Restricted accessResearch articleFirst published online 2026
Assessing organizational and physical risk factors among office workers: Key insights into musculoskeletal disorders prevention using fuzzy DEMATEL analysis
Work-related musculoskeletal disorders (WMSDs) necessitate addressing physical and organizational risks while comprehending their cause-effect dynamics to reduce their risks.
Objective
This study focused on validating the Persian version of WOAQ, evaluating organizational and workload risks through WOAQ and PWQ, and unraveling interrelationships among organizational factors with WMSDs using Fuzzy DEMATEL analysis.
Methods
Conducted as a cross-sectional study in 2024 among 100 employees in a private company in Kerman, Iran, this research utilized the Forward-Backward method for WOAQ translation. Reliability was gauged via Cronbach's alpha and test-retest methods. The PWQ and WOAQ were used in assessing workload and organizational risks. Fuzzy DEMATEL analysis was employed to elucidate cause-effect relationships between organizational factors.
Results
Analysis of 81 questionnaires (41 men, 40 women) revealed the WOAQ's reliability with Cronbach's alpha and test-retest scores of 0.927 and 0.865. Predominant WMSD prevalence was observed in the lower back. 41.50% and 31.70% of men experienced high and very high organizational and workload risks. The DEMATEL fuzzy analysis identified rewards, recognition, and quality of relationships with management as influential factors.
Conclusions
Understanding factors influencing WMSD prevalence encompasses physical, organizational, and psychosocial facets. Overlooking non-physical aspects contributes to physical risks and subsequent musculoskeletal disorders. Prioritizing improved management relationships and recognition systems was pivotal for effective WMSD prevention strategies.
AkebiT. Relationship between social-psychological factors and work-related musculoskeletal disorders: a questionnaire survey of Japanese radiological technologists. JJOMT2022; 70: 124–130.
2.
AyubYShahZ. Assessment of work related musculoskeletal disorders in manufacturing industry. J Ergonomics2018; 8: 1–5.
3.
MeishaDEAlsharqawiNSSamarahAA, et al.Prevalence of work-related musculoskeletal disorders and ergonomic practice among dentists in Jeddah, Saudi Arabia. Clin Cosmet Investig Dent2019; 11: 171–179.
4.
RibeiroTSerranheiraFLoureiroH. Work related musculoskeletal disorders in primary health care nurses. Appl Nurs Res2017; 33: 72–77.
5.
SheikhmozafariMJSalimiFAhmadiO. Risk assessment of MusculoSkeletal disorders among workers of a housekeeping service company in Kerman, Iran. Int J Musculoskelet Pain Prev2020; 5: 402–409.
SheikhmozafariMJ. Validity and reliability of the Persian version of the NPQ neck pain assessment questionnaire among Iranian housekeeping company workers. J Occup Hyg Eng2022 Jul 10; 9: 120–128.
8.
SalimiFSheikhmozafariMJTayebisaniS, et al.Risk assessment of musculoskeletal disorders prevalence in female hairdressers using RULA and NERPA techniques. Int J Musculoskelet Pain Prev2021; 6: 545–553.
9.
AsuquoEGTigheSMBradshawC. Interventions to reduce work-related musculoskeletal disorders among healthcare staff in nursing homes; an integrative literature review. Int J Nurs Stud Adv2021; 3: 100033.
10.
HeidarimoghadamRMohammadfamIBabamiriM, et al.Study protocol and baseline results for a quasi-randomized control trial: an investigation on the effects of ergonomic interventions on work-related musculoskeletal disorders, quality of work-life and productivity in knowledge-based companies. Int J Ind Ergon2020; 80: 103030.
11.
Executive HaS. Work-related musculoskeletal disorders statistics in Great Britain, 2022 London: United Kingdom, Health and Safety Executive2022[cited 2022 23 November]. Available from: https://www.hse.gov.uk/statistics/causdis/msd.pdf
12.
KhandanMMirshekariFKoorsaniE, et al.Subjective workload and musculoskeletal disorders among workers of a manufacturing company in Iran. Biotech Health Sci2018; 5: e13599.
13.
EpsteinSSparerEHTranBN, et al.Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg2018; 153: e174947–e174947.
14.
AkoduAKAshalejoZO. Work-related musculoskeletal disorders and work ability among hospital nurses. Journal of Taibah University Medical Sciences2019; 14: 252–261.
15.
KrishnanKSRajuGShawkatalyO. Prevalence of work-related musculoskeletal disorders: psychological and physical risk factors. Int J Environ Res Public Health2021; 18: 9361.
16.
YangMMyongJ-PLeeJ, et al.Association between irregular working hours and work-related musculoskeletal pain: results from the 6th Korean Working Conditions Survey. Ann Occup Environ Med2023; 35: e21.
17.
HoeVCUrquhartDMKelsallHL, et al.Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database Syst Rev2018; 10: CD008570.
18.
JanwantanakulPPensriPJiamjarasrangsriV, et al.Prevalence of self-reported musculoskeletal symptoms among office workers. Occup Med (Chic Ill)2008; 58: 436–438.
19.
SheikhmozafariMJAlizadePMAhmadiO. Validation of the Persian version of the workplace physical-ergonomic conditions evaluation (PECE) questionnaire. Int J Musculoskelet Pain Prev2021; 6: 554–561.
20.
SoroushMHassaniH. Musculoskeletal complaints associated with computer use and its ergonomic risks for office workers of a medical sciences university in Tehran. Ann Mil Health Sci Res2015; 13: 2–6.
21.
AbbasiAMBahmanipourSRahimiM, et al.Investigating the impact of ergonomics training in reducing musculoskeletal discomfort among office workers [research]. Occup Med2023; 15: 29–37.
22.
CelikSCelikKDirimeseE, et al.Büyükkara İ. Determination of pain in musculoskeletal system reported by office workers and the pain risk factors. Int J Occup Med Environ Health2018 Jan 1; 31: 91–111.
23.
ChineduOOHenryATNeneJJ, et al.Work-related musculoskeletal disorders among office workers in higher education institutions: A cross-sectional study. Ethiop J Health Sci2020; 30: 715–724.
24.
Jafari-NodoushanRTaherzadehSAnooshehVS, et al.Investigating the prevalence of musculoskeletal disorders and degree of body discomfort in administrative the office staff of the school of public health, shahid sadoughi university of medical sciences, Yazd [applicable]. Occupational Hygine and Health Promotion Journal2021; 5: 272–284.
25.
KakaraparthiVNVishwanathanKGadhaviB, et al.Clinical application of rapid upper limb assessment and nordic musculoskeletal questionnaire in work-related musculoskeletal disorders: a bibliometric study. Int J Environ Res Public Health2023; 20: 1932.
26.
RamdanIMDumaKSetyowatiDL. Reliability and validity test of the Indonesian version of the nordic musculoskeletal questionnaire (NMQ) to measure musculoskeletal disorders (MSD) in traditional women weavers. Glob Med Health Commun2019; 7: 123–130.
27.
SheikhmozafariMJMohammad AlizadehPAhmadiO, et al.Risk assessment of musculoskeletal disorders and its correlation with job factors: validating of an assessment questionnaire. Int J Musculoskele Pain Prev2022; 7: 708–719.
28.
AdamoKBPrinceSATriccoAC, et al.A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. Int J Pediatr Obes2009; 4: 2–27.
29.
KarimiLOakmanJ. The work organisation assessment questionnaire: validation for use with community nurses and paramedics. Int J Evid Based Healthc2020 Jun; 18: 222–230.
30.
KjønøLGKillingmoRMVigdalØN, et al.Assessing physical workload among people with musculoskeletal disorders: validity and reliability of the physical workload questionnaire. BMC Musculoskelet Disord2022; 23: 1–10.
31.
BotSTerweeCvan Der WindtD, et al.Internal consistency and validity of a new physical workload questionnaire. Occup Environ Med2004; 61: 980–986.
32.
GriffithsACoxTKaranikaM, et al.Work design and management in the manufacturing sector: development and validation of the work organisation assessment questionnaire. Occup Environ Med2006; 63: 669–675.
33.
KarimiLMeyerD. Validity and model-based reliability of the work organisation assessment questionnaire among nurses. Nurs Outlook2015 May-Jun; 63: 318–330.
34.
Wynne-JonesGVarnavaABuckR, et al.Examination of the work organization assessment questionnaire in public sector workers. J Occup Environ Med2009 May; 51: 586–593.
35.
MohammadipourFPourranjbarMNaderiS, et al.Work-related musculoskeletal disorders in Iranian office workers: prevalence and risk factors. J Med Life2018; 11: 328.
36.
KeyaertsSGodderisLDelvauxE, et al.The association between work-related physical and psychosocial factors and musculoskeletal disorders in healthcare workers: moderating role of fear of movement. J Occup Health2022; 64: e12314.
37.
DuJZhangLXuC, et al.Relationship between the exposure to occupation-related psychosocial and physical exertion and upper body musculoskeletal diseases in hospital nurses: a systematic review and meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci)2021 2021/08/01/; 15: 163–173.
38.
BezzinaAAustinENguyenH, et al.Workplace psychosocial factors and their association with musculoskeletal disorders: a systematic review of longitudinal studies. Workplace Health Saf2023; 71: 578–588.
39.
ZameniFNasiriPMahdiniaM, et al.Analysis of the causal relationships of shift work, job stress and job satisfaction with the occupational health level based on fuzzy DEMATEL method: a cross sectional study. J Health Saf Work2021; 11: 151–163.
40.
JoshiMAdhayeA. Ergonomic risk factor priority evaluation of hand fabric painters based on hybrid ISM–spherical fuzzy DEMATEL approach: ERGONOMIC RISK FACTOR PRIORITY EVALUATION. JSIR2024; 83: 873–887.
41.
NaqshbandiAAhmadiO. Determining the cause-effect relationship between risk factors affecting work-related musculoskeletal disorders (WMSDs) using the fuzzy DEMATEL method. Int J Musculoskelet Pain Prev2025; 10: 1149–1158.
42.
SheikhmozafariMJAhmadiO. Reliability and validity assessment of the Persian version of the noise exposure questionnaire (NEQ): an NIHL predictor tool [original article]. J Occup Health Epidemiol2022; 11: 209–222.
43.
KeatingXDZhouKLiuX, et al.Reliability and concurrent validity of global physical activity questionnaire (GPAQ): a systematic review. Int J Environ Res Public Health2019; 16: 4128.
44.
SheikhmozafariMJAhmadiO. Validity and reliability of Farsi version of office lighting survey questionnaire (OLS) [research article]. Journal of Occupational Hygiene Engineering2022; 8: 30–39.
45.
SheikhMozafariMJZadehFSMMohsenianA, et al.Evaluating lighting satisfaction in a public library: a study on the reliability and validity of a lighting evaluation questionnaire. WORK2025; 82: 188–204.
46.
KennedyLGKichlerEJSeabrookJA, et al.Validity and reliability of a food skills questionnaire. J Nutr Educ Behav2019; 51: 857–864.
47.
MohammadfamIAliabadiMMSoltanianAR, et al.Investigating interactions among vital variables affecting situation awareness based on fuzzy DEMATEL method. Int J Ind Ergon2019; 74: 102842.
48.
BavafaAMahdiyarAMarsonoAK. Identifying and assessing the critical factors for effective implementation of safety programs in construction projects. Saf Sci2018; 106: 47–56.
49.
ZhouQHuangWZhangY. Identifying critical success factors in emergency management using a fuzzy DEMATEL method. Saf Sci2011; 49: 243–252.
50.
KarimiLKaranika-MurrayMMeyerD. Cross-Validation of the work organization assessment questionnaire across genders. J Occup Environ Med2016; 58: 277–281.
51.
MagnavitaNMammiFRocciaK, et al.WOA: a questionnaire for the evaluation of work organization. Translation and validation of the Italian version. G Ital Med Lav Ergon2007; 29: 663–665.
52.
Basakci CalikBYagciNOztopM, et al.Effects of risk factors related to computer use on musculoskeletal pain in office workers. Int J Occup Saf Ergon2022; 28: 269–274.
53.
Kaya AytutulduGBirinciTTarakcıE. Musculoskeletal pain and its relation to individual and work-related factors: a cross-sectional study among turkish office workers who work using computers. Int J Occup Saf Ergon2022; 28: 790–797.
54.
HadgraftNTHealyGNOwenN, et al.Office workers’ objectively assessed total and prolonged sitting time: individual-level correlates and worksite variations. Prev Med Rep2016; 4: 184–191.
55.
KahramanTGözEGençA. Validity and reliability of the Turkish version of the physical workload questionnaire. Work2018; 59: 295–302.
56.
NoshadhaMMokhtariniaHRVahediM, et al.Translation, cross-cultural adaptation and validation of the Persian version of the physical workload questionnaire (PWQ). BMC Musculoskelet Disord2025; 26: 99.
57.
BontrupCTaylorWRFliesserM, et al.Low back pain and its relationship with sitting behaviour among sedentary office workers. Appl Ergon2019; 81: 102894.
58.
KingPHuddlestonWDarraghAR. Work-related musculoskeletal disorders and injuries: differences among older and younger occupational and physical therapists. J Occup Rehabil2009; 19: 274–283.
59.
WeyhCPilatCKrügerK. Musculoskeletal disorders and level of physical activity in welders. Occup Med (Chic Ill)2020; 70: 586–592.
60.
KoneruSTanikondaR. Role of yoga and physical activity in work-related musculoskeletal disorders among dentists. J Int Soc Prev Community Dent2015; 5: 199.
61.
CarayonPSmithMJ. Work organization and ergonomics. Appl Ergon2000; 31: 649–662.
62.
CarayonPSmithMJHaimsMC. Work organization, job stress, and work-related musculoskeletal disorders. Hum Factors1999; 41: 644–663.
63.
ArmanZNikooyMTsiorasPA, et al.Mental workload, occupational fatigue and musculoskeletal disorders of forestry professionals: the case of a loblolly plantation in northern Iran. Croat. J. For. Eng2022; 43: 403–424.
64.
LeeWLinJ-HHowardN, et al.Physiological responses, trunk posture, and work pace in commercial building cleaning in Washington State: An observational field study. J Saf Res2023; 86: 107–117.
65.
Wynne-JonesGVarnavaABuckR, et al.Examination of the work organization assessment questionnaire in public sector workers. J Occup Environ Med2009; 51: 586–593.
66.
KarimiLMeyerD. Validity and model-based reliability of the work organisation assessment questionnaire among nurses. Nurs Outlook2015; 63: 318–330.
67.
KarimiLKaranika-MurrayMMeyerD. Cross-validation of the work organization assessment questionnaire across genders: a study in the Australian health care sector. J Occup Environ Med2016; 58: 277–281.
