) and waking up early, and investigate the frequency and reason. The study objects are requested to answer according to fact. For quality of life, the study applies the quality of life scale (WHOQOL-BREF Taiwan version) [26], the content includes 7 physiological levels, 6 psychological levels, 4 social levels and 9 environmental levels, for a total of 28 questions. Each question applies the five-point method, the higher the score, the better the quality of life. The data collected by the study indicates the re-test reliability Cronbachs is 0.86, which is a good measuring tool.

The tool used by the study is a structural questionnaire (basic information, musculoskeletal discomfort symptoms, sleep disorder and quality of life), such as basic information (gender, birthday, height, weight, educational level, religious belief, marital status, living arrangements), work status (smoking and exercise habits, average number of work hours, work seniority, whether they get a rest or not, and whether they do housework or not), disease history (tendinitis, arthritis, lower back pain, diabetes, hypertension, heart disease, thyroid dysfunction), and whether they take medication or health food or not. In considering the basis of the application and coverage, the study refers to the Nordic musculoskeletal disorder questionnaire (NMQ), uses the Body Map to mark out the 12 body parts, and requires the samples to point out the painful parts and self evaluate the pain degree (five-point scale), appearance frequency, handling method, and the impact on life. According to the experts, if the questionnaires re-test reliability is between 0.77 and 1.00, it refers to 377

Result and Discussion


1. Sample description

According the actual cases received by the study, hotels at different levels will have different operation methods: for international hotels, a room attendant is in charge of a room, including making the bed and cleaning the bathroom (it takes about 30 to 40 minutes, on average), cleans 8~10 rooms a day, and works 8 hours a day (divided into 2

Journal of Occupational Safety and Health 19: 373-388 (2011)

shifts, morning: 9:00-17:00, and afternoon: 14:3022:30). For general hotels, a room attendant is in charge of a room (it takes about 20 to 30 minutes, on average), cleans 10~13 rooms a day, and there are also two shifts. For motels, 2~3 room attendants are in charge of a room (it takes about 7 to 10 minutes on average), cleans 30~45 rooms a day (depending on the occupancy rate), and they work a day (24 hours), get a day off, and are always on standby. The majority of the study objects are female (85.5%), and the average age is 40.9 years old. The average height is 159.7 cm, and the average weight is 57.7 kg. The most common education level is senior high school/vocational school (35.5%), and followed by college/university (27.0%) and junior high school (21.5%). The majority religious belief is Buddhism (36.8%), more than half of them are married and live with their spouse, and 30% are single. It can be found from the work and living habits that most of them do not smoke (86.3%) and often exercise (47.9%). The average monthly work hours are 187.9 hours, the work seniority is from 0.1 ~ 43.7 years, and they often have time to rest during work (75.5%). However, after they go home, most of them still need to do housework (66.7%). The disease history of the studys room attendants are as follows (the prevalence from low to high): diabetes 1.0%, heart disease 1.0%, thyroid disease 2.6%, hypertension 7.7%, arthritis 7.9%, lower back pain 10.3%, and tendinitis 12.1%. In which, the ones taking medications account for 16.8%, and the ones often consuming health food account for 45.5%. 378

2. The correlation between the work features and musculoskeletal discomfort prevalence of the room attendants

The most perceived body discomfort parts of the room attendants are the shoulders (47.9%) and waist (46.3%), followed by the neck (38.6%), fingers/wrists (33.1%), knees (31.5%) and ankles/ feet (28.1%). 40%~50% of the discomfort level is slight discomfort; and 30% is discomfort. 40%~50% of the symptom appearance time occurs at work; and 50%~60% occurs after work. The ones who handle the discomfort by themselves account for the most part, followed by going to Chinese doctors, and most of them do not take sick leave (94.9%). Tables 1, 2, and 4 show the clear grouping of monthly work hours and work seniority. For example: monthly work hours <160 refers to working less than 160 (excluding 160); 160and<180 refers to working more than 160 hours (including 160), and working less than 180 hours (excluding 180). When the monthly work hours of the room attendant is more than 200 hours, the neck (52.4%), upper back (29%) and elbow (23.4%) have significant musculoskeletal discomfort prevalence (p<0.05). Wu, etc. [27] pointed out that keeping the same posture for a long period of time easily leads to musculoskeletal fatigue. If insufficient rest is not received, it will lead to musculoskeletal discomfort. The ones with less average monthly rest days have a higher perceived musculoskeletal discomfort level.

Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

Table 1 the work features and body parts with musculoskeletal discomfort prevalence of the study objects
Body parts work features n Monthly work hours <160 160and<180 180and<200 200 Chi-square value Total seniority <1 1and<6 6and<11 11and<16 16and<21 21 Chi-square value Rest during work No Yes Chi-square value Do housework after work No Yes Chi-square value
a
a

neck (%) (46.2) (28.6) (38.3) (52.4) <0.001 35 86 36 19 4 10 (44.3) (41.1) (39.6) (32.8) (17.4) (30.3) 0.164 57 134 (47.1) (35.9) 0.707 70 121 (42.4) (36.7) 0.378 n

shoulders (%) (46.2) (44.8) (46.9) (54.8) 0.353 38 110 43 20 8 17 (48.1) (52.6) (47.3) (34.5) (34.8) (51.5) 0.166 63 173 (52.1) (46.4) 0.092 82 155 (49.7) (47.0) 0.281

upper arms n 7 57 29 36 (%) (17.9) (28.1) (22.7) (29.0) 0.377 19 55 30 10 6 8 (24.1) (26.3) (33.0) (17.2) (26.1) (24.2) 0.437 32 96 (26.4) (25.7) 0.175 37 92 (22.4) (27.9) 0.021 21 50 21 49 9 37 13 6 1 5 n 6 22 14 29

elbows (%) (15.4) (10.8) (10.9) (23.4) 0.009 (11.4) (17.7) (14.3) (10.3) (4.3) (15.2) 0.403 (17.4) (13.1) 0.757 (12.7) (15.2) 0.288

lower arms n 4 28 16 26 (%) (10.3) (13.8) (12.5) (21.0) 0.171 9 38 13 7 2 5 (11.4) (18.2) (14.3) (12.1) (8.7) (15.2) 0.607 22 52 (18.2) (13.9) 0.642 19 55 (11.5) (16.7) 0.163

fingers / wrists n 13 61 40 50 (%) (33.3) (30.0) (31.3) (40.3) 0.265 28 78 28 15 4 11 (35.4) (37.3) (30.8) (25.9) (17.4) (33.3) 0.305 54 109 (44.6) (29.2) 0.437 55 109 (33.3) (33.0) 0.958

18 58 49 65

18 91 60 68

Bold items refer to p<0.05.

Table 1(continue)
Body parts work features upper back n monthly work hours <160 160and<180 180and<200 200 Chi-square value Total seniority <1 1and<6 6and<11 11and<16 16and<21 21 Chi-square value
a a

waist n 19 92 55 62 (%) (48.7) (45.3) (43.0) (50.0) 0.701 44 104 40 19 9 12 (55.7) (49.8) (44.0) (32.8) (39.1) (36.4) 0.073 11 37 11 7 1 4 n 7 24 15 25

thighs (%) (17.9) (11.8) (11.7) (20.2) 0.134 (13.9) (17.7) (12.1) (12.1) (4.3) (12.1) 0.475 23 76 26 15 5 11 n 12 62 34 47

knees (%) (30.8) (30.5) (26.6) (37.9) 0.272 (29.1) (36.4) (28.6) (25.9) (21.7) (33.3) 0.445 22 49 13 6 3 3 n 8 32 30 26

legs (%) (20.5) (15.8) (23.4) (21.0) 0.351 (27.8) (23.4) (14.3) (10.3) (13.0) (9.1) 0.022

ankles / feet n 10 46 44 39 (%) (25.6) (22.7) (34.3) (31.5) 0.099 31 62 25 14 1 5 (39.2) (29.7) (27.5) (24.1) (4.3) (15.2) 0.011

(%) (23.1) (16.7) (27.3) (29.0) 0.039

9 34 35 36

18 60 20 8 3 5

(22.8) (28.7) (22.0) (13.8) (13.0) (15.2) 0.106

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Body parts work features upper back n Rest during work No Yes Chi-square value Do housework after work No Yes Chi-square value
a

waist n (%) n

thighs (%) n

knees (%) n

legs (%)

ankles / feet n (%)

(%)

40 74

(33.1) (19.8) 0.726

65 163

(53.7) (43.7) 0.404

21 49

(17.4) (13.1) 0.746

40 115

(33.1) (30.8) 0.872

29 67

(24.0) (18.0) 0.902

43 96

(35.5) (25.7) 0.568

38 76

(23.0) (23.0) 0.441

70 159

(42.4) (48.2) 0.136

23 48

(13.9) (14.5) 0.417

51 105

(30.9) (31.8) 0.774

30 66

(18.2) (20.0) 0.111

52 87

(13.5) (26.4) 0.499

Bold items refer to p<0.05

Table 2 the correlation analysis of the study objects work features and sleep(reach the significance)
work features monthly work hours <160 160and<180 180and<200 200 Total seniority <1 1and<6 6and<11 11and<16 16and<21 21
a

No n 23 101 56 46 (%) 59.0 49.8 43.8 37.1 n 16 102 72 78

Yes (%) 41.0 50.2 56.2 62.9 OR


a

Crude odds ratio 95% CI


b

Adjusted odds ratio p-value OR


a

95% CI

p-value

Difficult to sleep 1.00 1.45 1.85 2.44 (0.73, 2.91) (0.89, 3.83) (1.17, 5.08) Trend test =0.004 p=0.201 Sleep disruption 45 113 43 35 11 23 57.0 54.1 47.3 60.3 47.8 69.7 34 96 48 23 12 10 43.0 45.9 52.7 39.7 52.2 30.3 1.00 1.12 1.48 0.87 1.44 0.58 (0.67, 1.90) (0.81, 2.71) (0.44, 1.73) (0.57, 3.67) (0.24, 1.37) 0.660 0.207 0.692 0.440 0.211 1.00 1.35 2.05 1.24 2.37 0.95 (0.77, 2.36) (1.02, 4.14) (0.56, 2.74) (0.84, 6.72) (0.35, 2.56) 0.293 0.044 0.592 0.105 0.922 0.293 0.098 0.017 1.00 1.49 1.80 2.38 (0.73, 3.05) (0.84, 3.86) (1.09, 5.17) Trend test =0.003 p=0.350 0.279 0.132 0.029

Trend test =-0.016 p=0.199


b

Trend test =-0.004 p=0.806

The adjusted odds ratio has also controlled the age, gender, marital status, living arrangements, exercise habits, and smoking habits, n=491. OR= odds ratio; CI= confidence interval.

Work seniority and discomfort in the lower legs, ankles/feet have a significant correlation (p<0.05), in which, the ones with a higher prevalence rate are mostly the ones who have worked less than one year (27.8%, 39.2%), the ones with longer work seniority (>16 years) on the other hand can handle it in a proper way. The possible factor may be because the study objects are current workers; the ones who work longer and have musculoskeletal discomfort may have 380

left the job. Also, maybe the ones with longer work seniority have more work experience, so they know more how to themselves, and the information is worth being included in the training course. The ones who have to do housework after work (only upper arm discomfort-27.9%) have a significant difference (p<0.05) with the ones do not have to do housework after work (Table 1). This may be because that doing housework is a

Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

repeated movement with work, such as washing dishes, sweeping, and hanging up clothes, which all increase the arm movements.
3. The correlation between the work features and sleep disorder of room attendants

It is found from the crude odds ratio that along with the increasing monthly work hours, the waking up early condition has a significant increase trend in statistics (=0.006, p<0.05). The ones who rest during work are also have more difficulty waking up early than the ones who do not rest (OR=0.61,95% CI= 0.40, 0.92, p<0.05). In exploring the correlation between musculoskeletal discomfort and sleep disorder, age, gender, marital status, living arrangements, exercise habits, and smoking habits, etc. are controlled. The musculoskeletal discomfort parts that are found to have positive correlation with the difficulty getting to sleep include: neck (OR=2.24), waist (OR=1.58), and ankles/feet (OR=1.96), which means the abovementioned musculoskeletal discomfort easily leads to difficulty getting to sleep. The musculoskeletal discomfort parts which have a negative correlation with sleep disorder are thighs (OR=0.45), which means the musculoskeletal discomfort of the thighs will reduce the occurrence of having difficulty getting to sleep. The possible factor may be because of standing, walking, or operating for a long period of time during work which has led to the fatigue of the thighs (Table 3). However, the study statistics do not show any musculoskeletal discomfort parts that have a significant correlation with sleep disruption. The musculoskeletal discomfort part that has a significant positive correlation with waking up early is the neck (OR=2.01); and the part with a negative correlation is the upper arms (OR=0.49) (Table 3).

According to the sleep quality of the study objects, most of them have difficulty getting to sleep (54.2%), sleep disruption (45.5%) or waking up early (50.1%). It is found from the multiple regression analysis that the ones with monthly work hours >200 hours will have difficulty getting to sleep, which is 2.38 times that of the ones with monthly work hours <160 hours (95% CI= 1.09, 5.17, p<0.05) (Table 2). The factor that results in this phenomenon may be the accumulation of musculoskeletal discomfort [28], when the day time work hours are too long, the musculoskeletal system cannot be relieved from the rest, and the pain and tingling phenomenon will appear and further lead to difficulty getting to sleep. It can be found from the work seniority that the ones with the seniority of 6and<11 years will have sleep disruption 2.05 times more than the ones with the seniority of <1 year (95% CI= 1.02, 4.14, p<0.05) (Table 2). This may be because the ones with the seniority of 6and<11 years have to face more social issues, and at the same time, they need to start to cultivate the next generation, and therefore, they have more pressure [29]. It may also be because of the lack of female hormones for the elderly, so having to go to the bathroom frequently leads to sleep disruption [30]. 381

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Table 3 the correlation between musculoskeletal discomfort and sleep quality condition
Body parts with musculoskeletal symptoms neck No Yes shoulders No Yes upper arms No Yes elbows No Yes lower arms No Yes fingers / wrist No Yes upper back No Yes waist No Yes thighs No Yes knees No Yes legs No Yes ankles / feet No Yes
a

Difficulty getting to sleep No (%) Yes (%) OR


a,b

Sleep disruption No (%) Yes (%) OR


a,b

Waking up early No (%) Yes (%) OR


a,b

170(74.9) 57(25.1)

134(50.0) 134(50.0)

1.00 2.24

190(70.4) 80(29.6)

114(50.7) 111(49.3)

1.00 1.58

178(72.1) 69(27.9)

126(50.8) 122(49.2)

1.00 2.01

141(62.1) 86(37.9)

117(43.7) 151(56.3)

1.00 1.19

160(59.3) 110(40.7)

98(43.6) 127(56.4)

1.00 1.13

145(58.7) 102(41.3)

113(45.6) 135(54.4)

1.00 1.24

175(77.1) 52(22.9)

191(71.3) 77(28.7)

1.00 0.88

211(78.1) 59(21.9)

155(68.9) 70(31.1)

1.00 0.99

179(72.5) 68(27.5)

187(75.4) 61(24.6)

1.00 0.49

200(88.1) 27(11.9)

224(83.6) 44(16.4)

1.00 0.74

243(90.0) 27(10.0)

181(80.4) 44(19.6)

1.00 1.08

216(87.4) 31(12.6)

208(83.9) 40(16.1)

1.00 0.69

202(89.0) 25(11.0)

219(81.7) 49(18.3)

1.00 1.35

238(88.1) 32(11.9)

183(81.3) 42(18.7)

1.00 0.76

211(85.4) 36(14.6)

210(84.7) 38(15.3)

1.00 0.84

161(70.9) 66(29.1)

170(63.4) 98(36.6)

1.00 0.81

194(71.9) 76(28.1)

137(60.9) 88(39.1)

1.00 1.02

178(72.1) 69(27.9)

153(61.7) 95(38.3)

1.00 1.54

193(85.0) 34(15.0)

188(70.1) 80(29.9)

1.00 1.68

228(84.4) 42(15.6)

153(68.0) 72(32.0)

1.00 1.75

201(81.4) 46(18.6)

180(72.6) 68(27.4)

1.00 1.15

147(64.8) 80(35.2)

119(44.4) 149(55.6)

1.00 1.58

164(60.7) 106(39.3)

102(45.3) 123(54.7)

1.00 1.16

151(61.1) 96(38.9)

115(46.4) 133(53.6)

1.00 1.33

196(86.3) 31(13.7)

228(85.1) 40(14.9)

1.00 0.45

242(89.6) 28(10.4)

182(80.9) 43(19.1)

1.00 0.98

216(87.4) 31(12.6)

208(83.9) 40(16.1)

1.00 1.01

161(70.9) 66(29.1)

178(66.4) 90(33.6)

1.00 0.90

200(74.1) 70(25.9)

139(61.8) 86(38.2)

1.00 1.29

180(72.9) 67(27.1)

159(64.1) 89(35.8)

1.00 1.21

192(84.6) 35(15.4)

207(77.2) 61(22.8)

1.00 0.89

230(85.2) 40(14.8)

169(75.1) 56(24.9)

1.00 1.00

208(84.2) 39(15.8)

191(77.0) 57(23.0)

1.00 1.18

185(81.5) 42(18.5)

171(63.8) 97(36.2)

1.00 1.96

213(78.9) 57(21.1)

143(63.6) 82(36.4)

1.00 1.42

188(76.1) 59(23.9)

168(67.7) 80(32.3)
b

1.00 0.91

In addition, age, gender, marital status, living arrangements, exercise habits, and smoking habits are also controlled, n=491. Bold items refer to

p<0.05.

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Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

4. The correlation between the work features and the quality of life score of room attendants

has the lowest score (13.7), which is similar with the survey result that the researcher [16, 31, 32] processed focusing on workers with other occupations. The possible reason may be because the room attendants think the chemical detergent used to clean the bathroom is too much, the air does not flow that well in a confined space, like hotel buildings, some guests may smoke in the room and cause pollution, insufficient time and too much work, the salary does not meet the employees expectation, and lack of leisure, etc. which all show the importance the employees attached to workplace environmental health. To save the table space, Table 4 only listed

According to the quality of life scale (WHOQOL-BREF Taiwan version), the overall average quality of life score of the studys room attendants (standard deviation, 95% CI) is 56.6 (7.7, 55.9~57.3), in which the physiological, psychological, social and environmental quality scores are respectively: 15.0 (2.1, 14.8~15.2), 13.8 (2.6, 13.6~14.0 ), 14.1 (2.1, 13.9~14.3 ) and 13.7 (2.4, 13.5~13.9 ). In the various levels of the quality of life, the environmental category

Table 4 the correlation analysis of the study objects work features and quality of life(category) scores(reach the significance)
work features monthly work hours <160 160and<180 180and<200 200 Total seniority <1 1and<6 6and<11 11and<16 16and<21 21 Rest during work No Yes
a c e f b d

Crude regression coefficient X


a

Adjusted regression coefficient p-value


e,g

SD

95% CI

95% CI

p-value

e,g

Environmental category quality of life score 2.2 2.2 2.3 2.5 0.62 1.06 0.24 0 Social category quality of life score (-0.22, 1.46) (0.54, 1.58) (-0.34, 0.81) 0.146 0.000 0.416 0.05 0.63 0.16 0 (-0.80, 0.89) (0.11, 1.16) (-0.40, 0.72) 0.917 0.018 0.580

13.8 14.2 13.4 13.2

13.9 14.0 14.0 14.0 14.6 14.9

2.0 2.1 2.1 1.9 3.0 1.8

-0.94 -0.83 -0.91 -0.89 -0.28 0

(-1.80, -0.08) (-1.61, -0.04) (-1.76, -0.06) (-1.80, 0.02) (-1.41, 0.86)

0.033 0.038 0.036 0.055 0.631

-0.77 -0.73 -0.94 -0.94 -0.57 0

(-1.73, 0.20) (-1.57, 0.11) (-1.80, -0.08) (-1.87, -0.02) (-1.71, 0.58)

0.118 0.089 0.032 0.046 0.331

Physiological category quality of life score 14.5 15.2 2.2 2.0 -0.73 0 (-1.15, -0.31) 0.001 -0.44 0 (-0.88, -0.01) 0.045

Mean. Standard deviation. Coefficients Beta. CI= confidence interval. Univariate Linear Model is used to test the significance. Bold items refer to p<0.05.

The adjusted odds ratio has also controlled the age, gender, marital status, living arrangements, exercise habits, and smoking habits, n=491.

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Journal of Occupational Safety and Health 19: 373-388 (2011)

the ones with a score that reaches a significant correlation. In the adjusted crude regression coefficient analysis, the work features of room attendants and the overall quality of life and the quality of life (psychological category) do not have a significant correlation. However, it is found in the quality of life (physiological category) that the significant impact factor is whether there is rest during work. It can be seen that the ones without rest are significantly less than the ones with rest (= -0.44,95% CI= -0.88, -0.01, p<0.05) (Table 4). The possible factor that may lead to this phenomenon is that the room attendants often work overmuch, and the physiological demand will increase [16]. In the quality of life (social category), it is found that the ones with the work seniority being 6and<11 years and 11and<16 years have a significantly lower quality of life score (= -0.94, p<0.05) (Table 4). The possible factor may be along with the increasing work seniority, old coworkers gradually leave the job, and with the age and cultural gap, it is more difficult to have peer social support. In quality of life (environmental category), it is found that the ones with the monthly work hours being 160and<180 hours have a significantly higher quality of life score (= 0.63, 95% CI= 0.11, 1.16, p<0.05) (Table 4). The possible factor may be gradually getting used to the work environment, and no longer being threatened by the work environment. It can also be because Taiwanese workers can accept more hazardous work environments, and are more easily satisfied with the salary and benefits provided by the 384

company [31], and therefore, they can accept and be satisfied with the current living conditions. This also explains why the quality of life (environmental category) has a certain level of subjective identification. After age, gender, marital status, living arrangements, exercise habits, and smoking habits, etc. factors are controlled, it is found in the relationship between musculoskeletal discomfort and quality of life (Bold items refer to p<0.05) that the ones who said that their neck has musculoskeletal discomfort have a significantly (p<0.05) lower physiological (= -0.74), psychological (= -0.80), environmental (= -0.61) and overall (= -2.30) quality of life score. At the same time, the ones with ankles/ feet musculoskeletal discomfort also have a significantly (p<0.05) lower physiological (= -0.61), psychological (= -0.73), social (= -0.65) and overall (= -2.43) quality of life score. The ones with waist musculoskeletal discomfort have a significantly (p<0.05) lower physiological (= -0.50), psychological (= -0.56) and overall (= -1.51) quality of life score (Table 5). Therefore, it can be found from the studys quality of life score that the physiological, psychological, and environmental levels with lower scores which come with the neck, waist, ankles/feet musculoskeletal discomforts of room attendants may be the major factors for causing difficulty getting to sleep or waking up early.

Musculoskeletal Discomfort/Sleep Disorder/Quality of Life among Hotel Room Attendants

Table 5 Correlation between musculoskeletal discomfort and quality of life


Parts with
e

Physiological X
a

Psychological
c,d

Social
c,d

Environmental
c,d

Overall
c,d

musculoskeletal symptoms neck No Yes shoulders No Yes upper arms No Yes elbows No Yes lower arms No Yes fingers / wrist No Yes upper back No Yes waist No Yes thighs No Yes knees No Yes legs No Yes ankles / feet No Yes
a c e b d

SD

SD

SD

SD

SD

c,d

15.5 14.2

1.9 2.0

0 -0.74

14.3 12.9

2.4 2.7

0 -0.80

14.2 13.9

2.1 2.1

0 -0.16

14.2 12.9

2.2 2.3

0 -0.61

58.3 53.9

7.2 7.8

0 -2.30

15.5 14.5

1.9 2.0

0 -0.08

14.3 13.2

2.6 2.5

0 -0.23

14.3 13.9

2.2 2.1

0 -0.26

14.2 13.2

2.3 2.3

0 -0.20

58.3 54.8

7.5 7.5

0 -0.77

15.2 14.7

2.0 2.2

0 0.10

14.0 13.3

2.6 2.6

0 0.04

14.1 14.1

2.1 2.3

0 0.18

13.9 13.2

2.3 2.4

0 0.12

57.1 55.3

7.4 8.3

0 0.44

15.2 14.2

2.0 2.4

0 -0.02

13.9 13.0

2.6 2.6

0 0.37

14.1 13.9

2.2 1.9

0 0.25

13.9 12.6

2.3 2.5

0 -0.14

57.1 53.7

7.5 8.2

0 0.47

15.2 14.3

2.0 2.1

0 0.06

14.0 12.8

2.6 2.4

0 -0.50

14.1 14.0

2.1 2.0

0 0.11

13.9 12.7

2.3 2.5

0 -0.24

57.1 53.9

7.6 7.8

0 -0.56

15.3 14.5

2.0 2.1

0 0.07

14.1 13.2

2.5 2.7

0 -0.05

14.2 13.8

2.1 2.1

0 -0.20

14.1 13.0

2.3 2.3

0 -0.36

57.6 54.5

7.4 8.0

0 -0.54

15.3 14.1

1.9 2.2

0 -0.18

14.0 13.1

2.5 2.7

0 0.34

14.1 14.0

2.2 1.9

0 0.40

14.0 12.9

2.3 2.4

0 0.06

57.4 54.0

7.5 7.9

0 0.61

15.5 14.4

1.9 2.0

0 -0.50

14.3 13.2

2.6 2.5

0 -0.56

14.3 13.9

2.2 2.0

0 -0.23

14.1 13.2

2.4 2.3

0 -0.22

58.2 54.7

7.6 7.3

0 -1.51

15.2 14.1

2.0 2.4

0 -0.06

14.0 12.8

2.6 2.5

0 -0.46

14.1 13.7

2.1 2.0

0 -0.50

13.9 12.6

2.3 2.4

0 -0.34

57.2 53.2

7.5 8.2

0 -1.34

15.3 14.4

2.0 2.2

0 -0.34

14.1 13.2

2.6 2.6

0 -0.33

14.1 14.0

2.1 2.1

0 0.11

13.9 13.2

2.3 2.3

0 -0.08

57.5 54.7

7.5 7.9

0 -0.63

15.2 14.2

1.9 2.3

0 0.05

14.0 13.1

2.6 2.6

0 0.51

14.1 14.0

2.2 2.0

0 0.18

13.9 12.9

2.3 2.4

0 0.14

57.2 54.2

7.5 8.1

0 0.88

15.4 14.1

1.9 2.2

0 -0.61

14.2 12.8

2.4 2.7

0 -0.73

14.3 13.6

2.2 1.9

0 -0.65

14.1 12.8

2.3 2.3

0 -0.44

58.0 53.2

7.3 7.7

0 -2.43

Mean. Standard deviation. Coefficients Beta. Bold items refer to p<0.05. In addition, age, gender, marital status, education level, religious belief, living arrangements, exercise habits, and smoking habits are also controlled.

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Journal of Occupational Safety and Health 19: 373-388 (2011)

Recommendation
The cross-sectional study applies convenient sampling, which only applies the employees of the hotels listed by the Tourism Bureau as the study object. As in the occupation category, room attendants belong to the labor category [3], and therefore, the ones with poor physical strength have left the industry long ago. All study objects are current employees, and do not include employees who have been in the industry but have left the job, so the musculoskeletal discomfort prevalence estimated by the study may be underestimated [33]. As the quality of life (environmental and psychological category) scores for the room attendants are low, the industry owners are recommended to strengthen the focus and counseling on employees environmental and psychological health to improve the room attendants work-related quality of life. It is found from the study analysis that the room attendants of the three types of hotels (international hotels, general hotels and hostels and B&Bs) have a significant difference between the sleep disruption ratio and average quality of life (environmental category) scores, so it is recommended that the future study can focus on different levels for more in-depth exploration. If having to work overmuch and in a repetitive manner, even if the movement is in a reasonable range, once the musculoskeletal system does not have the appropriate tolerance, it will gradually accumulate stress and tension, causing damage [34]. In the study survey, the ones who 386

rest during work may account for 75.5%, but the rest still includes the lunch time, which means that 24.5% of room attendants work so hard that they dont even have a lunch break. Therefore, hotel employees are recommended to arrange time to rest during work, which not only can restore energy, but also avoid musculoskeletal damage. In occupational injury prevention, educational training is very important. Untrained and unfamiliar employees or the ones who lack work experience will more easily incur occupational injuries [35]. Therefore, room attendants shall have regular safety and health educational training to allow them to understand basic ergonomics concept, and learn the correct working method. The employers may not lack room attendants, but they shall still try to reduce the room attendants musculoskeletal discomfort or improve their work quality of life, which will also improve the harmony and benefits of both parties.

Acknowledgement
The research fund is granted by the Institute of Occupational Safety and Health, Council of Labor Affairs. We are hereby respectfully grateful.

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