Introduction
Musculoskeletal disorders (MSDs) are a leading global health concern for agricultural workers because of the physically demanding nature of manual labor, repetitive tasks, and prolonged postures that are common in the industry. This study by de Lavor et al. (2024) explored the impact of these physical behaviors on musculoskeletal pain in the neck, upper back, and lower back of viticulture workers, specifically examining how pain intensity correlates with physical activity during work and non-work hours. Unlike most studies that rely on self-reported data, this research used accelerometers to provide objective measures of physical behaviors, offering a robust method for identifying connections between physical work demands and musculoskeletal pain.
Study Objectives
The study aims to:
- Quantification of intensity and prevalence of musculoskeletal pain in viticulture workers.
- Investigate associations between various physical activities (e.g., sitting, standing, walking, lying down, and sleeping) during work and non-work periods and pain intensity.
- Identifying behavioral patterns that might predict pain in specific body areas provides a foundation for developing occupational health strategies tailored to agriculture.
Methodology
Study Design and Participants
This cross-sectional quantitative study was conducted between April and July 2022 on grape farms in Brazil’s São Francisco Valley. The sample consisted of 94 viticulture workers, which was reduced to 75 after excluding participants with invalid accelerometry data. Workers ranged in age and included both men and women engaged in activities such as pruning, harvesting, tying, and packing; roles that often require repetitive movements; and prolonged standing postures. The study adhered to ethical guidelines, and informed consent was obtained from all participants.
Data Collection Instruments
The study employed several key instruments:
- Sociodemographic and Occupational Questionnaire: Data on age, sex, BMI, job role, working hours, health status, and absenteeism.
- Pain Assessment: Pain intensity in the neck, upper back, and lower back was self-reported using a 0-10 scale, categorizing responses as “low” or “high” intensity based on clinical relevance.
- Accelerometry: Physical behaviors were tracked using an accelerometer (ActivPAL4) attached to the right thigh. The accelerometer measured and classified participants’ physical behaviors over at least four days, distinguishing between work and non-work activities.
Statistical Analysis
Binary logistic regression was used to test the associations between high-intensity pain in different body regions and time spent in physical behaviors during work and non-work hours. The study was adjusted for factors such as age, sex, and BMI to ensure robust results. Statistical analyses were conducted using the SPSS software, with significance set at 5%.
Results
Participant Characteristics
The final sample included 75 vineyard workers (65.3% female). Their average age was approximately 29 years, with a BMI of approximately 26.3 kg/m². Most participants were non-smokers and only over half reported consuming alcohol. Descriptive statistics indicated significant differences in pain prevalence across body regions, with the lower back being the most affected region.
Physical Behaviors During Work and Non-Work
The study found distinct behavioral patterns between work and non-work hours.
- Work Hours: Standing was the most common behavior, followed by sitting and walking. These behaviors reflect the physically intensive nature of viticulture.
- Non-Work Hours: Participants spent much of their non-work hours lying down and sitting, indicating a sedentary lifestyle when they were not engaged in labor-intensive activities.
On average, workers spent 199.2 minutes standing during work, while during non-work periods, lying down (310.1 min) and sitting (290.8 min) were predominant.
Figure . The total sample time spent on behaviors during the work and non-work periods (%).
Pain Intensity
This study revealed the following:
- Among the participants, 46.7% experienced high-intensity neck pain.
- A total of 52% of patients reported high-intensity upper back pain.
- Sixty% experienced high-intensity lower back pain, with packing workers reporting higher intensity than field workers.
These pain levels exceed those typically reported in other blue-collar occupations, suggesting that the physical demands of viticulture may uniquely contribute to musculoskeletal health issues.
Associations Between Physical Behaviors and Pain
Logistic regression analysis revealed significant associations for neck and upper back pain, but not for lower back pain.
- Neck Pain: Higher sleep time was significantly associated with reduced neck pain, suggesting that adequate rest could mitigate physical stress during daily tasks.
- Upper Back Pain: Prolonged sedentary behavior (lying down) during non-work hours was correlated with increased upper back pain. Additionally, females reported higher instances of upper back pain than males, suggesting potential gender-based ergonomic factors.
- Lower Back Pain:No specific physical behavior was significantly associated with lower back pain, suggesting that pain in this region might be influenced by other factors, such as age or long-term physical strain.
Discussion
Prevalence and Intensity of Musculoskeletal Pain
The high prevalence of pain in viticulture workers contrasts with previous findings in similar labor-intensive occupations. This discrepancy may reflect the unique demands of vineyard tasks that often require prolonged standing, repetitive arm movements, and poor ergonomic support, particularly in warmer climates.
- Neck Pain: Although neck pain was less prevalent than in other regions, its association with sleep duration highlights the potential protective effects of adequate rest. Sleep may allow for muscle relaxation and recovery from the physical exertion associated with vineyard tasks, thereby reducing neck pain.
- Upper Back Pain: The link between sedentary behavior during non-work hours and increased upper back pain is noteworthy. This may reflect a form of “occupational-leisure paradox,” where physical inactivity during non-work hours exacerbates the strain experienced during work hours. This underscores the need for a balanced approach to physical activity outside of work.
- Lower Back Pain: The lack of association between specific physical activities and lower back pain might suggest that pain in this region is a cumulative result of long-term physical exertion rather than day-to-day behavior. Older workers, in particular, may experience more pronounced lower back pain due to years of exposure to physically demanding work.
Implications for Occupational Health in Viticulture
This study provides valuable insights into improving occupational health practices in viticulture:
- Reducing Sedentary Time: Interventions encouraging moderate physical activity outside work hours could alleviate the upper back pain. Encouraging walking or light exercise during breaks or after work may help mitigate the negative effects of prolonged standing and sedentary postures.
- Sleep Hygiene Programs: Promoting better sleep hygiene can serve as a preventive strategy against neck pain. Providing workers with information on the importance of sleep quality and creating schedules that allow sufficient rest could benefit musculoskeletal health.
- Ergonomic Adjustments: Given the physical demands of vineyard work, ergonomic improvements can reduce strain on the musculoskeletal system. For example, adjustable workstations for packing tasks or ergonomic tools for pruning and harvesting can alleviate the impact of repetitive tasks and poor posture.
- Gender-specific Interventions: With women reporting higher upper back pain, ergonomic assessments tailored to specific physical needs may benefit female workers, particularly in tasks involving repetitive upper body movements.
Limitations and Future Directions
While the study makes significant contributions to the understanding of musculoskeletal pain in viticulture, some limitations warrant mention:
Cross-Sectional Design: This cross-sectional nature prevents the establishment of causality between behavior and pain. Longitudinal studies could provide stronger evidence of the causative links.
Sample Size: Although adequate, the sample size may not represent all viticulture workers, and future research should aim for larger and more diverse samples.
Lack of Psychosocial Factors. The study did not include psychosocial variables, such as job satisfaction or stress, which have been shown to affect pain perception. Future research should incorporate these variables to obtain a more comprehensive view of musculoskeletal pain determinants.
Despite these limitations, the use of accelerometry for objective physical behavior measurement in this study is a major strength. By focusing on both work and non-work periods, this study offers a holistic perspective on how work behaviors and rest patterns influence musculoskeletal health.
Conclusion
This study highlights the complex interactions between work behaviors, rest periods, and musculoskeletal pain in viticulture. These findings suggest that both the demands of vineyard work and sedentary lifestyles during non-work hours contribute to pain in different body regions. Addressing these issues requires a multifaceted approach, including ergonomic adjustments, health education, and lifestyle interventions to improve the well-being of workers in this labor-intensive field.
This study also challenges traditional assumptions about blue-collar work, showing that viticulture workers engage in both physically intensive and sedentary behaviors, each affecting musculoskeletal health differently. By integrating findings from accelerometer data, this study lays the groundwork for more precise and targeted occupational health interventions in agriculture, offering a promising direction for future studies and workplace health policies.
Recommendations for Future Research: Future studies should consider longitudinal designs to examine changes in musculoskeletal pain over time, potentially exploring interventions that encourage active recovery outside work hours or implementing sleep hygiene programs in agricultural settings. Additionally, examining psychosocial factors in relation to pain could provide a deeper understanding of how mental and emotional well-being interacts with physical health in demanding agricultural roles.
Read all at: De Lavor, J. M., Pina, A. K. A., De Brito, C. A., De Almeida, W. B., Brusaca, L. A., Schmit, E. F. D., De Oliveira, A. B., Da Silva, A. A. M., Magalhães, P. A. F., & Locks, F.. (2024). Objective Measures of Work and Non-Work Physical Behaviors Associated with Neck and Back Pain in Viticulture Workers. Applied Sciences, 14(21), 9637. https://doi.org/10.3390/app14219637